Neonatal Jaundice: Treatment Strategies

11 Mar

Nice review post on Aug 3 by F. DiFranco covers causes and indications for work up.

 

The two mainstays of treatment are phototherapy and exchange transfusion.

 

Phototherapy Guidelines

 

neo1

Transfusion Guidelines 

neo2

What other supportive therapies are out there to bridge to or augment phototherapy and transfusion therapy?

 

Adequate hydration. May continue breastfeeding although supplementing with formula has been associated with a more rapid fall in bilirubin.

 

Treating other causes [i.e. acidosis, infection, G6PD, hemolysis, hypothyroidism, hypopituitarism, hypotension, hypothermia, hypoglycemia, hypoalbuminemia, hypoxia (past or ongoing), upper GI obstruction (pyloric stenosis), discontinuing use of sulfa drugs and TPN with lipids]

 

IVIG. 500 -1000 mg/kg/dose over 2 to 6 hours. Effective in immune hemolytic disease

 

Phenobarbital. 5-8 mg/kg/day. Increases liver metabolism.

 

– Sn-Mesoporphyrin. 6 umol/kg IM once. Inhibits production of bilirubin.

 

 

Submitted by K. Dabrowski.

 

References: American Academy of Pediatrics Subcommittee on Hyperbilirubinemia: Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004, 114:297-316.

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