Different approaches in management of neonatal unconjugated hyperbilirubinemia: a review article

Abstract

Background

Neonatal hyperbilirubinemia is a prevalent condition that affects newborns, characterized by elevated serum bilirubin levels. The accumulation of bilirubin can cause neurotoxicity, resulting in various complications, and in severe cases, even mortality. The underlying pathophysiology of this condition primarily involves an inconsistency between the synthesis and excretion of bilirubin. Despite the short- and long-term side effects of phototherapy, it is considered a core treatment of neonatal hyperbilirubinemia. Exchange transfusion is considered a last resort in cases where phototherapy fails. Several studies have investigated the use of various agents either to replace phototherapy or to be added as adjuvants to reduce the time required for phototherapy and hence minimize the adverse effects. Some of these studies have demonstrated positive outcomes, indicating their effectiveness, while others have failed to yield any significant differences in treatment duration.

Main text

The present review summarized the etiology of neonatal hyperbilirubinemia. It was demonstrated that neonatal hyperbilirubinemia has mainly two types: Conjugated and unconjugated hyperbilirubinemia. Treatment options for neonatal hyperbilirubinemia were discussed with phototherapy as the most prevalent and successful option followed by exchange transfusion. Side effects of phototherapy were also discussed together with the different approaches introduced to clinical practice to minimize these side effects.

Conclusion

Phototherapy is the most successful treatment of neonatal hyperbilirubinemia, although its side effects are of great concern. Studies introducing adjuvants such as zinc sulfate and ursodeoxycholic acid have demonstrated promising results in reducing the duration of phototherapy and minimizing the side effects. However, these results are inconclusive, and further research is required to validate the safety and efficacy of these adjuvants.