A 32 weeks premature, healthy infant weighing less than 1 kg is having jaundice with serum bilirubin level of 5 mg%. Ideal management in such a case would be: September 2006
Ans. B: Phototherapy Phototherapy is the primary treatment in neonates with unconjugated hyperbilirubinemia. The photoisomers of bilirubin are excreted in bile and, to some extent, in urine. Phototherapy acts by several ways: Configurational isomerization Structural isomerization Photo-oxidation Indications: Premature infants (less than 35 weeks gestational age): The following total bilirubin levels are suggested for premature infants. BihWeight (g)-- --Total Bilirubin (mg/dl) 2000-2499-- -- -- -- --11 to 14 1501-1999 --------------- -8 to 12 Less than 1500-- -- --5 to 8 Use the lower levels for: Babies with risk factors Bilirubin levels measured within 72 hours of bih "Risk factors" include the following: Hemolysis Sepsis Asphyxia (5 minute Apgar of 3 or less) Temperature instability Acidosis (pH < 7.20 for more than 1 hour) ifypoalbuminemia (< 2.5 mg/dl) CNS signs (e.g. lethargy)
Observation
Phototherapy
Medical management
Exchange transfusion