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April 2013 Newsletter

Phototherapy for Premature Infants with Hyperbilirubinemia

Nathan Rodgers, M.D., M.H.A. is working with Carl D’Angio, M.D. and Sanjiv Amin, M.D. on two projects in neonatology. The first is the data analysis for a previously completed clinical trial investigating the clinical indications for discontinuing phototherapy in moderately premature infants with non-hemolytic hyperbilirubinemia. Many Neonatal Intensive Care Units (NICUs), including ours, wait to discontinue phototherapy until the total serum bilirubin has remained below a predetermined threshold level of serum bilirubin for 2 consecutive 12 hour periods. We demonstrated that phototherapy can be discontinued once the total serum bilirubin has peaked and fallen by 10%, without increasing the total number of rounds or hours of phototherapy. This implies that, in the currently conventional regimen, this population may receive too much phototherapy. Furthermore, if phototherapy can be discontinued earlier than what is empirically practiced in many NICUs, this population of infants could breastfeed and bond with parents earlier and more often during the first several days of life. An abstract of this work has been accepted for presentation at the 2013 Pediatric Academic Society's Annual Meeting in Washington, DC.

The second project is an ongoing randomized, blinded clinical trial to see if regularly scheduled glycerin suppositories can decrease total hours of phototherapy in 30 - 35 weeks gestational age premature infants with idiopathic hyperbilirubinemia undergoing phototherapy. A common, but not evidence-based, practice in many NICUs is to give scheduled glycerin suppositories to stimulate bowel movements and decrease enterohepatic circulation of bilirubin. This has not been systematically studied in this population. Dr. Rodgers and his mentors have hypothesized that this intervention does not improve or hasten clearance of bilirubin and may therefore unnecessarily expose babies to the risk of untoward effects. Thus far, they have enrolled over 50 subjects and hope to complete enrollment for this study by this summer.