Can I Stop Phototherapy for This Baby?

From 105 808 neonates born at ≥35 weeks’ gestation at 1 of 17 Kaiser Permanente Northern California hospitals between 2012 and 2014, Chang et al 9 identified a cohort of 7048 newborns treated with phototherapy. The objective of the study was to identify predictors of “rebound, ” defined as a return to treatment threshold levels within 72 hours of discontinuation of a neonate’s first round of phototherapy treatment. These data were then used to create a score that could predict the probability of rebound and help clinicians decide when to discontinue phototherapy. The rich electronic dataset available to the researchers included a number of key variables, including gestational age, sex, birth weight, feeding type, direct antiglobulin test results, and details regarding the initiation, course, and termination of phototherapy. Total serum and direct bilirubin data were also included. With 4.6% of the sample experiencing a return to treatment threshold after cessation of phototherapy, Chang et al 9 identified multiple significant predictors of rebound hyperbilirubinemia, including Asian race and exclusive breastfeeding, but their parsimonious prediction score was formulated using only 3 variables: gestational age, age at phototherapy initiation, and “relative” total serum bilirubin (level at cessation minus the AAP phototherapy threshold). Specifically, a gestational age of <38 weeks and higher relative serum bilirubin were associated with an increased likelihood of rebound hyperbilirubinemia, whereas older age at phototherapy initiation was protective. These observations are consistent with those of other studies, 10, 11 and the fact that infants with hemolytic disease–associated hyperbilirubinemia are much more likely to both require early phototherapy and experience a rebound. The prediction score calculated from these variables generated thresholds where rebound hyperbilirubinemia was highly unlikely, something that can easily be included in the clinical care of such neonates. Importantly, use of this score could have resulted in a 1-day shorter hospital stay for roughly one-third of those treated with phototherapy, something that would be desirable for all stakeholders.