[Intensive phototherapy treatment for severe haemolytic disease of the newborn]

OBJECTIVE: To discuss the use of alternative treatment methods in hemolytic disease of newborn to replace common early exchange transfusion. METHODS: Case report of newborn with intensive Rh incompatibility treated with intensive phototherapy, plus phenobarbital instead of traditional early exchange transfusion.RESULTS: The neonatés cord blood showed 9.2 mg/dL of total bilirubin and 39% hematocrit. He was medicated with phenobarbital and intensive phototherapy at once. There was a rapid growing hyperbilirubinemia followed by stabilization for almost 60 hours with little changes, but without levels that justified an exchange transfusion. He became progressively anemic and needed a concentrate transfusion. When he was five days old, he was discharged and returned to follow-up at the 7th week of life when his bone marrow was beginning to recover from anemia.CONCLUSIONS: This case demonstrates that pharmacologic agents and intensive phototherapy can be as useful as advantageous in severe hemolytic disease of newborn. We should always try to use them before adopting more aggressive therapies.