Condition

• Phototherapy is used to remedy jaundice, or hyperbilirubinemia, in newborn infants. More red blood cells (RBCs) are needed for fetal circulation; when a baby is born its liver destroys uneeded RBCs and the waste is called bilirubin. It is normally eliminated through the gut and the skin.
  
  

Pathology

• Premature infants with underdeveloped livers cannot eliminate bilirubin normally. Elevated levels can cause brain damage, or neurodevelopmental impairment. Aggressive management of phototherapy is not used for term infants.
  
  

Procedure

• Exposure to full spectrum or ultraviolet light stimulates the breakdown and elimination of bilirubin. Infants' eyes and genitals are shielded and as much skin as possible is exposed to phototherapy lights. Extra fluids are given.
  
  

Differences

• Aggressive phototherapy in the Texas study began as soon as possible after birth, regardless of bilirubin level, and continued for two weeks. In conservatively managed phototherapy, treatment was not initiated until bilirubin reached a threshold level, relative to weight and age of the infant. Treatment continued (for at least 24 hours) until adequate results were obtained.
  
  

Considerations

• Researchers in the Texas study noted a slight, but not significant, decrease in neurodevelopmental impairment in aggressively treated infants when they were tested at 18 to 22 months. However, this possible benefit was offset by other findings; slightly fewer of the aggressively treated infants survived.