A 5-day-old term neonate presents with cutaneous jaundice. Total serum bilirubin is 19 mg/dL with 95% unconjugated fraction. What is the primary therapy to prevent kernicterus?
Answer and explanation
Correct answer: C. Intensive phototherapy
- Step 1: Severe unconjugated hyperbilirubinemia can cross the blood-brain barrier and deposit in the basal ganglia, causing acute bilirubin encephalopathy and irreversible kernicterus.
- Step 2: Intensive phototherapy with blue-green light (wavelength 460-490 nm) photoisomerizes unconjugated bilirubin into water-soluble lumirubin, which is excreted in bile and urine without hepatic conjugation.
Answer
Intensive phototherapy.
Why not the others: Exchange transfusion is reserved for severe refractory hyperbilirubinemia when bilirubin levels exceed critical thresholds or fail to decline with intensive phototherapy. Phenobarbital takes days to induce hepatic glucuronosyltransferase and has no role in acute neonatal hyperbilirubinemia. Laparotomy is indicated for surgical conditions like biliary atresia, which presents with conjugated hyperbilirubinemia.
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