Abstract
Background: Bilirubin associated brain damage is great in the preterm and low birth weight newborns. Phototherapy is able to control the level of bilirubin in low birth weight newborns. Objective:To show the role of prophylactic phototherapy in the management of very low birth weight newborns weighting(1-1.5)kg with hyperbilirubinemia in comparison to therapeutic method. Patients and Methods: Across sectional study; Very low birth weight newborns weighting (1–1.5)kg were included in the study and admitted to neonatal care unit because of their very low birth weight and family consent had taken about admission and prophylactic phototherapy from some families so the total number of newborns was forty, twenty newborns were received phototherapy within nine hours of birth and lasted for seven days while twenty newborns were received phototherapy when indicated according to birth weight and continued to seventh day after birth , analysis was made for mean daily bilirubin level , duration of phototherapy , peak bilirubin level in the prophylactic and therapeutic groups and blood exchange need. Results: The highest daily mean level of Total Serum Bilirubin(TSB) of prophylactic group was 6.5±0.4 mg/dl, which happened on the fifth day. In the therapeutic group, it was 8.7±0.5 mg/dl on the fifth day after birth. There was significant difference in the TSB values of prophylactic group which was less than that of therapeutic group from second to sixth days( p<0.0001). The median duration of phototherapy in the treatment group was shorter than that of the prophylactic group. Conclusion: Prophylactic phototherapy in very low birth weight preterm infants weighting (1-1.5) kg can significantly decrease jaundice after birth compared with the therapeutic group, also this study indicate that there is significant high TSB level among males in both groups in comparison to females.
Highlights
Neonatal jaundice is common problem worldwide and it is effectively treated with phototherapy .Multiple phototherapy units are sometimes used to increase the light intensity and improve the efficacy of phototherapy [1]
Table(2) showed that the fifth day after birth was the day of maximal mean TSB level in both groups, but the total mean TSB level in the prophylactic group was significantly lower on the second to sixth days after birth and significantly higher on the first and seventh days after birth than the therapeutic group
In a study done by Remin l study[14] in Iran showed significant difference with high TSB level in the treatment group which go with study, the peak mean TSB level in Remin study[14] in the prophylactic group was on the third day and in the treatment group was on the fourth day, the results of present study were nearly consistent with study in Iran, this may be due to similar range of birth weight(1-1.5)kg and could be due to similar time of starting and ending of phototherapy in both groups
Summary
Neonatal jaundice is common problem worldwide and it is effectively treated with phototherapy .Multiple phototherapy units are sometimes used to increase the light intensity and improve the efficacy of phototherapy [1]. The premature newborn infant has an exaggerated form of physiologic jaundice with mean serum TSB concentrations reaching peaks of 10 to 12 mg/dl (171 to 205 μmol/L ) or more with delay in reaching the maximum concentration as compared with full-term neonates (on the fifth and sixth day of life) This could be considered physiologic because of its occurrence in all preterm infants, the mean peak of un conjugated bilirubin concentrations higher than 10 mg/dl may be associated with acute bilirubin encephalopathy or kernicterus in certain high-risk, very low birth weight neonates[4,5].many neonatologists aggressively approach hyperbilirubinemia in very low birth weight (VLBW) neonate and use prophylactic or early phototherapy to prevent TSB levels from ever becoming sufficiently great to require exchange transfusion[6].
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