Phototherapy In Infants Research Articles

Validity of transcutaneous bilirubin measurements during and after phototherapy in term and late preterm infants.

The application of in-house, photo-opaque patches enhanced the correlation and agreement between TcBC and TSB during and after discontinuation of phototherapy. This may prove particularly useful in resource-limited settings where commercial devices are unavailable. • Transcutaneous bilirubin measurement has been widely used as a screening method for neonatal hyperbilirubinemia. • The accuracy of transcutaneous bilirubin measurements during and after phototherapy in infants with hyperbilirubinemia has been debated. • Our study demonstrated that utilizing carefully designed photo-opaque patches enhanced the accuracy of transcutaneous bilirubin measurement during and after phototherapy. • Effective in-house alternatives are crucial in resource-limited settings where commercial opaque patches are not always accessible or affordable.

Investigation of EEG changes before and after phototherapy in infants with severe hyperbilirubinemia.

Despite the known effect of hyperbilirubinemia in neonates, the effect of phototherapy on electroencephalography (EEG) remains unknown. Therefore, we aimed to determine the alteration of electroencephalography in infants with hyperbilirubinemia before and after phototherapy. This cross-sectional study was performed on infants of≥35 weeks of gestation with hyperbilirubinemia. Information including age, sex, birth weight, hemoglobin levels, and treatment measures was recorded. In all studied infants, an EEG was performed before (in the first eight hours of hospitalization) and after treatment (after phototherapy or blood transfusion). The required duration of phototherapy, hospitalization and adverse effects were assessed then EEG of the neonates was compared before and after treatment. A total of 52 infants (44% female and 56% male) were included in this study. Mean gestational age, weight, and bilirubin were 38.6±1.53 weeks, 3150±625 g, and 23.87±4.36 mg/dl, respectively. The most common findings before phototherapy were Frontal Theta (21 patients, 40.4 percent) and Delta Brush (14 patients, 26.9%), while the most common findings after phototherapy were Frontal Theta (20 patients, 38.5%) and Delta Brush (19 patients, 36.5%). Mean±SD of bilirubin in infants with and without Delta Brush was 21.30±1.67 mg/dl and 19.95±0.94 mg/dl, respectively. Hyperbilirubinemia in newborns may be linked to altered EEG findings. After phototherapy, the Frontal theta was reduced, but the Delta brush was intensified. Bilirubin levels were higher in infants with Delta Brush in their EEG compared to infants without this finding.

Intravenous Immunoglobulin Use in Hemolytic Disease Due to ABO Incompatibility to Prevent Exchange Transfusion.

IntroductionIntravenous immunoglobulin (IVIG) has been widely used to treat the hemolytic disease of the newborn (HDN). Although it has been shown that IVIG treatment reduces the duration of phototherapy and hospitalization, the use of IVIG in hemolytic disease due to ABO incompatibility has been controversial in recent years. This study aimed to investigate the role of IVIG in the prevention of exchange transfusion in infants with ABO HDN who presented with bilirubin levels at or above the level of exchange transfusion.Materials and MethodsThis study evaluated the data of infants with ABO HDN in the Turkish Neonatal Jaundice Online Registry. The infants with ABO HDN who met the total serum bilirubin level inclusion criteria (within 2–3 mg/dL of exchange transfusion or even above exchange transfusion level) were included in the study according to the guidelines from the American Academy of Pediatrics and the Turkish Neonatal Society. All patients were managed according to the unit protocols recommended by these guidelines and received light-emitting diode (LED) phototherapy. Infants who only received LED phototherapy, and who received one dose of IVIG with LED phototherapy were compared.ResultsDuring the study period, 531 term infants were included in the study according to inclusion criteria. There were 408 cases in the phototherapy-only group, and 123 cases in the IVIG group. The demographic findings and the mean bilirubin and reticulocyte levels at admission were similar between the groups (p > 0.05), whereas the mean hemoglobin level was slightly lower in the IVIG group (p = 0.037). The mean age at admission was earlier, the need for exchange transfusion was higher, and the duration of phototherapy was longer in the IVIG group (p < 0.001, p = 0.001, and p < 0.001, respectively). The rate of re-hospitalization and acute bilirubin encephalopathy (ABE) was higher in the IVIG group (p < 0.001 and p = 0.01, respectively).ConclusionIn this study, we determined that one dose of IVIG did not prevent an exchange transfusion nor decrease the duration of phototherapy in infants, who had bilirubin levels near or at exchange transfusion level, with hemolytic disease due to ABO incompatibility.

