Phototherapy In Newborns Research Articles

Mechanisms of Cardiovascular Changes of Phototherapy in Newborns with Hyperbilirubinemia.

During phototherapy of jaundiced newborns, vasodilation occurs in the skin circulation compensated by vasoconstriction in the renal and mesenteric circulation. Furthermore, there is a slight decrease in cardiac systolic volume, and blood pressure, as well as an increase in heart rate and discrete changes in the heart rate variability (HRV). The primary change during phototherapy is the skin vasodilation mediated by multiple mechanisms: 1) Passive vasodilation induced by direct skin heating effect of the body surface and subcutaneous blood vessels, modified by myogenic autoregulation. 2) Active vasodilation mediated via the mechanism provided by axon reflexes through nerve C-fibers and humoral mechanism via nitric oxide (NO) and endothelin 1 (ET-1). During and after phototherapy is a rise in the NO:ET-1 ratio. 3) Regulation of the skin circulation through the sympathetic nerves is unique, but their role in skin vasodilation during phototherapy was not studied. 4) Special mechanism is a photorelaxation independent of the skin heating. Melanopsin (opsin 4) - is thought to play a major role in systemic vascular photorelaxation. Signalling cascade of the photorelaxation is specific, independent of endothelium and NO. The increased skin blood flow during phototherapy is enabled by the restriction of blood flow in the renal and mesenteric circulation. An increase in heart rate indicates activation of the sympathetic system as is seen in the measures of the HRV. High-pressure, as well as low-pressure baroreflexes, may play important role in these adaptation responses. The integrated complex and specific mechanism responsible for the hemodynamic changes during phototherapy confirm adequate and functioning regulation of the neonatal cardiovascular system, including baroreflexes.

Efficacy of kangaroo mother care combined with neonatal phototherapy in newborns with non-pathological jaundice: A meta-analysis.

The kangaroo-mother care method (KMC) is a skin-to-skin contact-centered care approach with numerous benefits for neonates, but its impact on the treatment of jaundiced neonates is unknown. This study aimed to investigate the efficacy of KMC combined with neonatal phototherapy (NNPT) in treating neonates with non-pathological jaundice. Relevant articles were searched in PubMed, Embase, Web of Science, and Cochrane Library databases from database establishment to April 2022. The outcomes included, without limitation, serum bilirubin levels, and duration of phototherapy. This meta-analysis included five studies (4 randomized controlled trials and 1 observational study) involving four hundred eighty-two neonates with non-pathological jaundice. The results showed that the group receiving KMC combined with NNPT had lower serum bilirubin at 72 h after intervention [weighted mean difference (WMD) = -1.51, p = 0.03], shorter duration of phototherapy [standard mean difference (SMD) = -1.45, p < 0.001] and shorter duration of hospitalization (SMD = -1.32, p = 0.002) compared to NNPT group. There was no difference in peak bilirubin in both groups of neonates (WMD = -0.12, p = 0.62). KMC combined with NNPT helped to treat non-pathological jaundice in newborns compared to NNPT alone.

Cardiovascular changes during phototherapy in newborns.

Phototherapy is the most effective non-invasive method of neonatal hyperbilirubinemia treatment. Application of this method can be associated with side effects including changes in the cardiovascular system. During phototherapy, the primary effects in the cardiovascular system include cutaneous vasodilation leading to skin hyperperfusion and subsequent redistribution of blood. The increased blood flow through the skin is associated with increased transepidermal water loss. Further effects include an increase in cerebral blood flow. Redistribution of blood to the cutaneous bed is compensated by hypoperfusion in the splanchnic area (mostly postprandial) and a significant reduction of the renal blood flow. Regarding closure/reopening of the ductus arteriosus, the results suggest that that phototherapy does not affect ductal patency. During phototherapy the cardiac output can be slightly reduced due to a decreased stroke volume, especially in preterm newborns. Systemic blood pressure is decreased and heart rate is elevated in both preterm and term newborns during phototherapy. The heart rate variability is slightly reduced. Symbolic dynamics analysis of the short-term HRV showed that during phototherapy the activity of the ANS regulating the heart rate is shifted towards the dominancy of the sympathetic activity. The responses in the cardiovascular system of premature/mature newborns without other pathology confirm a well physiologically functioning control of this system, even under specific conditions of phototherapy.

