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What happens when we challenge our long-standing assumptions about phototherapy in the NICU? In this special installment of our Rethinking Phototherapy series, Ben and Daphna are joined by Dr. Deepak Manhas to examine one of the most complex questions: how should we manage hyperbilirubinemia in preterm infants?

Unlike term babies, preemies face unique risks—shorter red blood cell lifespan, immature bilirubin conjugation, lower albumin binding, and increased blood-brain barrier permeability—all of which make them more vulnerable to bilirubin-induced neurologic dysfunction. This conversation explores why traditional guidelines cannot simply be applied to preterm infants and why clinicians often initiate phototherapy earlier.

Dr. Manhas discusses the creation of gestation-specific treatment charts, the challenges and dangers of exchange transfusion in this fragile population, and the uncertain role of therapies such as IVIG, albumin, and phenobarbital. The team also unpacks practical issues: what “double phototherapy” should really mean, how to order irradiance and body surface area coverage with precision, and the role of bili blankets in promoting family bonding.

By situating this discussion in the broader Rethinking Phototherapy series, the episode highlights both the progress and the unanswered questions in caring for preterm infants.

📖 Reference: Pathogenesis and Management of Indirect Hyperbilirubinemia in Preterm Neonates Less Than 35 Weeks: Moving Toward a Standardized Approach (NeoReviews)

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As always, feel free to send us questions, comments, or suggestions to our email: [email protected]. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.

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