Efficacy and safety of probiotics in neonatal hyperbilirubinemia: Randomized controlled trial

IntroductionThere have been many studies evaluating the role of probiotics in the management of necrotizing enterocolitis (NEC), yet few studies related to the role of probiotics in the management of neonatal jaundice. The purpose of this study was to determine the efficacy and safety of utilizing probiotics in the management of neonatal hyperbilirubinemia. MethodsThis study was a single blinded randomized clinical trial conducted on 2–28 day old term and near-term infants (35–42 weeks gestational age) that were hospitalized with neonatal jaundice in Bandar Abbas, Iran in 2016. The primary outcome of this study was to evaluate the duration of hospitalization in neonates with neonatal jaundice. Secondary outcomes were to determine the percentage of infants who needed phototherapy on the 2nd, 3rd, 4th, and 5th days of admission. Data were analyzed by SPSS software and descriptive statistics and Chi-square and independent samples t-test. ResultsOne hundred and twenty-six (126) breastfed infants were enrolled in this study and randomly assigned to one of two groups. The non-probiotic group included 61 (48.4%) patients and the probiotic group included 65 (51.6%) patients. Duration of hospitalization was 3.10 ± 0.569 days in the non-probiotic group versus 3 ± 0.901 in the probiotic group (p = 0.469). The percentage of patients discharged in the probiotic group was significantly higher in comparison to the non-probiotic group on the 3rd day of admission (p = 0.008) and Discharged early. The percentage of patients discharged were similar between the two groups on the 2nd, 4th, and 5th days of admission (p > 0.05). ConclusionProbiotics are not effective in lowering the duration of phototherapy in infants with hyperbilirubinemia. Although probiotics can increase the rate of discharge on the 3rd day of admission in infants with neonatal hyperbilirubinemia, the rate of hospital discharge was not different in the probiotic and non-probiotic groups on the 2nd, 4 th, and 5 th days of admission. ClinicalTrials.gov Identifier: NCT03266913.

Sunlight for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates.

Sunlight for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates.

898 Delayed cord clamping does not increase need for phototherapy in infants of women with diabetes

898 Delayed cord clamping does not increase need for phototherapy in infants of women with diabetes

Challenges of phototherapy for neonatal hyperbilirubinemia (Review).

Phototherapy is universally recognized as the first option for treating neonatal jaundice due to its unparalleled efficiency and safety in reducing the high serum free bilirubin levels and limiting its neurotoxic effects. However, several studies have suggested that phototherapy may elicit a series of short- and long-term adverse reactions associated with pediatric diseases, including hemolysis, allergic diseases, DNA damage or even cancer. The aim of the present review was to summarize the etiology, mechanism, associated risks and therapeutic strategies for reducing high neonatal serum bilirubin levels. In order to shed light on the negative effects of phototherapy and to encourage implementation of a reasonable and standardized phototherapy scheme in the clinic, the present review sought to highlight the current understanding of the adverse reactions of phototherapy, as it is necessary to further study the mechanism underlying the development of the adverse effects of phototherapy in infants in order to explore novel therapeutic alternatives.

Bilirubin/albumin (B/A) ratios correlate with unbound bilirubin levels in preterm infants.

A strong correlation between the bilirubin/albumin (B/A) ratio and unbound bilirubin (UB) levels in newborns ≥35 weeks of gestation has been reported. However, in preterm infants, the usefulness of B/A ratios remains unclear. We obtained serum from 381 newborns <35 weeks of gestation. UB levels were measured using the glucose oxidase-peroxidase method. Total serum bilirubin (TB) and albumin (Alb) concentrations were measured spectrophotometrically. Samples were then stratified into two groups based on the infant's phototherapy use. B/A ratios were calculated and correlated with UB levels. Samples taken from infants prior to or never receiving phototherapy (No PTx) were then stratified by gestational age (GA) epochs: 22-27, 28-29, 30-31, and 32-34 weeks and B/A ratios correlated with UB levels. B/A ratios significantly correlated with UB levels in samples from the No PTx cohort (n = 1250; y = 1.83x - 0.15, r2 = 0.93) when compared with samples from infants post-phototherapy (Post-PTx, n = 2039; y = 1.05x + 0.09, r2 = 0.69). Even when stratified by GA, the correlation remained. In preterm infants <35 weeks of gestation, B/A ratios correlated with UB levels better in infants prior to or never receiving phototherapy than in those infants receiving phototherapy. The bilirubin/albumin (B/A) ratio significantly correlates with unbound bilirubin (UB) levels in preterm infants <35 weeks of gestation. The B/A ratio can be used as an index of UB levels in preterm infants <35 weeks of gestation. The B/A ratio is useful, especially when UB measurements are not available, for managing hyperbilirubinemia in preterm infants.

