Techniques to lower the level of TSB include:
fluid intake to maximize renal excretion (not proven to be effective, but may
improve bilirubin level if dehydration is a factor)
enteral intake to stimulate intestinal motility & excretion of bilirubin via stool
Bilirubin is enterohepatically circulated in intestinal lumen and recycled
Glycerin suppository to stimulate intestinal motility
Phototherapy (Note that photoproducts are excreted in both urine and bile)
IVIG for Coombs positive or ABO incompatibility patients
Exchange transfusion
PHOTOTHERAPY
Please see Figure 2 as a guide on when to start phototherapy. Efficacy is affected by:
the spectrum of light, energy output (irradiance) in the blue light range, and infant’s
exposed surface area. To achieve maximal efficacy, use special blue (narrow spectrum)
tubes. They carry the marking “F20 T12/BB”. Placing the light as close to the infant as
possible optimizes irradiance. Irradiance of at least 30 W.-^2 is confirmed with an
appropriate irradiance meter.^ A fiberoptic blanket on the infant’s underside increases
surface area exposed to blue light. The eyes should be covered to minimize/eliminate
theoretical retinal harm. There should be a demonstration of a decrease in total bilirubin
concentration after 4-6 hours of phototherapy.