Neonatal Hyperbilirubinemia Clinical Trial
Official title:
Safe Threshold to Discontinue Phototherapy in Term and Late Preterm Infant With Hemolytic Disease of Newborn: A Randomized Controlled Trial
We hypothesized that adopting a lower rather than a higher threshold for phototherapy
discontinuation will be associated with reduced rates of rebound hyperbilirubinemia in term
and late preterm neonates with hemolytic disease of newborn.
Objectives: The investigators aimed to compare the safety of implementing low-threshold,
compared to high- threshold, of TSB for phototherapy interruption in term and late preterm
neonates with hemolytic disease of newborn.
Neonates in high-threshold group phototherapy will be ceased if TSB level is 50-100 µmol/L
below the appropriate 2004 AAP phototherapy threshold, whereas neonates in the low-threshold
group phototherapy will be stopped if TSB reached ˃100 µmol/L below the AAP threshold.
Phototherapy will be commenced for neonates in both groups according to AAP
guidelines.Neonates will be treated with intensified overhead blue LEDs phototherapy if they
have a TSB level at or above phototherapy threshold. Neonates will be started on intensified
360◦ LED phototherapy if they have TSB level within 50µmol/L below the exchange threshold.
The administration of IVIG is indicated in infants with isoimmune hemolytic disease if TSB
lies within 34 to 51 micromol/L of the threshold for exchange transfusion and not responding
to initial intensified phototherapy.Infants with a TSB concentration above the thresholds for
exchange should have immediate intensified 360◦ LED phototherapy, and preparation for
exchange transfusion will be started.Infants showed clinical signs of acute bilirubin
encephalopathy will have an immediate exchange transfusion.
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