Discontinuation Of Phototherapy Research Articles

The effect of phototherapy on cerebral blood flow velocity in preterm infants

Cerebral blood flow velocity was studied with two‐dimensional/pulsed Doppler ultrasound before, during and after discontinuation of phototherapy in 22 preterm infants (gestational age ≤ 32 weeks), who were treated for a minimum of 12 h with blue‐light phototherapy for non‐haemolytic hyperbilirubinaemia. Before the cerebral blood flow velocity measurements, patency of the ductus arteriosus was diagnosed by Doppler echocardiography. All infants had normal brain ultrasound scans. Mean cerebral blood flow velocity increased significantly after initiation of phototherapy in all infants. Only in “healthy” (non‐ventilated) infants did cerebral blood flow velocity return to pre‐phototherapy values (baseline) after discontinuation of phototherapy, whereas in “unhealthy” (ventilated) infants cerebral blood flow velocity did not return to baseline. In 10 infants the ductus arteriosus reopened during phototherapy. In those infants, mean cerebral blood flow velocity returned to pre‐phototherapy values after 2 h of phototherapy prior to its discontinuation.

The Effect of Phototherapy on Renal Blood Flow Velocity in Preterm Infants

Mean renal blood flow velocity (RBFV) was studied with two-dimensional/pulsed Doppler ultrasound and relative renal vascular resistance (RVR) was calculated before, during, and after phototherapy treatment in 30 preterm infants (gestational age ≤32 weeks) who were treated for a minimum of 12 h with phototherapy for nonhemolytic hyperbilirubinemia. RBFV decreased, whereas RVR increased significantly after the initiation of phototherapy. In ‘healthy’ (nonventilated) infants RBFV and RVR returned to baseline values after discontinuation of phototherapy. Whereas in ‘unhealthy’ (ventilated) infants, RBFV and RVR did not return to baseline values after discontinuation of phototherapy. In 16 infants (>50% of the cases) the ductus arteriosus reopened during phototherapy.

The effect of phototherapy on cerebral blood flow velocity in preterm infants.

Cerebral blood flow velocity was studied with two-dimensional/pulsed Doppler ultrasound before, during and after discontinuation of phototherapy in 22 preterm infants (gestational age < or =32 weeks), who were treated for a minimum of 12h with blue-light phototherapy for non-haemolytic hyperbilirubinaemia. Before the cerebral blood flow velocity measurements, patency of the ductus arteriosus was diagnosed by Doppler echocardiography. All infants had normal brain ultrasound scans. Mean cerebral blood flow velocity increased significantly after initiation of phototherapy in all infants. Only in "healthy" (non-ventilated) infants did cerebral blood flow velocity return to pre-phototherapy values (baseline) after discontinuation of phototherapy, whereas in "unhealthy" (ventilated) infants cerebral blood flow velocity did not return to baseline. In 10 infants the ductus arteriosus reopened during phototherapy. In those infants, mean cerebral blood flow velocity returned to pre-phototherapy values after 2 h of phototherapy prior to its discontinuation.

Methylene Blue-induced Phototoxicity: An Unrecognized Complication

To describe photosensitization after prenatal exposure to a toxic amount of methylene blue and to alert pediatricians that, in a review of the literature, photosensitization (which this dye is capable of) has not been reported as a complication of prenatal exposure. A descriptive report of physical findings and significant laboratory tests in a very low birth weight preterm infant with prenatal exposure to methylene blue and a comparison of this reported case with previously described patients' complications and treatment. Neonatal intensive care unit. Monitoring of laboratory tests to assess for methylene blue toxicity: two exchange transfusions for methemoglobinemia, hemolytic anemia, and hyperbilirubinemia; phototherapy for hyperbilirubinemia; and pathologic examination of skin bullae. Within hours of exposure to phototherapy, redness developed on all exposed areas of the patient's skin (which was initially deep blue), followed by bullae and desquamation of about 35% of the total skin surface area. The desquamation of erythematous areas continued even after discontinuation of phototherapy. Complete re-epithelialization was attained by 3 weeks of age. In addition to this newly observed complication, the patient had other previously described toxic effects. We have reported a previously unrecognized complication associated with high prenatal exposure to methylene blue and treatment with phototherapy. Methylene blue phototoxicity may be related to the high prenatal dose of the dye relative to patient's small size and young gestational age.

Phototherapy for Neonatal Nonhemolytic Hyperbilirubinemia

Phototherapy, an effective treatment for neonatal indirect hyperbilirubinemia, has guidelines for its initiation but none for its discontinuation. In our study, phototherapy was begun at a mean age of 90 hours in 28 full-term and 30 preterm infants with indirect nonhemolytic hyperbilirubinemia. After three days, phototherapy was halted at a mean bilirubin concentration of 13.0 +/- 0.7 mg/dL in term and 10.7 +/- 1.2 mg/dL in preterm infants, levels higher than those used by other investigators. Bilirubin rebound then occurred at a mean of 12.5 hours to a level of 0.86 +/- 1.0 mg/dL in term and at a mean of 14.1 hours to a level of 0.83 +/- 0.56 mg/dL in preterm infants. No complications were observed nor was there a need for reinstitution of phototherapy. Based on these data, discontinuation of phototherapy at higher bilirubin concentrations and earlier home discharge than previously described appear harmless for both term and preterm neonates.

9 PHENOBARBITAL CONTROL IN POSTPHOTOTHERAPY REBOUND

Two groups of term newborns with jaundice due to ABO incompatibility were studied to evaluate the action of phenobarbital in diminishing the postphototherapy rebound. Twenty newborns received only prototherapy (group A) and 20 phototherapy plus phenobarbital (group B). Group B received double treatment for 3 days. At that time phototherapy was discontinued mantaining the phenobarbital. The sample to evaluate bilirubinemia in both groups was taken 12-24 hours after discontinuation of phototherapy. RESULTS We conclude that phenobarbital was effective to avoid the postphototherapy rebound.

THE TEN COMMANDMENTS OF PHOTOTHERAPY

Thou shalt 1. Not use phototherapy prior to determination of etiology.1,2 2. Not use phototherapy in infants with direct hyperbilirubinemia (conjugated direct bilirubin level &amp;gt; 2 mg/100 ml).1,3 3. Not judge jaundice clinically in infants treated with phototherapy, but measure serum bilirubin level every 4 to 12 hours as indicated.1,2 4. Monitor temperature of infants placed under phototherapy initially every hour for the first four hours and thereafter every four to six hours.2,3 5. Weigh low-birth-weight infants receiving phototherapy twice daily. Increase their fluid intake above requirements by 2% to 10% depending on postnatal age, cardiac status, and whether the infant is under a radiant warmer or an adequately humidified incubator.1,3 6. Protect eyes with adequately designed patches. Turn off light and remove eye patches when parents are visiting.2,3 7. Monitor hematocrit value, particularly in hemolytic diseases.1,2 8. Watch for rebound of bilirubin level following discontinuation of phototherapy. Delay discharge by about 6 to 12 hours till rebound can definitely be ruled out.2 9. Change the lamps after 20% decrease of original irradiance output. Consult with the manufacturer of the individual lamps used, or energy output in the blue spectrum (425 to 475 mm) every 200 hours of use.1,2 10. Check all phototherapy units for proper electrical grounding.