Do We Have to Obtain Rebound Bilirubin Levels and What is the Optimal Time?

• Published in: The journal of pediatric research 2019-03, Vol.6 (1), p.7-11
• Main Authors: Ozdemir, Hulya, Bilgen, Hulya Selva, Memisoglu, Asli, Unkar, Zeynep Alp, Mutlu, Ali, Ozek, Eren
• Format: Article
• Language: English
• Subjects: Care and treatment; Etiology (Medicine); Hemolysis; Hyperbilirubinemia; Infants; Jaundice; Management; Methods; Neonatal diseases; newborn; Newborn infants; Outcome and process assessment (Medical care); Phototherapy; Physiological aspects; Premature infants; Prognosis; rebound bilirubin; Tıp
• ISSN: 2147-9445; 2147-9445; 2587-2478
• DOI: 10.4274/jpr.galenos.2019.03064

Aim: We aimed to determine the frequency of rebound hyperbilirubinemia (RHB) needing treatment and therefrom, to clarify the clinical importance of routinely checking serum total bilirubin (STB) levels after the cessation of phototherapy and to define an optimal time to check STB levels for the detection of RHB. Materials and Methods: Term and late preterm babies who received phototherapy were included in this study. The demographic and clinical features, time of onset of jaundice, phototherapy time and results to determine the etiology of jaundice were recorded for all babies. Serum "rebound" bilirubin measurements were performed two times at 12 and at 24 hours after the cessation of phototherapy. The re-initiation of phototherapy according to the 12th and 24th hour STB levels was accepted as "early rebound" and "late rebound", respectively. IBM SPSS 22 was used for statistical analyses. Results: Data was available for 110 infants. The rebound rate requiring phototherapy was 9.1% (n=10) and all had a risk factor. Most of the babies (9/10) rebounded at the 12th hour after the termination of phototherapy. Hemolysis and prematurity were found to be statistically significant for RHB (p=0.008; p=0.048). Conclusion: Post-phototherapy bilirubin follow-up may be incorporated using a combined approach of individualization, evaluation of risk factors, and application of common sense before discharge. Our study showed that STB levels could be measured after the cessation of phototherapy, especially in patients with a risk factor, at the 12th hour before discharge. Randomized controlled studies with larger sample sizes are still needed for definitive recommendations. Keywords: Hyperbilirubinemia, newborn, phototherapy, rebound bilirubin