Optimizing timing of bilirubin screening the Neonatal Intensive Care Unit

Background Treatment of neonatal indirect hyperbilirubinemia with phototherapy is necessary for the prevention of kernicterus. Guidelines for the use of phototherapy in infants born at ≥35 weeks’ gestation were published by Bhutani, et al and endorsed by the American Academy of Pediatrics. Consensus-based recommendations for phototherapy treatment and exchange transfusion of premature infants were published in 2012 by Maisels, et al. However, there are no published recommendations for the timing of screening for hyperbilirubinemia in NICU patients. In 2012, our Neonatology Division implemented internal guidelines for phototherapy with recommendations for timing of screening serum bilirubin levels, based on the group’s consensus. Five years later, we queried whether these guidelines for screening were …

Increased risk of hemangioma after exposure to neonatal phototherapy in infants with predisposing risk factors.

To determine the relationship between neonatal phototherapy and future risk of clinically significant hemangioma. We analysed a cohort of 678879 infants born after 34weeks gestation comprising 3975242 person-years of follow-up over 11years (2006-2016). The exposure was phototherapy the first 28days of life. The outcome was hemangioma that required in-hospital treatment during follow-up. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of phototherapy with risk of hemangioma, accounting for preterm birth, low birthweight and congenital anomalies. The incidence of hemangioma was greater in neonates who received phototherapy than in untreated infants, but there was no association in adjusted models (HR 1.19, 95% CI 0.89-1.58). Risk of hemangioma was elevated in infants who received phototherapy and were born late preterm (HR 2.35, 95% CI 1.51-3.64), with low birthweight (HR 1.91, 95% CI 1.12-3.24), or with anomalies (HR 5.09, 95% CI 3.42-7.58). Without phototherapy, these three risk factors were more weakly associated with hemangioma. Neonatal phototherapy in infants with predisposing risk factors may increase the chance of hemangioma, but confirmation in further studies is needed.

Effects of Soybean Lipid Infusion on Unbound Free Fatty Acids and Unbound Bilirubin in Preterm Infants

To assess the effects of a soybean lipid emulsion infusions on levels of unbound (free) bilirubin (Bf) and unbound free fatty acids (FFAu) as well as changes in Bf and total serum bilirubin (TSB) during phototherapy in infants born preterm. Ninety-seven infants born preterm (birth weight: 500-2000 g; gestational age: 23-34 weeks) were enrolled to investigate the effect of 0, 1, 2, and 3 g/kg/d of intralipid infusion on Bf and FFAu. Pre- and postphototherapy TSB, FFAu, and Bf also were analyzed in 91 infants to assess the effects of phototherapy. FFAu levels were measured with the fluorescent probe ADIFAB2 and Bf by the fluorescent Bf sensor BL22P1B11-Rh during intralipid infusion and at start and end of phototherapy. TSB and plasma albumin were measured by the diazo and bromcresol green techniques, respectively. Bilirubin-albumin dissociation constants were calculated based on Bf and plasma albumin. Bf and FFAu increased with increasing intralipid dosage across all gestational ages. TSB and Bf were correlated significantly when infants received 0 or 1 g/kg/d of intralipid but not at greater doses of intralipid (2 and 3 g/kg/d). Although phototherapy effectively reduced both TSB and Bf in the total phototherapy group (by 32% and 12%, respectively), it reduced TSB, but not Bf, in infants less than 28 weeks of gestation. Increasing intralipid doses result in increasing FFAu levels, which are associated with increased Bf independent of TSB. In infants born extremely preterm (<28 weeks of gestation), phototherapy effectively reduces TSB but not Bf.

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

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.

Blue Light and Ultraviolet Radiation Exposure from Infant Phototherapy Equipment

Phototherapy is the use of light for reducing the concentration of bilirubin in the body of infants. Although it has become a mainstay since its introduction in 1958, a better understanding of the efficacy and safety of phototherapy applications seems to be necessary for improved clinical practices and outcomes. This study was initiated to evaluate workers’ exposure to Optical Radiation from different types of phototherapy devices in clinical use in Italy.During infant phototherapy the staff monitors babies periodically for around 10 min every hour, and fixation of the phototherapy beam light frequently occurs: almost all operators work within 30 cm of the phototherapy source during monitoring procedures, with most of them commonly working at ≤25 cm from the direct or reflected radiation beam.The results of this study suggest that there is a great variability in the spectral emission of equipments investigated, depending on the types of lamps used and some phototherapy equipment exposes operators to blue light photochemical retinal hazard.Some of the equipment investigated presents relevant spectral emission also in the UVA region. Taking into account that the exposure to UV in childhood has been established as an important contributing factor for melanoma risk in adults and considering the high susceptibility to UV-induced skin damage of the newborn, related to his pigmentary traits, the UV exposure of the infant during phototherapy should be “as low as reasonably achievable,” considering that it is unnecessary to the therapy. It is recommended that special safety training be provided for the affected employees: in particular, protective eyewear can be necessary during newborn assistance activities carried out in proximity of some sources. The engineering design of phototherapy equipment can be optimized. Specific requirements for photobiological safety of lamps used in the phototherapy equipment should be defined in the safety product standard for such equipment.

