HYPERBILIRUBINEMIA or jaundice when severe and if untreated has disastrous yet preventable neurotoxic effects, specifically, bilirubin-induced encephalopathy or kernicterus.1,2 Intraoperative phototherapy using an underbody bili blanket (red arrows) can minimize treatment interruptions, which is preferential during light therapy. Although dual-source (anterior and posterior) light therapy is preferred, this may not allow for operative access to the patient. As seen in these images, the patient should be positioned to provide maximal light to skin interface, with the cautery pad positioned to allow maximal light exposure. Patients should be well hydrated and have eye shields because phototherapy may result in dehydration from insensible losses and toxicity to the immature retina. Although surgery should be delayed until hyperbilirubinemia is resolved, in emergent or semiurgent cases, maintenance of phototherapy intraoperatively, especially in lengthy cases, should be considered.
Source: Anesthesiology