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Journal : Paediatrica Indonesiana

Rebound serum bilirubin levels after single vs. double phototherapy

Paediatrica Indonesiana Vol 54 No 5 (2014): September 2014
Publisher : Indonesian Pediatric Society

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Abstract

Background Hyperbilirubinemia is the most common clinicalphenomenon found in newborns. Phototherapy is the standardtreatment for lowering bilirubin levels in neonates. Whileintensive (double) phototherapy produces a more rapid declinein serum bilirubin levels than standard (single) phototherapy,greater rebound effects may occur.Objective To assess bilirubin levels in neonates with hyperbilirubinemiawho underwent single or double phototherapy, includingrebound bilirubin levels after phototherapy termination.Methods An open, randomized, controlled trial was con ductedat H. Adam Malik Hospital and Dr. Pirngadi Hospital, Medan,from August 2009 until January 2010. Subjects with indirecthyperbilirubinemia were divided into two groups. One groupreceived single phototherapy (n = 41) and other receiveddouble photo therapy (n = 40) . Measurements of total plasmabilirubin level were conducted at 12 hours and at 24 hoursof phototherapy, as well as at 24 hours after phot otherapytermination. Rebound bilirubin serum level was defined asan increment of about 1 - 2 mg/dL serum bilirubin afterphototherapy discontinuation.Results The decreases in serum bilirubin levels were significantlygreater in the do uble phototherapy group for observationsat 12 h ours , 24 h ours, and 24 hours after phototherapyt ermination (P = 0.0001). At the 24-hour observation afterterminationofphototherapy, only 1 neonate (2.7%) in the singlephototherapy group compared to 4 neonates (10.8%) in thedouble phototherapy group had serum bilirubin level increasesof 1 - 2 mg/dL. Fisher's exact test did not reveal a significantdifference in rebound serum bilirubin occurrence in the twogroups (P = 0.358).Conclusion Double phototherapy shows significantly greaterdecrease in bilirubin level compared to single phototherapywithin a same period of time. Rebound serum bilirubin levels aftersingle and double phototherapy may occur in some patients withhyperbilirubinemia, as bilirubin production continues. However,260 • Paediatr Irulones, Vol. 54, No. 5, September 2014there is no significant difference in rebound effects between singlevs. double phototherapy.

Co-Authors ABDUL GAFUR Adang Hardi Gunawan Afif, Muhammad Nur Agung Cahyono Agung Putra Wijaya, Agung Putra Agus Sugiarto Andini, Yuri Tri Aprilina, Ulfah Arnelis Djalil Asih Purnami Widiastuti Asri, Peggy Nurida Bidari, Masgusti Dinda Caswita Caswita Cecep Taufik Rustendi Dharma Himawan, Muhammad Agung Dian Mulawarmanti, Dian Diba, Shofura Farah Dwi Kurniawati, Dwi Dwi Laila Sulistiowati, Dwi Laila Elin Erlina Sasanti Eni Indriani Eni Kartika, Eni Enny Lestari Eva Meizara Puspita Dewi, Eva Meizara Fajarin, Rindang Febby Eka Putri Febrian Budi Pratama FELLY YULIAN FF, FELLY Fitri Rahmawati Fitriyani ZS, Syawalia Florensia Evindonta Bangun, Florensia Evindonta Gita Novian Hermana Gunawan, A. H. Guslihan Dasa Tjipta, Guslihan Dasa Hamzah Afandi Hanafiah A. Haninda Bharata Hariyati Purwaningsih Hasaruddin Hafid, Hasaruddin Indah Damayanti, Indah Iswanti, Nina Iwan Nurwantoro, Iwan Jayadinata, Asep Kurnia Juhamzah, Sulfiani Karim, Nina Karina Katibi, Ahmad Yakub Khairi, Husain Kholid, Rifki Rachman Kusuma, Ariya Eka Laksmi A. Lenap, Indria Puspitasari Lucia Maria Santoso, Lucia Maria M Coesamin M. Coesamin Mahfudho, Zahidatun Maskuroch Adesty Muhammad Safrudin Yafie Muhammad Yusuf Mulia, Septi Dianna Bunga Mustika, Lia Nanda, Evi Tirto Nasrun Nasrun Ningrum, Nia Widya Novianti, Elvita Lia Nurhanurawati Nurhanurawati Nurlaili Nurlaili Nurul Rohmah Nurvita Nurvita Nur’ainingsih, Dyah Parindra Kusriantoko Pentatito Gunowibowo Pratiwi, Ganjar Febriyani Pratiwi, Rafi Puji Rahayu Purnama Dewi Putri, Apriliani Qorri Ayuni Rani, wayan Widya Regina Lichteria Panjaitan, Regina Lichteria ria septiana Ridfah, Ahmad Ridfah, Ahmad Rini Asnawati Rini Rita T Marpaung Riyanto Riyanto Rizal Ramadhan Rizki Agustianto Robith Hudaya ROCHMAN R, ROCHMAN Rosalia Deviana Cahyaningrum Rusdi Setiono Sangaji, Darma Sapitri, Nonik Mega Sarlina Sarlina, Sarlina Silvana, Silvana Siti Laelatul Chasanah, Siti Laelatul Slamet Suprayogi Soraya, Rahayu Sri Hastuti Noer Sri Hastuti Noer Sri Setiyowati Sri Setyowati Sriyono Sriyono Sugeng Sutiarso Sukmawati, Fitriani Supriatmo Supriatmo, Supriatmo Syakir Mahid Tina Yunarti Titi Murniati Utami, Fithrina Yudha Utari Rezki Veronika Yulianti Wayan Rumite Wijayanti, Chusna Yuliana Yuliana Yulisa Yulisa Yuniarti, Tina Yunilda Yunilda YUSLI MARIADI Zuma Herdiyanti