When should phototherapy be stopped?

[juan carlos vidal]

Hello group,
We continue discussing in our hospital when we would have to suspend phototherapy,
According to AAP 2 to 4 mg/dl below the threshold value of the day of start of treatment,
this could be good as a reference for patients older than 48 hours,
but If we take patients who are admitted within 24 hours of life with values of 8 to 10 mg/dl, not so much
What strategy or what values do you use in your hospitals to discontinue phototherapy?

[Jens.backstrom]

Hi!

AAP anticipated questions regarding this topic:

"A baby was started on phototherapy early, so getting the TSB 2 mg/dL lower than the threshold at the time that phototherapy was started seems like overkill. Is it really necessary to do that?

The reason for suggesting comparing the current TSB to the threshold at the time the phototherapy was started is that it provides a way to account for two risk factors at once: earlier age at initiation of phototherapy and the current bilirubin level.1 Generally, babies for whom phototherapy is started at < 24 hours are more likely to have hemolysis and are at higher risk of rebound. Another clinical prediction rule that uses the difference between the current TSB and the current threshold is available,2 and it is an option to use it to guide phototherapy discontinuation decisions. As described in the guideline, it is important to have well-coordinated follow-up after discharge.

1. Chang PW, Newman TB. A simpler prediction rule for rebound hyperbilirubinemia Pediatrics. 2019;144(1):e20183712.
2. Chang PW, Kuzniewicz MW, McCulloch CE, Newman TB. A clinical prediction rule for rebound hyperbilirubinemia following inpatient phototherapy. Pediatrics. 2017;139(3):e20162896."

I too find AAP's recommendation to be somewhat overkill. Maybe starting threshold=stopping threshold would be a viable approach?