Routine Versus Intensive Monitoring of Serum Bilirubin Levels in Neonatal Jaundice

Shrutin Ulman, Ranjan Kumar Pejaver, Anil Raikar

The incidence of bilirubin-induced neurological deficit in India is estimated to be high even if there is no formal documentation through the maintenance of a national kernicterus directory. Most of the neonatal intensive care units (NICUs) in India follow the American Academy of Paediatrics’ (AAP) guidelines for neonates more than 35 weeks’ postgestational age (PGA). In small neonates, phototherapy (PT) is initiated if the total serum bilirubin level (TSB) is about 0.5% to 75% of the body weight in healthy and sick neonates, respectively, in accordance to the National Neonatology Forum’s (NNF) guidelines 2010. However, it has been seen that the facilities for initiating PT are woefully inadequate in our country. The authors surmise that if TSB level is monitored every 12 hours instead of 24 hours in healthy neonates with hyperbilirubinemia, then PT can be tailored more precisely to the requirement of the neonate. This will help in optimizing the use of PT equipment in the NICU with several benefits for all stakeholders, namely neonates requiring treatment, NICU staff, parents, and the hospital management.

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