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Supplemental IV fluids may interfere with breastfeeding and are not routinely recommended. However, they can reduce the need for exchange transfusion and patients at high risk of crossing this threshold should receive supplemental fluids.
The use of a rebound TSB is not recommended as it is unlikely with a falling TSB 3 mg/dL below phototherapy initation level that retreatment will be necessary.
Unconjugated hyperbilirubinemia (TSB >95th percentile) in newborns (≥35 weeks gestational age) is a normal process with almost all of them reaching a total serum bilirubin greater than 1 mg/dL (17 micromol/L). In certain populations however, the level of bilirubin may increase to levels, which after crossing the blood brain barrier and binding to brain tissue, result in bilirubin-induced neurologic dysfunction (BIND). Early identification of these populations and intervention is key to the proper care of all neonates.
Neonates have intrinsic mechanisms in bilirubin metabolism that lead to nonpathogenic jaundice;
Although transcutaneous bilirubin does correlate with serum values there is significant variation between different races and skin pigmentation. TCB also cannot be used after the introduction of phototherapy. Therefore, its use should be limited to screening with confirmatory testing necessary prior to treatment.
There is some observational data that phototherapy MAY be associated with an increased risk of childhood cancer. However, this risk is likely small and there are many confounders to the data that has been documented to date. Therefore, phototherapy still represents the most reasonable choice of therapy for high risk hyperbilirubinemia, but should be avoided in patients who are not in this population.