Rebound hyperbilirubinaemia in neonates admitted to Mofid Children's Hospital, Tehran, Iran

Abstract

Introduction and aim. Approximately 60% of term neonates and 80% of preterm neonates develop hyperbilirubinaemia in the first week of life. Rebound hyperbilirubinaemia may occur after cessation of phototherapy, especially when the Coombs test is positive, in premature infants, and in those treated with phototherapy for less than 72 hours. The main aim of this study was to evaluate the billirubin level 24 and 48 hours after cessation of phototherapy in neonates admitted to our hospital with jaundice. We also evaluated haemoglobin (Hb) levels and duration of phototherapy for a possible association with rebound hyperbilirubinaemia. Patients and methods. The study was a clinical trial in term neonates (gestational age ?37 weeks) with hyperbilirubinaemia who were admitted to the Department of Neonatology at Mofid Children's Hospital, Tehran, Iran. Exclusion criteria were neonatal infection, glucose- 6-phosphate dehydrogenase deficiency, a history of neonatal exchange transfusion, and parental refusal. Phototherapy was delivered via a Philips TL 45/20W at 15 - 20 cm distance from the skin. We discharged patients after cessation of phototherapy. Total serum bilirubin (TSB) was checked in the neonates 24 and 48 hours after cessation of phototherapy. We included patients in whom follow-up tests were completed at 24 and 48 hours after discharge. Chi-square and Student's t-tests were used for data analysis using SPSS version 13.0 (SPSS Inc., Chicago, IL, USA). Results. Twenty-ve girls and 37 boys were included in the study. The mean admission age was 5.4 (standard deviation (SD) آ±0.5) days for girls and 8.0 (SD آ±0.6) days for boys (p=0.041). The mean Hb values for the girls and the boys were 15.0 (SD آ±0.39) g/dl and 15.9 (SD آ±0.36) g/ dl, respectively (p=0.108). The mean TSB levels for the girls and the boys were 322.6 (SD آ±9.4) ?mol/l and 322.3 (SD آ±7.3) ?mol/l, respectively (p>0.05). The mean admission and pre-discharge TSB levels of 322.3 (SD آ±5.6) ?mol/l and 187.9 (SD آ±3.2) ?mol/l were significantly different (p=0.0). The mean TSB levels 24 and 48 hours later were 197.8 (SD آ±4.6) and 195.1 (SD آ±5.3) ?mol/l, respectively, with no significant difference between them (p>0.05). Conclusion. We found no significant differences between mean TSB levels at the time of termination of phototherapy and 24 and 48 hours later. We therefore do not recommend checking for rebound bilirubinaemia after phototherapy.