Blue-Green (~480 nm) versus Blue (~460 nm) Light for Newborn Phototherapy—Safety Considerations

We have previously shown that the phototherapy of hyperbilirubinemic neonates using blue-green LED light with a peak wavelength of ~478 nm is 31% more efficient for removing unconjugated bilirubin from circulation than blue LED light with a peak wavelength of ~452 nm. Based on these results, we recommended that the phototherapy of hyperbilirubinemic newborns be practiced with light of ~480 nm. Aim: Identify and discuss the most prominent potential changes that have been observed in the health effects of phototherapy using either blue fluorescent- or blue LED light and speculate on the expected effects of changing to blue-green LED light phototherapy. Search the phototherapy literature using the terms neonate, hyperbilirubinemia, and phototherapy in the PubMed and Embase databases. Transitioning from blue fluorescent light to blue-green LED light will expose neonates to less light in the 400-450 nm spectral range, potentially leading to less photo-oxidation and geno-/cytotoxicity, reduced risk of cancer, and decreased mortality in extremely low-birthweight neonates. The riboflavin level may decline, and the increased production and retention of bronze pigments may occur in predisposed neonates due to enhanced lumirubin formation. The production of pre-inflammatory cytokines may rise. Hemodynamic responses and transepidermal water loss are less likely to occur. The risk of hyperthermia may decrease with the use of blue-green LED light and the risk of hypothermia may increase. Parent-neonate attachment and breastfeeding will be positively affected because of the shortened duration of phototherapy. The latter may also lead to a significant reduction in the cost of phototherapy procedures as well as the hospitalization process.

Correlation of the transcutaneous bilirubin and serum bilirubin levels measured before and after phototherapy in newborns: a prospective observational study

Aim: The purpose of the present study was to show the reliability of the transcutaneous bilirubin (TcB) measurement as an alternative method to total serum bilirubin (TSB) when starting treatment with phototherapy (PT), which is one of the most important treatment methods of hyperbilirubinemia as a very common practice in the neonatal period and eliminates the disadvantages of blood collection.&#x0D; Materyal and Method: Two measurements were made to evaluate whether there was a correlation between the total serum bilirubin and transcutaneous bilirubin level measurement for follow-up in newborns who were hospitalized and prospectively followed up in the Newborn Intensive Care Unit of Karabuk University Medical Faculty Training and Research Hospital between April 13 and June 30, 2022 (Level III Neonatal Center) who were scheduled for starting phototherapy. The primary result was the correlation between TcB and TSB at the first 24 hours and after, at the initiation of FT, termination of FT, and 12 hours after PT was discontinued.&#x0D; Results: The TSB and TcB values of the newborns ​​were measured at the beginning of PT, at the end of PT, and 12 hours after PT was ended. The first measurement values ​​were 11.60±5.16 and 10.72±4.02, respectively; the second measurement values ​​were 7.45±2.34 and 6.35±2.83, respectively; and the third measurement values ​​were 8.03±2.45 and 7.35±2.63 mg/dL, respectively. A strong positive correlation was found among all measurement values. Also, when the newborns who received FT for the first 24 hours were evaluated by subgrouping, the high correlation between TcB and TSB levels continued.&#x0D; Conclusion: The present study showed that there is a significant relationship between TcB taken from the covered skin and TSB at the start, end, and 12 hours after PT. Also, when the newborns who received PT for the first 24 hours were evaluated in a subgroup, it was found that TCB measurement predicted the TSB level at a high level before and after PT. Based on these findings, it was concluded that TcB measurement, including in the first 24 hours, is reliable in the follow-up of newborns receiving PT for the treatment of hyperbilirubinemia. However, we think that larger prospective controlled studies are required in this respect.

