Efficacy of bidirectional fiber-optic phototherapy for neonatal hyperbilirubinemia.

Abstract

To evaluate the efficacy of fiber-optic phototherapy using the standard Ohmeda Biliblanket, a large version, double standard Biliblankets, and conventional phototherapy using daylight fluorescent lamps in full-term, healthy infants with nonhemolytic hyperbilirubinemia. Full-term, healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 micromol/L or 222 micromol/L at <48 hours of age) were allocated randomly to one of four modes of phototherapy: standard fiber-optic mat (Ohmeda Biliblanket), a large version, double standard Biliblankets, and conventional phototherapy. Bilirubin levels were monitored every 12 hours. Exposure was stopped when bilirubin levels were less than 185 micromol/L, the minimum duration being 24 hours. A total of 171 infants were studied; 42 were exposed to standard fiber-optic phototherapy, 43 to large fiber-optic phototherapy, 42 to double-fiber-optic phototherapy, and 44 to conventional phototherapy. Durations of exposure were 87.05 +/- 6.09 (SEM), 82.57 +/- 5.84, 64.85 +/- 5.43, and 62.61 +/- 3.74 hours, respectively; the 24-hour decline rates were 10.26% +/- 1.84%, 14. 50% +/- 1.53%, 21.82% +/- 1.71%, and 19.00% +/- 1.65%, respectively; the overall decline rates over the whole exposure period were 0.47% +/- 0.03%, 0.52% +/- 0.04%, 0.71% +/- 0.05%, and 0.75% +/- 0.04% per hour, respectively. The efficacy of double-fiber-optic phototherapy and conventional phototherapy was similar and significantly better than that of the large fiber-optic mat and the standard fiber-optic mat in duration, 24-hour decline rate, and overall decline rate. The large mat was slightly better than the standard-size mat with regard to 24-hour decline rate and overall decline rate, but this difference was not significant. Failure of phototherapy occurred only in the large fiber-optic mat group (3 of 43) and the standard fiber-optic mat group (4 of 42); none occurred in the other two groups, but differences not statistically significant. The nursing personnel were more comfortable with single fiber-optic phototherapy, which caused no initial disturbance to the swaddled infants as did conventional phototherapy, but found double-fiber-optic phototherapy difficult to use. For efficacy of fiber-optic phototherapy in full-term infants to be comparable to that of our conventional phototherapy, the light dose of the standard mats needs to be doubled.