Management

• General—adequate hydration, nutrition, other supportive measures.

• Treat underlying cause—antibiotics, metabolic disturbances.

• Haemolytic anaemia—blood transfusion.

• Specific phototherapy (light source with wavelength between 400-500mm) effective in treating most causes of unconjugated hyperbilirubinaemia. Note: contraindicated in conjugated hyperbilirubinaemia.

• Exchange transfusion—the indications are complex. Main indication is severe haemolytic anaemia and is used in full-term infants when the bilirubin is >340|_imol/L and at a lower concentration in premature infants.

• Hyperbilirubinaemia due to mechanical obstruction may need surgery. Outcome

In most infants hyperbilirubinaemia resolves by 2 weeks. When pathology has been excluded the commonest cause of prolonged hyperbilirubinaemia persisting beyond this period is breastfeeding. In 20% healthy breast-fed infants the bilirubin is still significantly 4 at day 21. Kernicterus is not a complication but the condition causes concern before it spontaneously remits.

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