A study on effect of phototherapy in term new-born in a tertiary care centre in south Rajasthan

Background: Phototherapy is a safe and effective method for management of neonatal hyperbilirubinemia with no serious untoward side effects. Hypocalcemia is a common and lesser observed adverse effect of phototherapy.Methods: This study was a prospective observational study done in department of pediatrics, RNT Medical College, Udaipur (Rajasthan). Serum calcium level was observed in term neonates admitted for phototherapy.Results: Out of total 80 neonates included in study 40 received phototherapy and 40 were control. Neonates receiving phototherapy had significantly lower level of serum calcium. Other complication were rashes, loose stool, fever and dehydration.Conclusions: We can conclude from this study that hypocalcemia is a significant complication of phototherapy in newborn and probably monitoring of serum calcium level in babies under phototherapy is warranted.

Phototherapy for preterm newborns—historical controversies and RCT evidence

: The Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight randomized controlled trial (A-v-C RCT), published in 2008, was designed to address two long standing intertwined controversies about bilirubin and phototherapy in preterm newborns. The older controversy, dating from the 1950s, was whether ‘low’ bilirubin levels might cause CNS injury in preterm newborns. The newer and less well-known controversy began when scrutiny of the 1974–1976 NICHD Collaborative Phototherapy Trial revealed that the results were consistent with increased mortality risk in the phototherapy arm for ELBW newborns: relative risk (RR) 1.49, 95% CI: 0.93, 2.40. The results of the A-v-C RCT fueled rather than settled the controversy regarding safety of phototherapy for ELBW newborns: mortality was higher with aggressive phototherapy in the 501–750 g stratum, but the strength of the association was not strong enough that the evidence of causation would be considered indisputable (RR 1.13, 95% CI: 0.96, 1.34). By contrast, the A-v-C RCT essentially proved that mean peak total serum bilirubin (TSB) levels ~10 mg/dL (~171 mmol/L) can cause lasting CNS injury in ELBW newborns: RR 0.86 (95% CI: 0.74, 0.99) for neurodevelopmental impairment (NDI) with aggressive phototherapy and mean peak TSB 7.0±1.8 mg/dL versus 9.8±2.1 mg/dL with conservative phototherapy (120±31 versus 168±36 mmol/L). For profound NDI, the RR was 0.68 (95% CI: 0.52, 0.89), and by Bayesian analysis the probability that aggressive phototherapy reduced profound NDI was 0.99. A recently begun large multicenter RCT evaluating cycled phototherapy as a means to reduce exposure to phototherapy in newborns with birth weight <751 g or gestational age <27 weeks could resolve the mortality risk controversy.

Value of the Direct Antiglobulin Test in Predicting the Need for Phototherapy in Newborns.

PurposeGuidelines for managing neonatal hemolytic disease of the newborn (HDN) recommend a selective approach in the use of direct antiglobulin test (DAT). In Saudi Arabia, many hospitals still perform routine DAT for all newborns. This study assessed the need for phototherapy in relation to DAT results in full-term healthy newborns.Patients and MethodsA retrospective analysis of all healthy newborns admitted during 2018 was performed. The primary outcome was the association of positive DAT results with phototherapy.ResultsThere were 1463 newborns born during the study period. The DAT was positive at 4.4%. The 24-hour bilirubin levels were higher in DAT-positive cases (P=0.06); however, peak bilirubin levels were not correlated with the DAT results (P=0.717). Thirty-six neonates (2.46%) required phototherapy, and the need was similar among DAT-positive and DAT-negative cases (P=0.271). The most common indication for phototherapy was clinical jaundice in 22 neonates (61.1%), followed by DAT positivity in 12 (33.3%) and hospital protocol in 2 patients (5.6%) (P <0.01 by chi-square overall comparison).ConclusionOur results indicate that factors other than DAT positivity are important in assessing the need for phototherapy in newborns. Clinical signs of jaundice were indicators of high serum bilirubin levels and subsequent phototherapy, further indicating that the DAT test was overused in predicting the need for phototherapy.

Impacts of phototherapy on DNA damage and total oxidant/ antioxidant status in jaundiced newborns.

