Comparison of fiberoptic and conventional phototherapy for neonatal hyperbilirubinemia

Abstract

We were interested in the comparison of fiberoptic and conventional phototherapy for neonatal hyperbilirubinemia reported by Tan.1Tan KL. Comparison of the efficacy of fiberoptic and conventional phototherapy for neonatal hyperbilirubinemia.J PEDIATR. 1994; 125: 607-612Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar He reported that fluid intake was increased during phototherapy to offset the increased fluid loss during exposure but did not indicate whether the extent of this problem varied according to the mode of phototherapy. Increased fluid loss during phototherapy is a significant clinical problem in the term infant when the mother is trying to establish breast-feeding and in very low birth weight infants, in whom dehydration may lead to hypernatrenia. Transdermal water loss, respiratory water loss, and gastrointestinal water loss can all be involved.2Oh W Karechi H. Phototherapy and sensible water loss in the newbom infant.Am J Dis Child. 1972; 124: 230-232PubMed Google Scholar, 3Wu PYK Moosa A. Effect of phototherapy on nitrogen and electrolyte levels and water balance in jaundiced preterm infants.Pediatrics. 1978; 61: 193-198PubMed Google Scholar Because it is possible to give fiberoptic phototherapy (using the Biliblanket; Ohmeda Critical Care, Columbia, Md.) with the infant clothed, we hypothesized that transdermal water loss would be less because the presence of clothing would create a microclimate with increased local humidity. We also had sumised that there might be less heating of the skin because the fiberoptic light plate is not hot. We have compared fluid loss during fiberoptic phototherapy and conventional phototherapy. Twenty-four infants (birth weight 831 to 4520 gm) with a clinical indication for phototherapy were randomly assigned in a crossover trial design; each infant received 12 hours of treatment with the Biliblanket and 12 hours of conventional phototherapy (blue/white lamps; Air-Shields Vickers, Hatboro, Pa.) 40 cm distance from the infant's abdomen. Total fluid loss (transdermal, respiratory, urinary, and gastrointestinal) and insensible fluid loss (transdermal plus respiratory) were measured by repeated weighing before and after each treatment, careful recording of fluid input during each treatment, and weighing of diapers (to measure gastrointestinal and urinary losses). Total fluid loss was 138.7 gm/12 hours (SD ± 59.0) during Biliblanket treatment and 140.9 gm/12 hours (SD ± 78.1) during conventional phototherapy (p =0.78). Insensible fluid loss during Biliblanket treatment was 55.1 gm/12 hours (SD ± 39.3) compared with 43.8 gm/12 hours (SD ± 35.2) during conventional phototherapy (p = 0.129). Total fluid loss in 10 infants with birth weights (<1500 gm during Biliblanket treatment was 111.5 gm/12 hours compared with 105.4 gm/12 hours during conventional phototherapy (p = 0.61). Insensible loss during Biliblanket treatment was 47 gm/l2 hours (SD ± 45.2) compared with 29.7 gm/12 hours (SD ± 35.6) during conventional phototherapy (confidence interval for difference between means 4.5 to 29.9, p 0.026). These results show that term infants had no overall difference in fluid loss with the two modes of phototherapy, but there was evidence of increased insensible water loss during Biliblanket treatment in the infants <1500 gm. They appear to have compensated by decreasing urine volume. Although some nurses believed that the fiberoptic plate caused local warming, axillary temperature measurements did not show a significant difference between the two treatments. The opinions of our nurses in the neonatal intensive care unit were substantially different from those reported in Tan's aritcle. They commented that the noise of the fan was troublesome and the light plate was uncomfortable for preterm infants to lie on. In contrast, the nurses and mothers on the postnatal wards were enthusiastic about the Biliblanket because it is much easier for the mother to breast-feed during phototherapy; the lack of eyepads was also viewed as very positive. We conclude that the Biliblanket is a useful alternative (or adjunct) to conventional phototherapy, but attention to adequate hydration is just as important during Biliblanket treatment as with conventional phototherapy. 9/35/63487