Prophylactic Versus Therapeutic Phototherapy in Very Low Birth Weight Infants

Abstract

Background: Preterm and very low birth weight (VLBW) infants are at great risk of hyperbilirubinemia and bilirubin-associated brain damage. Objectives: The aim of this study was to compare the efficacy of prophylactic versus therapeutic phototherapy in VLBW infants. Patients and Methods: Fifty VLBW infants were randomly assigned to receive either phototherapy from the first day of life regardless of their serum bilirubin level for up to five days (prophylactic group) or phototherapy when their bilirubin level reached half the exchange transfusion level (therapeutic group). All data, including gestational age, gender, birth weight, serum bilirubin level on the first day, peak serum bilirubin concentration, the age at which the peak serum bilirubin level was reached, duration of phototherapy, and the number of exchange transfusions, were studied and analyzed. Results: The mean bilirubin level on the first day in both groups exhibited no significant difference. The peak serum bilirubin was 7.7 ± 1.4 and 8.5 ± 2.1 mg/dL in the prophylactic and therapeutic group, respectively, and there was no significant difference in the age at which the peak serum bilirubin levels were reached in both groups (2.4 ± 1.2 vs. 2.1 ± 1 days in the prophylactic and the therapeutic group, respectively). The mean duration of phototherapy in the prophylactic group was 84 ± 43 hours, while for the therapeutic group it was 72 ± 39 hours, and hence the difference was not significant. The need for an exchange transfusion was lower in the prophylactic group compared to the therapeutic group (33% vs. 7%), although the difference was not statistically meaningful (P < 0.112). Conclusions: According to our study, phototherapy should not be used as prophylactic therapy for all VLBW infants, but rather it should be individualized in order to maintain low bilirubin levels.