<prompt> A 32 weeks premature, healthy infant weighing less than 1 kg is having jaundice with serum bilirubin level of 5 mg. Ideal management in such a case would be: September 2006ObservationPhototherapyMedical managementExchange transfusion  <response>: Ans. B: Phototherapy Phototherapy is the primary treatment in neonates with unconjugated hyperbilirubinemia. The photoisomers of bilirubin are excreted in bile and, to some extent, in urine. Phototherapy acts by several ways: Configurational isomerization Structural isomerization Photo-oxidation Indications: Premature infants less than 35 weeks gestational age: The following total bilirubin levels are suggested for premature infants. BihWeight g-- --Total Bilirubin mgdl 2000-2499-- -- -- -- --11 to 14 1501-1999 --- -8 to 12 Less than 1500-- -- --5 to 8 Use the lower levels for: Babies with risk factors Bilirubin levels measured within 72 hours of bih Risk factors include the following: Hemolysis Sepsis Asphyxia 5 minute Apgar of 3 or less Temperature instability Acidosis pH 7.20 for more than 1 hour ifypoalbuminemia 2.5 mgdl CNS signs e.g. lethargy 