Neonatal jaundice medical therapy: Difference between revisions
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* According to the American Academy of Pediatrics (AAP), IVIGs are recommended in the patients with neonatal jaundice due to hemolytic diseases and alloimmunization.<ref name="AAP2004" /> | * According to the American Academy of Pediatrics (AAP), IVIGs are recommended in the patients with neonatal jaundice due to hemolytic diseases and alloimmunization.<ref name="AAP2004" /> | ||
* Intravenous immunoglobulins may reduce the need of exchange transfusion when they are introduced to patients with alloimmunization diseases like Rh hemolytic disease and ABO incompatibility disease.<ref name="pmid12496219">{{cite journal| author=Gottstein R, Cooke RW| title=Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn. | journal=Arch Dis Child Fetal Neonatal Ed | year= 2003 | volume= 88 | issue= 1 | pages= F6-10 | pmid=12496219 | doi= | pmc=1755998 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12496219 }}</ref> | * Intravenous immunoglobulins may reduce the need of exchange transfusion when they are introduced to patients with alloimmunization diseases like Rh hemolytic disease and ABO incompatibility disease.<ref name="pmid12496219">{{cite journal| author=Gottstein R, Cooke RW| title=Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn. | journal=Arch Dis Child Fetal Neonatal Ed | year= 2003 | volume= 88 | issue= 1 | pages= F6-10 | pmid=12496219 | doi= | pmc=1755998 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12496219 }}</ref> | ||
* | * Preferred regimen: IVIG 500 mg/kg every 2 hours | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
The mainstay of treatment of patients with neonatal jaundice is phototherapy, intravenous immunoglobulins and blood exchange.
Medical Therapy
- Phototherapy or blood transfusion are recommended by the American Academy of Pediatrics (AAP) for the treatment of neonatal jaundice.[1]
- It is recommended to treat the newborns with phototherapy or blood transfusion in order to decrease the risk of severe hyperbilirubinemia and kernicterus development.
Phototherapy
- Phototherapy is considered as the safest intervention approach used in treatment of neonatal jaundice.
- Phototherapy showed its efficacy in lowering the level of the total serum bilirubin in all patients with neonatal jaundice regardless the underlying cause.[2][3]
- Phototherapy also acts on preventing the rise of the bilirubin to the level of exchange transfusion threshold.[4]
- The total bilirubin level should be assessed every three hours after starting the phototherapy. The efficacy of phototherapy is assessed by the drop of the bilirubin level which is the best indicator of the neonatal response to the phototherpay.[5]
- If the level of the bilirubin still high after initiating the phototherapy, blood transfusion is indicated and to be initiated.
Mechanism of phototherapy
- Phototherapy can lower the level of bilirubin in neonatal jaundice via the following mechanisms:[6][7]
- Isomerization of bilirubin to lumirubin which is more soluble[8]
- Isomerization of bilirubin isomers to less toxic isomers (ex. 4Z and 15E)
- Phototherapy converts bilirubin into soluble polar compounds by oxidation
- Different sources of the light required for phototherapy: [9]
- Home phototherapy
- Sunlight exposure
- Filtered sunlight
- Fluorescent tubes
- Halogen white light
- Blue LEDs
Adverse effects of phototherapy
- Although phototherapy is of a high safe margin, the following adverse effects are associated with phototherpay in some cases:
Exchange transfusions
- Blood transfusion is reserved for the patients who still have high level of bilirubin even after receiving treatment by phototherapy.[1]
- The role of exchange transfusion is to remove the bilirubin from the blood stream especially if the patient infants show complications of acute bilirubin encephalopathy or kernicterus.[13]
- Exchange transfusion has its best outcome in the patients with jaundice due to alloimmunization diseases.
