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Treatment of Hyperbilirubinemia in Newborns

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Neonatology

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Abstract

The main aim of treating hyperbilirubinemia is to prevent kernicterus and/or neurodevelopmental impairment. Recommendations for treatment are based primarily on the total serum bilirubin (TSB) levels but also as a function of gestational age, birth weight, bilirubin/albumin ratios, and risk factors that increase the risk of bilirubin neurotoxicity. Setting thresholds for intervention in the premature neonate is more challenging than in term babies. Phototherapy is effective in lowering the circulating bilirubin or preventing it from rising further; its primary purpose is to prevent the need for an exchange transfusion. Phototherapy uses visible light energy to change the shape and structure of bilirubin, converting it to molecules that can be excreted even when normal conjugation is deficient. Exchange transfusion remains an important if infrequently required intervention. It is recommended in any infant who is jaundiced and manifests signs of intermediate to advanced stages of acute bilirubin encephalopathy even if the TSB is falling. Pharmacologic agents used in the management of hyperbilirubinemia can accelerate the normal metabolic pathways for bilirubin clearance, inhibit the enterohepatic circulation of bilirubin, and interfere with bilirubin formation by blocking the degradation of heme or inhibiting hemolysis. Currently, the only drug in clinical use is intravenous immunoglobulin.

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Authors and Affiliations

  1. Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Jon F. Watchko

  2. Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children’s Hospital, Royal Oak, MI, USA

    M. Jeffrey Maisels

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  1. Jon F. Watchko
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  2. M. Jeffrey Maisels
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Correspondence to Jon F. Watchko .

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Editors and Affiliations

  1. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Giuseppe Buonocore

  2. Department of Pediatrics Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy

    Rodolfo Bracci

  3. Liverpool Women’s Hospital Neonatal Unit, Liverpool, UK

    Michael Weindling

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Watchko, J.F., Maisels, M.J. (2018). Treatment of Hyperbilirubinemia in Newborns. In: Buonocore, G., Bracci, R., Weindling, M. (eds) Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-319-29489-6_223

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  • DOI: https://doi.org/10.1007/978-3-319-29489-6_223

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29487-2

  • Online ISBN: 978-3-319-29489-6

  • eBook Packages: MedicineReference Module Medicine

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