Bulut Ö, Dürüyen S. Impacts of phototherapy on DNA damage and total oxidant/antioxidant status in jaundiced newborns. Turk J Pediatr 2019; 61: 697-703. Jaundice is common in newborn babies, and pathologic hyperbilirubinemia is frequently treated with phototherapy. Although it is considered to be safe, the side effects of phototherapy in newborns are still a matter of debate. In this study, the impacts of two types of phototherapy, conventional fluorescence and intensive light-emitting diodes (LED), on DNA damage and total oxidant/ antioxidant status in jaundiced newborns were assessed. The study group included 40 newborns (gestation age ≥ 37 weeks) on days 2-8 after birth. Newborns were divided into two groups on the basis of need for phototherapy: 20 newborns were exposed to conventional phototherapy (Group I); and 20 infants were exposed to intensive phototherapy (Group II). Blood samples were taken from all infants at admission and after phototherapy to determine plasma 8-hydroxy-2-deoxy-guanosine (8-OH-dG; a marker of DNA damage), total oxidant status (TOS), and total antioxidant capacity (TAC). The oxidative stress index (OSI) was also calculated. Demographic information was recorded, and DNA damage, TOS, and TAC were compared. There were no differences in demographic information between the two groups. There were no significant differences in DNA damage, TOS, TAC, and OSI between Groups I and II before phototherapy (p > 0.05) and no significant differences in DNA damage, TOS, TAC, and OSI between the two groups after phototherapy (p > 0.05). However, the TAC decreased significantly in both groups after phototherapy (p < 0.01). These findings suggest that conventional and intensive phototherapies do not affect DNA damage and oxidative stress, supporting the safety of its use as the preferred treatment for jaundiced newborns.

Childhood Seizures After Phototherapy.

From 499 642 infants born at ≥35 weeks' gestation in 1995-2011 followed for ≥60 days, we excluded 1773 that exceeded exchange transfusion thresholds and 1237 with seizure diagnoses at <60 days. We ascertained phototherapy, covariates, and outcomes from electronic records and existing databases. Our primary outcome was ≥1 encounter with a seizure diagnosis plus ≥1 prescription for an antiepileptic drug. We used Cox and Poisson models to adjust for bilirubin levels and other confounding variables. A total of 37 683 (7.6%) infants received any phototherapy. The mean (SD) follow-up time was 8.1 (5.2) years. The crude incidence rate per 1000 person-years of the primary outcome was 1.24 among phototherapy-exposed children and 0.76 among those unexposed (rate ratio: 1.63; 95% confidence interval [CI]: 1.44 to 1.85). The adjusted hazard ratio (aHR) was 1.22 (95% CI: 1.05 to 1.42; P = .009). Boys were at higher risk of seizures overall (aHR = 1.18; 95% CI: 1.10 to 1.27) and had a higher aHR for phototherapy (1.33; 95% CI: 1.10 to 1.61) than girls (1.07; 95% CI: 0.84 to 1.37), although effect modification by sex was not statistically significant (P = .17). The adjusted 10-year excess risks per 1000 were 2.4 (95% CI: 0.6 to 4.1) overall, 3.7 (95% CI: 1.2 to 6.1) in boys, and 0.8 (95% CI: -1.7 to 3.2) in girls. Phototherapy in newborns is associated with a small increased risk of childhood seizures, even after adjusting for bilirubin values, and the risk is more significant in boys.

Efficacy of Subthreshold Newborn Phototherapy During the Birth Hospitalization in Preventing Readmission for Phototherapy