- Exchange transfusion may have the following complications:
- Hemolytic reactions
- Infections
- Portal vein thrombosis
- Electrolyte disturbances
- Increase blood volume
- Iron overload
Intravenous Immunoglobulins (IVIG)
- According to the American Academy of Pediatrics (AAP), IVIGs are recommended in the patients with neonatal jaundice due to hemolytic diseases and alloimmunization.[1]
- Intravenous immunoglobulins may reduce the need of exchange transfusion when they are introduced to patients with alloimmunization diseases like Rh hemolytic disease and ABO incompatibility disease.[14]
- Preferred regimen: IVIG 500 mg/kg every 2 hours
References
- ↑ 1.0 1.1 1.2 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia (2004). "Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation". Pediatrics. 114 (1): 297–316. doi:10.1542/peds.114.1.297. PMID 15231951. Unknown parameter
|month=ignored (help) - ↑ Amato M, Inaebnit D (1991). "Clinical usefulness of high intensity green light phototherapy in the treatment of neonatal jaundice". Eur. J. Pediatr. 150 (4): 274–6. doi:10.1007/BF01955530. PMID 2029920. Unknown parameter
|month=ignored (help) - ↑ Ip S, Chung M, Kulig J, O'Brien R, Sege R, Glicken S; et al. (2004). "An evidence-based review of important issues concerning neonatal hyperbilirubinemia". Pediatrics. 114 (1): e130–53. PMID 15231986.
- ↑ Newman TB, Kuzniewicz MW, Liljestrand P, Wi S, McCulloch C, Escobar GJ (2009). "Numbers needed to treat with phototherapy according to American Academy of Pediatrics guidelines". Pediatrics. 123 (5): 1352–9. doi:10.1542/peds.2008-1635. PMC 2843697. PMID 19403502.
- ↑ Bhutani VK, Johnson L, Sivieri EM (1999). "Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns". Pediatrics. 103 (1): 6–14. PMID 9917432.
- ↑ Ennever JF, Costarino AT, Polin RA, Speck WT (1987). "Rapid clearance of a structural isomer of bilirubin during phototherapy". J Clin Invest. 79 (6): 1674–8. doi:10.1172/JCI113006. PMC 424499. PMID 3584465.
- ↑ Leung C, Soong WJ, Chen SJ (1992). "[Effect of light on total micro-bilirubin values in vitro]". Zhonghua Yi Xue Za Zhi (Taipei) (in Chinese). 50 (1): 41–5. PMID 1326385. Unknown parameter
|month=ignored (help) - ↑ Stokowski LA (2006). "Fundamentals of phototherapy for neonatal jaundice". Adv Neonatal Care. 6 (6): 303–12. doi:10.1016/j.adnc.2006.08.004. PMID 17208161. Unknown parameter
|month=ignored (help) - ↑ Vreman HJ, Wong RJ, Stevenson DK (2004). "Phototherapy: current methods and future directions". Semin Perinatol. 28 (5): 326–33. PMID 15686263.
- ↑ Rubaltelli FF, Da Riol R, D'Amore ES, Jori G (1996). "The bronze baby syndrome: evidence of increased tissue concentration of copper porphyrins". Acta Paediatr. 85 (3): 381–4. PMID 8696003.
- ↑ Wickremasinghe AC, Kuzniewicz MW, Grimes BA, McCulloch CE, Newman TB (2016). "Neonatal Phototherapy and Infantile Cancer". Pediatrics. 137 (6). doi:10.1542/peds.2015-1353. PMID 27217478. Review in: Evid Based Med. 2017 Mar;22(1):39-40
- ↑ Oláh J, Tóth-Molnár E, Kemény L, Csoma Z (2013). "Long-term hazards of neonatal blue-light phototherapy". Br J Dermatol. 169 (2): 243–9. doi:10.1111/bjd.12335. PMID 23521230.
- ↑ Johnson L, Bhutani VK (2011). "The clinical syndrome of bilirubin-induced neurologic dysfunction". Semin Perinatol. 35 (3): 101–13. doi:10.1053/j.semperi.2011.02.003. PMID 21641482.
- ↑ Gottstein R, Cooke RW (2003). "Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn". Arch Dis Child Fetal Neonatal Ed. 88 (1): F6–10. PMC 1755998. PMID 12496219.