Management of infants 35

weeks gestation
Three methods of treatment are
commonly used to decrease the level
of unconjugated bilirubin:
phototherapy, exchange transfusion,
and pharmacologic therapy.

Phototherapy
Indication: Most infants with
increasing jaundice are treated with
phototherapy when it is believed that
bilirubin levels could enter the toxic
range.

 Recommendations for exchange transfusion

apply to infants who are receiving appropriate
intensive phototherapy but whose TSB
continues to increase to the levels listed.
For all infants, an exchange transfusion is
recommended if the infant shows signs of
acute bilirubin encephalopathy, such as
hypertonia, arching, retrocollis, opisthotonus,
or high-pitch cry (which rarely occur in very
low birthweight infants).

 Side effects
a. Bronze baby syndrome (BBS).
b. Congenital erythropoietic
porphyria.
c. Retinal effects.