Indications for phototherapy in neonatal jaundice.

Phototherapy, the most widely used and effective treatment for neonatal jaundice, has virtually superseded exchange transfusion even in severe hyperbilirubinemia. There is as yet no consensus regarding the indications of phototherapy. The following approach can be suggested. Neonates with jaundice not due to hemolysis can be treated with Bilibed(R)-type phototherapy if their serum bilirubin level exceeds 170 mu mol/L between 24 h and 36 h of postnatal age. Conventional phototherapy can be used if the serum bilirubin exceeds 220 mu mol/L between 24 h and 36 h or 250 mu mol/L after 36 h of postnatal age. Intensive phototherapy can be recommended when serum bilirubin rises above 300 mu mol/L before 36 h or 330 mu mol/L after 36 h of age. Hemolytic jaundice requires intensive phototherapy, which should be started at birth in progressive forms and according to the serum bilirubin time-course in less severe forms. Intensive phototherapy is mandatory in every neonate with a serum bilirubin level greater than 350 mu mol/L.