Hyperbilirubinemia Refractory to Phototherapy
A newborn with elevated total serum bilirubin (TSB) due to hemolytic disease was placed on a mattress with embedded phototherapy lights for treatment, but the TSB continued to climb. The patient was transferred to the neonatal ICU for an exchange transfusion. The neonatologist requested testing of the phototherapy lights, and their irradiance level was found to be well below the recommended level. The lights were replaced, the patient's TSB level began to drop, and the exchange transfusion was aborted. In the accompanying commentary, Vinod K. Bhutani, MD, and Ronald J. Wong, both of Stanford University School of Medicine, discuss the use of phototherapy to treat severe neonatal hyperbilirubinemia and how to measure irradiance.