Do we have to obtain rebound bilirubin levels and what is the optimal time?

INTRODUCTION: We aimed to determine the frequency of rebound hyperbilirubinemia (RHB) needing treatment and therefrom, to clarify the clinical importance to routinely check serum total bilirubin (STB) levels after the cessation phototherapy and to define an optimal timing to check STB levels for detecting RHB.
METHODS: Term and late preterm babies who received phototherapy were included in the study. The demographic and clinical features, time of onset of jaundice, phototherapy time and results to determine the etiology of jaundice were recorded for all babies. Serum “rebound” bilirubin measurements were performed for a total of two times including at 12 and at 24 hours after terminating phototherapy. The reinitiation of phototherapy according to the 12th and 24th hour STB levels was accepted as “early rebound” and “late rebound”, respectively. IBM SPSS 22 was used for statistical analyses.
RESULTS: Data was available for 110 infants. The rebound rate requiring phototherapy was 9.1% (n: 10) and all had a risk factor. Most of the babies (9/10) rebounded at the 12th hour after the termination of phototherapy. Hemolysis and prematurity were found to be statistically significant for RHB (p: 0.008; p: 0.048).
DISCUSSION AND CONCLUSION: Post-phototherapy bilirubin follow up may be incorporated using a combined approach of individualization, evaluation of risk factors, and application of common sense before discharge. Our study showed that STB levels could be measured after the cessation of phototherapy, especially in patients with a risk factor, at the 12th hour before discharge. Randomized controlled studies with larger sample sizes are still needed for definitive recommendations.