Treatment of hyperbilirubinemia

Abstract

The indications for the treatment of hyperbilirubinemia and the methods used for treatment vary according to the individual circumstances. Thus, treatment of hyperbilirubinemia can be prophylactic, when the purpose is to prevent further increase in the total serum bilirubin (TSB) level, or therapeutic, where the objective is to rapidly decrease a TSB level that is a threat to the infant. In some units, phototherapy is initiated soon after birth in all infants whose birth weight is <1000 g, irrespective of the TSB level. The TSB level can be lowered (or prevented from increasing further) in one of three ways: a) exchange transfusion, which removes bilirubin mechanically; b) phototherapy, which converts bilirubin to products that can bypass the liver’s conjugating system and be excreted in the bile or the urine without further metabolism and c) pharmacologic agents that interfere with heme degradation and bilirubin production, accelerate the normal metabolic pathways for bilirubin clearance, or inhibit the enterohepatic circulation of bilirubin.