Treatment of jaundiced newborns with subthreshold phototherapy (phototherapy given to newborns with bilirubin levels below those recommended in American Academy of Pediatrics [AAP] guidelines) is common. However, the use of subthreshold phototherapy may have risks and increase costs, and, to date, it has not been systematically studied in newborns. To estimate the efficacy of subthreshold phototherapy for newborns with total serum bilirubin (TSB) levels from 0.1 to 3.0 mg/dL below the appropriate AAP phototherapy threshold during the birth hospitalization in preventing readmissions for phototherapy, and to identify predictors of readmission for phototherapy. Retrospective cohort study of 25 895 newborns born at 35 or more weeks' gestation, born in 1 of 16 Kaiser Permanente Northern California hospitals from January 1, 2010, through December 31, 2014, with at least 1 TSB level from 0.1 to 3.0 mg/dL below the appropriate AAP phototherapy threshold and not exceeding the threshold during the birth hospitalization. Data were analyzed from November 1, 2015, to November 28, 2017. Subthreshold phototherapy during the birth hospitalization. Readmission for phototherapy. Among 25 895 newborns with qualifying TSB levels from 0.1 to 3.0 mg/dL below the appropriate AAP phototherapy threshold, 4956 (19.1%) received subthreshold phototherapy and 241 of these (4.9%) were readmitted for phototherapy compared with 2690 of 20 939 untreated newborns (12.8%) (unadjusted odds ratio [OR], 0.35; 95% CI, 0.30-0.40). In a logistic regression model, adjustment for confounding variables, including gestational age, race/ethnicity, formula feedings per day, and the difference between the TSB level and the phototherapy threshold, strengthened the association (OR, 0.28; 95% CI, 0.19-0.40). Estimated numbers needed to treat ranged from 60.8 in the lowest quintile of predicted risk to 6.3 in the highest quintile. Newborns who received formula feedings had lower adjusted odds of readmission for phototherapy compared with exclusively breastfed newborns (OR, 0.58; 95% CI, 0.47-0.72 for >0 to <2 formula feedings per day; OR, 0.24; 95% CI, 0.21-0.27 for ≥6 formula feedings per day). Subthreshold phototherapy was associated with a 22-hour longer length of stay (95% CI, 16-28 hours). Subthreshold phototherapy during the birth hospitalization is effective in preventing readmissions for phototherapy; however, for each readmission prevented, many newborns require phototherapy who would otherwise not need it.

Effect of Chicory Extract Bath on Neonatal Bilirubin Levels: A Randomized Clinical Trial study

Objective: Jaundice is a common problem in infants, particularly premature infants (60-80%). The most common treatment of neonatal jaundice is phototherapy; however, traditional and complementary medicine is preferred due to complications of phototherapy in newborns. This study evaluates the effect of Chicory extract bath on bilirubin levels of infants with jaundice hospitalized in educational hospitals in Isfahan, Iran.Methods: This study was a double blind randomized clinical trial in which participants included 64 mature infants with neonatal jaundice admitted to the selected hospitals of Isfahan. The infants were randomly assigned to two groups receiving phototherapy (n=32), and phototherapy with bath with 500 cc of chicory extract prepared by hydroalcoholic method and made in Iran (n=32). The infants were bathed by trained nurse with chicory extract before phototherapy as well as 24 and 48 hours after phototherapy; then, the infants received phototherapy. During treatment, serum bilirubin was measured and recorded every 24 hours continuously. Control infants only received phototherapy; during treatment, serum bilirubin was measured and recorded every 24 hours.Results: The results showed no significant difference in mean bilirubin levels between the two groups on admission (P=0.37), while mean bilirubin level of phototherapy infants was significantly higher than that of infants receiving phototherapy and chicory extract bath in 24 hours after (P=0.014), and 48 hours after intervention (P=0.011).Conclusion: The results showed that chicory extract bath with phototherapy can be effective in reducing neonatal jaundice. Keywords: Bilirubin, Chicory extract, Infants, Jaundice, Phototherapy.

Hyperbilirubinemia and phototherapy in newborns: Effects on cardiac autonomic control

BackgroundNeonatal jaundice and its phototherapeutic treatment can lead to several side effects involving activation of autonomic control mechanisms. AimThe aims of this study are to investigate the autonomic nervous system changes in icteric neonates using heart rate variability (HRV) and to assess the effect of phototherapy on short-term heart rate dynamics as an indicator of autonomic nervous control of cardiovascular system. MethodsHRV recordings from 20 icteric full-term neonates before, during and after phototherapy and from 20 healthy controls were analyzed. In addition to traditional time and frequency domain measures, heart rate complexity parameters including normalized complexity index (NCI), normalized unpredictability index (NUPI), pattern classification indices (0V%, 1V%, 2LV%, 2UV%) and irreversibility index (P%) on four time scales were evaluated. All measures were derived from data segments of 1000 RR intervals. ResultsThe analysis revealed higher values of 1V%, 2LV%, and lower P% in neonates with hyperbilirubinemia compared to controls. While HRV magnitude did not change, mean heart rate increased during and after the phototherapy. Nonlinear analysis showed a decrease of complexity, unpredictability and pattern classification measures 2LV% and 2UV%. In contrast, 0V% and irreversibility index P% were increased during and at least 30min after phototherapy. ConclusionThe results suggest a shifted autonomic balance in icteric neonates compared to the controls and its further alterations during phototherapy. As the nonlinear HRV parameters are independent of the linear methods, they can provide new information about the cardiac regulatory mechanisms and their changes in neonates.

