432 Effect of Infants' Position on Serum Bilirubin Level During Concentional Phototherapy

Abstract

Background: Alternating exposure of front and back of infants during phototherapy is widely practiced.Aim: Compare rate of decline in total serum bilirubin concentration (TSB) during phototherapy in infants treated in supine position throughout versus infants alternating between supine and prone position every 3 h. Further, survey current practice in two Scandinavian countries.Methods: 112 infants with gestational age above 32 weeks, healthy except for non-haemolytic hyperbilirubinaemia, were randomised to one of the treatment groups. TSB was measured at start-up and after 12 and 24 h of therapy. Transcutaneous bilirubin concentration (TcB) was measured midsternum in a subgroup of 10 infants including both groups. A questionnaire about routines for position changes during phototherapy was send to all 41 neonatal departments in Denmark and Norway.Results: No significant differences in decline of TSB were observed between the two treatment groups: After 12 h of therapy TSB had decreased 32% in both groups and after 24 h 49% and 50%, respectively. TcB decreased rapidly during the first 150 min of treatment and approached a plateau at 35% of the initial level. In two thirds of Danish and Norwegian departments infants were routinely turned during phototherapy, most often every 3rd h.Conclusion: No difference in the decrease of TSB was observed wheather the infants were turned during phtotherapy or treated in supine position throughout. An explanation for this lack of effect of turning infants might be that photobilirubins are mainly produced in the intravascular space. Alternating exposure during phototherapy is widely practiced in Scandinavia.