Does the LATCH Score Assessed in the First 24 Hours After Delivery Predict Non-Exclusive Breastfeeding at Hospital Discharge?

The aims of this study were to analyze the relationship between the LATCH score assessed in the first 24 hours after delivery and non-exclusive breastfeeding at discharge and to identify a cutoff for the LATCH score in order to identify women with higher risk of non-exclusive breastfeeding who may need additional breastfeeding support. We conducted a prospective observational study in the Maternity Ward of the Institute for Maternal and Child Health "Burlo Garofolo" (Trieste, Italy) and collected data from 299 mother-infant dyads. The rate of nonexclusive breastfeeding was inversely related to the LATCH score (p<0.001) with non-exclusive breastfeeding infants scoring less (6.9) than infants exclusively breastfed at discharge (7.6) (p=0.001). In multivariate analysis, non-exclusive breastfeeding was also associated with cesarean section, primiparity, and infant phototherapy. In order to support maternity staff in providing targeted interventions, we identified four LATCH score cutoffs associated with as many risk groups for non-exclusive breastfeeding at discharge. The LATCH score is a useful tool to identify mother-infant pairs who might benefit from additional skilled support in specific subgroups at risk of non-exclusive breastfeeding at discharge. Future research is needed to explore if the LATCH score assessed in the first days of life can also predict the duration of breastfeeding.

The effect of kangaroo mother care on the duration of phototherapy of infants re-admitted for neonatal jaundice

Objective: We investigated the effect of kangaroo mother care (KMC) on the duration of phototherapy of jaundiced neonates. Methods: Fifty Egyptian newborns hospitalized for jaundice were investigated through a prospective observational study to determine whether intermittent KMC would reduce the duration of phototherapy required. Results: The babies who received KMC recovered earlier from jaundice and needed a shorter duration of phototherapy than the control group (68.14 ± 24.32 hour versus 100.86 ± 42.26 hour, p = 0.004). Conclusion: KMC may be an effective intervention to reduce the duration of phototherapy needed when jaundiced babies are hospitalized.

432 Effect of Infants' Position on Serum Bilirubin Level During Concentional Phototherapy

Background: Alternating exposure of front and back of infants during phototherapy is widely practiced.Aim: Compare rate of decline in total serum bilirubin concentration (TSB) during phototherapy in infants treated in supine position throughout versus infants alternating between supine and prone position every 3 h. Further, survey current practice in two Scandinavian countries.Methods: 112 infants with gestational age above 32 weeks, healthy except for non-haemolytic hyperbilirubinaemia, were randomised to one of the treatment groups. TSB was measured at start-up and after 12 and 24 h of therapy. Transcutaneous bilirubin concentration (TcB) was measured midsternum in a subgroup of 10 infants including both groups. A questionnaire about routines for position changes during phototherapy was send to all 41 neonatal departments in Denmark and Norway.Results: No significant differences in decline of TSB were observed between the two treatment groups: After 12 h of therapy TSB had decreased 32% in both groups and after 24 h 49% and 50%, respectively. TcB decreased rapidly during the first 150 min of treatment and approached a plateau at 35% of the initial level. In two thirds of Danish and Norwegian departments infants were routinely turned during phototherapy, most often every 3rd h.Conclusion: No difference in the decrease of TSB was observed wheather the infants were turned during phtotherapy or treated in supine position throughout. An explanation for this lack of effect of turning infants might be that photobilirubins are mainly produced in the intravascular space. Alternating exposure during phototherapy is widely practiced in Scandinavia.

Effect of infants’ position on serum bilirubin level during conventional phototherapy

To compare the decrease in total serum bilirubin (TSB) concentration during conventional phototherapy in infants treated in supine position exclusively versus infants alternated between exposure in supine and prone position every third hour. Moreover, to survey current practice patterns in two Scandinavian countries as far as alternating exposure. A total of 112 infants with non-haemolytic hyperbilirubinaemia, but otherwise healthy, and a gestational age > or =33 weeks were randomized to one of the treatment groups. All infants received phototherapy for 24 h. TSB was measured at start of phototherapy and after 12 and 24 h of treatment. Questionnaires about routines for position changes in infants during phototherapy were sent to all 41 neonatal departments in Denmark and Norway. No statistically significant differences in the decrease in TSB were observed between the two treatment groups: at 12 h of therapy, TSB decreased 32% in both groups and at 24 h 49% and 50%, respectively. In two-thirds of Danish and Norwegian departments, the infants were routinely turned during phototherapy, most often every third hours. The decrease in TSB was not significantly associated with positioning of the infant during conventional phototherapy. Alternating exposure is widely practiced in Scandinavia but is unnecessary.

Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight