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Chapter 49 ■ Phototherapy 361

H. Discontinuation of Phototherapy

and Follow-Up

1. There is no single standard for discontinuing phototherapy. The total serum bilirubin (TSB) level that

determines the discontinuation of phototherapy

depends on the age of the infant, the age and bilirubin

level at which treatment was initiated, and the etiology

of the hyperbilirubinemia (1,22).

2. For infants who are readmitted to the hospital (usually

for TSB levels of 18 mg/dL or higher), phototherapy

may be discontinued when the serum bilirubin level

falls below 13 to 14 mg/dL.

3. For infants who are readmitted with hyperbilirubinemia and then discharged, significant rebound is

uncommon, but may still occur. In cases of prematurity, positive direct antiglobulin (Coombs) test, and for

babies treated <72 hours, the likelihood of rebound is

much higher, and these risk factors should be

taken into account when planning postphototherapy

follow-up (23). Generally, a follow-up bilirubin measurement within 24 hours after discharge is recommended (1).

I. Complications of Phototherapy

“Phototherapy has been used in millions of infants for more

than 30 years, and reports of significant toxicity are exceptionally rare” (1).

Complications include the following.

1. “Bronze baby syndrome” occurs in some infants with

cholestatic jaundice who are exposed to phototherapy,

as a result of accumulation in the skin and serum of

porphyrins. The bronzing disappears in most infants

within 2 months (24). Rare complications of purpuric

eruptions due to transient porphyrinemia have been

described in infants with severe cholestasis who receive

phototherapy (25).

2. Diarrhea or loose stools (26)

3. Dehydration secondary to insensible water loss

4. Skin changes ranging from minor erythema, increased

pigmentation, and skin burns, to rare and more severe

blistering and photosensitivity in infants with porphyria

and hemolytic disease. Concerns about an increase in

the number of melanocytic nevi have not been substantiated (27).

5. Although there is a risk of potential retinal damage

from light exposure, adverse effects have not been

reported in neonates because eye patches are used routinely (28).

6. Separation of mother and infant and interference with

bonding.

References

1. American Academy of Pediatrics Subcommittee on

Hyperbilirubinemia. Management of hyperbilirubinemia in the

newborn infant 35 or more weeks of gestation. Pediatrics. 2004;

114:297.