Rebound Increase in Bilirubin Level with its Risk Factors after Treatment by Intensive Phototherapy for Neonatal Hyperbilirubinemia Al-Maaroof Zainab W1, Abbas Wisam2, Al-Jamil Abdulkareem Shatti2 1Department of Pathology, Faculty of Medicine, University of Babylon, Iraq 2Babylon Teaching Hospital for Maternity and Pediatrics, Babylon City, Iraq Online published on 8 March, 2019. Abstract Background Approximately 60% of term newborns and 80% of preterm newborns
develop jaundice in the first week of their lives. The role of intensive phototherapy is of great importance to avoid blood exchange transfusion. Significant bilirubin rebound can occur after intensive phototherapy due to the clinical state and existence of risk factors. The objectives of current study were to detect the incidence and risk factors of significant bilirubin rebound in neonatal indirect hyperbilirubinemia developed after intensive phototherapy. Methods A prospective study was done on 275 neonates in the neonatal care unit at Babylon Teaching Hospital for Maternity and Pediatrics for the period from April to December/2016. Patients who received intensive phototherapy are followed for checking of significant bilirubin rebound. Intensive phototherapy was administered according to standard guidelines. Patients were investigated for TSB and PCV every 12±6 hours, then re-checked after 18±6 hours after stopping phototherapy. Results From the total jaundiced patients included in our study, 30/275(10.9%) developed significant bilirubin rebound. Of the latter, 17/30(56.66%) developed rebound before their discharge from hospital and 13/30(43.3%) developed rebound after discharge. Most common assigned etiologies of rebound were onset of jaundice before 60 hours of life (9.45%; P=0.010), Rh incompatibility (9.09%; P≤0.001), age on presentation less than 60 hours (8.36%; P≤0.001) and weight less than 2.5kg (7.27%; P= 0.003). Among neonates without these four risk factors, the rebound was not detected, while in neonates with one, two, three or four risk factors, rebound was detected in: 16.66%(5/30), 20%(6/30), 30%(9/30) and 33.33%(10/30), respectively. Conclusions Significant bilirubin rebound occurred in 10.9% of patients and most significant risk factors were onset of jaundice <60hr of life, Rh incompatibility and birth weight <2.5kg. Top Keywords Rebound bilirubin, risk factors, intensive phototherapy, low birth weight, Rh incompatibility. Top |