Efficacité et tolérance des immunoglobulines polyvalentes dans l’hyperbilirubinémie néonatale par incompatibilité ABO. Méta-analyse

ABO fetomaternal red blood cell incompatibility (ABO FMI) induces an immune hemolysis after fetal transfer of hemolyzing maternal anti-A or anti-B. ABO hemolytic disease (ABO HD) remains the most frequent cause of severe and early jaundice in newborns. High levels of unconjugated hyperbilirubinemia may induce acute and chronic neurological complications. Severe hyperbilirubinemia can be prevented by first-line phototherapy (PT) treatment, but exchange transfusion (ET) is required if treatment is not effective, even if ET is linked with high hemodynamic, infectious, gastrointestinal, and/or biological morbidity. Intravenous human polyclonal immunoglobulins (IVIg) have been proposed in concomitant use with PT in order to avoid the requirement for ET in ABO FMI. Electronic databases of all published clinical trials in neonatal hyperbilirubinemia due to ABO incompatibility were systematically queried for randomized controlled clinical trials comparing PT alone to PT associated with IVIg based on the requirement for ET. Duration of PT and adverse events were optional criteria. A meta-analysis of the selected data was performed on six selected trials out of 28 found. IVIg doses ranged from 0.5 to 1.5 g/Kg in one to three administrations. Requirement for ET was lower in the IgIV+PT group, with a relative risk of 0.27 [CI 95% 0.17-0.42; P<0.00001], expressed as a number needed to treat of five neonates to avoid one ET. The mean duration of PT was 4 days in the PT group and association of PT with IVIg significantly reduced the duration of PT treatment by 0.84 days. The tolerance of the IVIg and PT association was good with no reported cases of ulcerative enterocolitis in 265 treated newborns. IVIG associated with PT reduces the need for ET and the duration of PT in newborns with hyperbilirubinemia due to ABO hemolytic disease. Their efficacy and good tolerance prompt consideration of IVIg as a therapeutic adjuvant to PT in severe hemolytic hyperbilirubinemia due to ABO incompatibility.

The Value of Transcutaneous Bilirubin Measurement from a Protected Forehead Skin during Phototherapy in Newborns with Neonatal Hyperbilirubinemia

The Value of Transcutaneous Bilirubin Measurement from a Protected Forehead Skin during Phototherapy in Newborns with Neonatal Hyperbilirubinemia

Evaluating the efficacy of phototherapy devices

The field of newborn phototherapy (PT) has clearly arrived at a strategic period of transition from the use of traditional light sources, such as fluorescent, halogen and halogen/fiberoptic, towards the use of presently fast developing, versatile solid state light emitting diode (LED) technology. The time also appears to be ripe for the replacement of ineffective, defective, and worn-out devices that deliver inadequate therapy, as has been demonstrated through recent surveys in India, Nigeria, and Brazil [1-3]. Because of a rapidly expanding global market for PT devices, the medical device industry, particularly in India, appears to be actively engaged in the production of newer and, undoubtedly, more effective and affordable LEDbased devices.

