Treatment aims in preventing bilirubin related neurodevelopmental defects without any harm. The almost complete disappearance of pathological kernicterus in this population resulting from fairly aggressive phototherapy proves its efficacy. While the lack of any other evidence to support this approach and the possibility that phototherapy may have some less desirable consequences makes it a topic of debate.

Guidelines for initiating phototherapy and exchange transfusions (NICHHD Neonatal Research Network Trial)-

Birth weight (g)= 501-750

Aggressive management

• Phototherapy begins- ASAP after enrollment
• Exchange transfusion- ⩾0 mg/dl

Conservative management

• Phototherapy begins- ⩾0 mg/dl
• Exchange transfusion- ⩾0 mg/dl

Birth weight (g)= 751-1000

Aggressive management

• Phototherapy begins- ASAP after enrollment
• Exchange transfusion- ⩾0 mg/dl

Conservative management

• Phototherapy begins- ⩾0 mg/dl
• Exchange transfusion- ⩾0 mg/dl

Complications

Major complications in phototherapy are exceptionally rare, while the most common complication of phototherapy in the LBW infant is associated with the presence of direct hyperbilirubinaemia or cholestatic jaundice (usually after prolonged parental nutrition). Exchange transfusion should replace phototherapy in cases of bronze baby syndrome if it does not lower TSB. 

Infants with severe cholestatic jaundice receiving phototherapy may encounter Purpuric bullous eruptions rarely.

Source: Maisels MJ, Watchko JF. Treatment of jaundice in low birth weight infants, Archives of Disease in Childhood - Fetal and Neonatal, 2003;88:F459-F463.