[Evaluation of two guidelines for the management of hyperbilirubinemia in newborn babies weighing less than 2,000 g].

OBJECTIVE To evaluate the use of two phototherapy guidelines for the treatment of hyperbilirubinemia in newborn babies weighing less than 2,000 g. METHODS Eighty-one newborn infants with birth weight less than 2,000 g were studied. They were divided in two groups: the "early" group, which started phototherapy 12 hours after birth, undergoing treatment for at least 96 hours; and the "late" group, which received phototherapy whenever the transcutaneous bilirubin reached 8 mg/dl and phototherapy suspended when bilirubin levels fell to 5 mg/dl. The following factors were analyzed: maintenance of transcutaneous bilirubin levels below 10 mg/dl, mean value of daily transcutaneous bilirubin, the highest transcutaneous bilirubin value and the period it first occurred, and duration of treatment. RESULTS In the early group, 20% of all patients showed transcutaneous bilirubin level higher than 10 mg/dl compared to 60% of patients in the late group. The highest daily mean rate of transcutaneous bilirubin in the early group was 6.6 mg/dl, which happened on the 7th day. In the late group, it was 8.6 mg/dl on the 2nd day after birth. The median duration of phototherapy treatment used in the early group was 96 hours (minimum of 96 and maximum of 156 hours) and in the late group, 51 hours (minimum of zero and maximum of 120 hours). None of the babies needed changes in the treatment (double phototherapy or exchange transfusion). CONCLUSION The use of early phototherapy treatment for babies weighing less than 2,000 g is safer when compared to the late group, considering satisfactory the maintenance of transcutaneous bilirubin levels below 10 mg/dl.