Efficacy of prophylactic phototherapy for prevention of hyperbilirubinemia in very low birth weight newborns

Ma Mannan ,Sadeka Choudhury Moni,Mohammod Shahidullah,Ismat Jahan,Zahidul Hasan,Arjun Chandra Dey

doi:10.3329/bsmmuj.v6i2.29132

Abstract

Background: Jaundice is a common clinical condition in newborn occurring in approximately 60% of term and 80% of preterm infants. Unconjugated hyperbilirubinemia is universally common in all preterm infants especially in newborns with very low biLth weight. Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinemia that can lead to bilirubin encephalopathy. Significant heterogeneity in the approach to the treatment of jaundiced neonates exists throughout the world. Phototherapy is the most common treatment for neonatal hyperbilirubinemia and could be most effective in preventing the sequelae of hyperbilirubinemia if initiated prophylactically. This randomized clinical trial has been proposed with the objective of assessing the efficacy of prophylactic photo therapy in preventing significant rise of unconjugated hyperbilirubinemia in premature neonates weighing less than 1500 gram and therefore to decrease the need for exchange transfusion and finally to reduce hospital stay due to hyperbilirubinemia. Methods: This randomized controlled clinical trial enrolled sixty newborns with birth weight less than 1500 gram. They were divided into two groups: 1) Prophylactic group, in whom phototherapy was started within 24 hours of birth and continued for 7 days and 2) Control group in whom therapeutic phototherapy was started considering serum bilirubin level and other clinical conditions as per institutional guidelines. Mean value of total serum bilirubin (TSB), duration of phototherapy, the need for exchange transfusion and duration of hospital stay in both groups were analyzed.Results: The maximum mean TSB level in prophylactic group was observed on 7th day and in control group it was observed on 3rd day of life. The total serum bilirubin levels were significantly lower in the 3rd and 5th days of life in the prophylactic group in comparison to control group (P value 0.001). Total serum bilirubin level exceeded therapeutic range in 6 (21 %) and 14 (50 %) newborns of the prophylactic group and control groups respectively (P value 0.026). No documented side effects of prophylactic phototherapy was observed. Conclusion: The use of prophylactic photo therapy for infants weighing less than 1500 grn is effective and sate when compared to the control group, considering satisfactory maintenance of low total serum bilimbin levels during first 7 days of life.

Highlights

Jaundice is a common clinical condition in newbom occurring in approximately 60% of term and 80% of preterm infants
The study population were premature newborn infants weighing < 1500 gram .The objective of the study was to assess the efficacy of prophylactic phototherapy in preventing significant rise of unconjugated hyperbilirubinemia in premature neonates weighing less than 1500 grams and to decrease the need for therapeutic phototherapy as well as exchange transfusion and to reduce hospital stay due to hyperbilirubinemia.Inc1usioncriteriawerepretermnewborninfants< 1500 gram who were admitted within[24] hours of birth in NICU during the study period
Therapeutic phototherapy was started in control group considering serum bilirubin level and other clinical conditions as per existing institutional guidelines

Summary

Introduction

Jaundice is a common clinical condition in newbom occurring in approximately 60% of term and 80% of preterm infants. Phototherapy is the most common treatrnent for neonatal hyperbilirubinemia and could be most effective in preventing the sequelae of hyperbilirubinemia if initiated prophylactically This randomized clinical trial has been proposed with the objective ofassessing the efficacy ofprophylactic phototherapy in preventing significant rise of unconjugated hyperbilirubinemia in premature neonates weighing less than 1500 gram and to decrease the need for exchange transfusion and to reduce hospital stay due to hyperbilirubinemia. Methods: This randomized contolled clinical trial enrolled sixty newborns with birth weight less than 1500 gram They were divided into two groups: 1) Prophylactic group, in whom phototherapy was started within 24 hours of birth and continued for 7 days and 2) Control group in whom therapeutic phototherapy was started considering serum bilirubin level and other clinical conditions as per institutional guidelines. Conclusion: The use of prophylactic phototherapy for infants weighing less than 1500 gm is effective and safe when compared to ttre control group, considering satisfactory maintenance of low total serum bilirubin levels during first 7 days of life

Objectives

Methods

Results