Treatment of Hyperbilirubinemia

The following methods are necessary for Treatment of hyperbilirubinemia:

1. Encourage at least 8- 10 times a day breastfeeding and avoid using pacifiers.
2. Avoid adding water or glucose water to mother's milk. If supplementation is required for any reason, give 30 mL of expressed breast milk or formula each feeding to term and near-term babies.
3. In the instance of chronic breast milk jaundice, nursing is halted until bilirubin levels lowered.
4. Phototherapy is beneficial in both the prevention and treatment of comb's negative hyperbilirubinemia, regardless of the etiology. If an infant's bilirubin level is very high or fast rising, phototherapy will be useful in preventing complications.

How does phototherapy work?

The procedure of applying fluorescent light to the baby's exposed skin is known as phototherapy. The kid is naked and placed in a lit incubator to keep warm, while a high intensity, cold, blue-fluorescent light absorbs the bilirubin and changes it into a harmless form (convert bilirubin to Lumi Rubin via structural isomerization) that can be expelled in both bile and urine. This process begins as soon as the newborn is exposed to light, perhaps making bilirubin less dangerous even before blood levels decline. Phototherapy is beneficial in the first 24-48 hours of treatment, with diminishing potency beyond that. Following that, the photoisomers degrade to natural unconjugated bilirubin in the colon and are reabsorbed.

Photo Therapy also has some side effects: 

1. Effects on the retina
2. Diarrhea occurs as a result of a high quantity of bilirubin and bile salts discharged into the intestines during medication.
3. Dehydration as a result of increased insensible water losses through the skin and feces
4. Syndrome of the Bronze Baby ( transient gray- bronze discoloration of infants skin)
5. Other symptoms include tiredness, disinterest in nursing, rashes, heat, increased metabolic rate, and so on.

Apart from the above mentioned treatment methodologies for hyperbilirubinemia, the following methods can be applied as well:

Exchange transfusion:

It is the preferred therapy for newborns of any weight who have abnormally high bilirubin levels. If bilirubin levels become dangerously high, an exchange transfusion is done to reduce them. A catheter is inserted at the cut surface of the umbilical chord into the umbilical vein, and the newborn's blood is replenished with compatible fresh blood obtained within 72 hours. It aids in the removal of hypersensitive erythrocytes from circulation as well as the reduction of blood bilirubin levels.

Exchange transfusion indication

1. Positive direct comb's test
2. Hemoglobin concentrations of less than 10- 12 mg/dl
3. Fetal hydrops
4. Symptoms of heart failure
5. Full-term babies have bilirubin levels of 20mg/dl, whereas preterm babies have levels of 15mg/dl.

Pharmaco- therapy

There is no medicine available in the well baby nursery to treat jaundice, but phenobarbitone given to the mother 1-2 weeks before delivery of an infant with known severe hemolytic disease reduces the risk of repeating problems in the coming newborn baby by reducing the infant's hepatic enzymes as well as increased hepatic intake of bilirubin and excretion of bilirubin into the bile.

Surgery

In the instance of biliary atresia, surgery is undertaken.

Treatment of hemolytic disease can be done in the following ways:

• Transfusion exchange
• Give acid citrate dextrose and calcium gluconate 
• Replace the blood.
• Intrauterine transfusion for fetal erythroblastosis

REFERENCES

HealthLine. 2005. 2017 http://www.healthline.com/health/newborn-jaundice

KidsHealth. 1995. 2017 http://www.aboutkidshealth.ca/En/HealthAZ/ConditionsandDiseases/Symptoms/Pages/Jaundice-in-newborns.aspx

Mayo Clinic. 1998. 03 April 2014 http://www.mayoclinic.org/diseases-conditions/infant-jaundice/basics/definition/con-20019637

MedicineNet. 1996. 2017 http://www.medicinenet.com/jaundice_in_adults/article.htm

Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/001559.htm

Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/007309.htm

Medscape. 1994. 2017 http://emedicine.medscape.com/article/178757-overview

NHS Choice. http://www.nhs.uk/Conditions/Jaundice-newborn/Pages/Treatment.aspx

Web MD. 2005. 2017 http://www.webmd.com/parenting/baby/tc/jaundice-in-newborns-hyperbilirubinemia-topic-overview#1