الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
ntroduction: Neonatal hyperbilirubinemia is a common problem.
Approximately 60% of term infants and 80% of preterm infants
develop jaundice in the first week of life. Despite hyperbilirubinemia
being a common morbidity among neonates, few studies have
systematically studied the phenomenon of post‐phototherapy rebound,
data about the phenomenon of bilirubin rebound is lacking.
Objectives: The aim of this study was to determine whether a rebound
in serum bilirubin level occurs within 24 hours after discontinuation of
phototherapy in neonates with hyperbilirubinemia and to identify
aetiological factors for hyperbilirubinemia that could be used to select
infants at risk for rebound.
Study design: A prospective clinical survey was performed on 133
term and preterm neonates treated with phototherapy. Neonates were
tested for T.S.B 24(±6) hours after discontinuation of phototherapy, with
additional testing as clinically indicated. The main outcome measure,
significant bilirubin rebound, was defined as a post-phototherapy T.S.B
≥15 mg/dl. Phototherapy was not reinstituted in all cases of rebound, but
rather according to clinical indications.
Results: A total of 29 (21.8%) neonates developed significant rebound,
mean (±SD) T.S.B was 16.45 (±0.99) mg/dl. Multiple logistic regression
analysis for risk factors for significant bilirubin rebound showed
significant risk for aetiological risk factors including hemolysis (odds
ratio 1.241, 95% CI 1.117 to 2.496) and positive direct Coombs test (odds
ratio 6.392, 95% CI 1.530 to 26.706). Sixteen of those (55.2%) were
retreated with phototherapy, mean (±SD) T.S.B was 16.9 (±1.1) mg/dl.
Multiple Logistic regression analysis for risk factors for re-admission for
phototherapy showed significant risk for aetiological risk factors
including hemolysis (odds ratio 1.121, 95% CI 1.048 to 2.307) and
positive direct Coombs test (odds ratio 7.162, 95% CI 1.571 to 32.658).
Also there was a trend for re-admission for phototherapy with weight <
2kg (odds ratio 5.976, 95% CI 0.818 to 43.685).
Conclusion: Post-phototherapy neonatal bilirubin rebound to clinically
significant levels may occur, especially in cases of hemolysis, direct
Coombs test positivity and low birth weight < 2kg. These risk factors
should be taken into account when planning post-phototherapy follow up.
Key words: Neonatal hyperbilirubinemia – Bilirubin rebound