Efficacy of Double and Triple Phototherapy in Term Newborns With Hyperbilirubinemia: The First Clinical Trial

Icterus is the most common medical problem in neonates and phototherapy is the standard treatment for neonatal hyperbilirubinemia. This study aimed to compare the efficacy and length of hospital stay of double and triple phototherapy in newborns with indirect hyperbilirubinemia. In a clinical trial, 40 healthy term newborns (gestational age >37 weeks) with bilirubin > or =12 and > or =15 mg/dL in the second and third day, respectively, were randomly assigned to triple (n=20) or double phototherapy (n=20) groups. Total and direct serum bilirubin were measured at admission, 8, 16, and 24 hours after beginning of phototherapy, and every 12 hours thereafter until discharge (when bilirubin levels reached < or =10 mg/dL). There were 21 male (52%) and 19 female (48%) term neonates, with significant difference between patients' age, weight, and age of icterus. There was no significant difference in the rate of bilirubin decline between the two groups within the first 8, 16 and 24 hours. There was no significant difference in mean length of hospital stay between the two groups. Analysis of complications showed no difference between triple and double groups. Triple phototherapy failed to reduce total serum bilirubin and shorten length of hospitalization more rapidly than double phototherapy.

A chromosomal-effect study of intensive phototherapy versus conventional phototherapy in newborns with jaundice

In this study, we aimed to make a comparison between chromosomal effects caused by conventional phototherapy and intensive phototherapy in jaundiced newborns. The study group included 83 newborns with gestation age of ≥35 weeks, and on days 3–10 after birth. Newborns were divided into four groups on the basis of total serum bilirubin (TSB) levels upon admission and need for phototherapy. The intensive group ( n = 19) consisted of newborns who received light-emitting diode (LED) phototherapy, the conventional group ( n = 23) consisted of newborns who received conventional phototherapy, the jaundiced control group ( n = 21) consisted of newborns whose TSB levels were higher than 10 mg/dL (average = 13.7 ± 1.5 mg/dL) on admission and who did not receive phototherapy, and the non-jaundiced control group ( n = 20) consisted of newborns whose TSB levels were less than 5 mg/dl (average = 3.6 ± 0.8 mg/dL). TSB level of the intensive group at admission was 20.2 ± 1.3 mg/dL, whereas the level of conventional group was 19.6 ± 1.5 mg/dL. Blood samples were taken from all infants on admission to determine sister chromatid exchange (SCE 1) frequency. Blood sampling was repeated on discharge (SCE 2) of infants who had received phototherapy. Demographic information, hospitalization details and the rate of decline in TSB were recorded, and frequencies of SCE 1 and SCE 2 were compared. There was no difference in demographic information among the four groups. SCE 1 frequencies in 50 metaphases were evaluated in the intensive, conventional, jaundiced control and non-jaundiced control groups, and the SCE 1 frequency was determined as 9.37/cell, 9.54/cell, 9.23/cell and 6.17/cell, respectively. The SCE 1 frequency of the jaundiced groups (intensive, conventional and newborns-with-jaundice control group) was significantly higher than that in the non-jaundiced control group ( p = 0.001). There was no significant difference between the intensive group and the conventional group in SCE 2 frequency (13.5/cell vs 13.55/cell, p = 0.39). SCE 2 frequency was higher than SCE 1 frequency in both the intensive and conventional groups ( p = 0.001). A strong correlation was found between admission TSB and SCE 1 frequency ( p = 0.001; r = 0.79). The rate of decline in TSB was higher in the intensive group compared with the conventional group (0.26 mg/(dL h) vs 0.14 mg/(dL h); p = 0.001). We found that intensive and conventional phototherapies similarly increase SCE frequency in newborns. There was a strong, positive correlation between the TSB-on-admission level and SCE 1 frequency. In the light of this study, we may conclude that intensive and conventional phototherapies may have an effect on chromosomes in jaundiced newborns. TSB levels higher than 10 mg/dL are, too, reported hazardous on chromosomes. Further studies are warranted to elucidate this relationship.

Development of an eye protector for phototherapy on newborns: a technology

Hyperbilirubinemia results from the predisposition of newborns to produce bilirubin and their ability to excrete it. The treatment applied is phototherapy; however, one of its complications is degeneration of the retina by exposure to light, making it essential to provide proper eye protection. The objective of this study is to describe the development of an invention (utility model patented) for eye protection in newborn phototherapy. This invention aims to replace the current widespread practice of using improvised means that are uncomfortable for the baby and disrupt the mother/child relationship. A study was made of the radiances emitted by light sources used in phototherapy. The invention consists of an eye protector model for use during the newborn's phototherapy, allowing greater closeness between mother and baby. The device is easy to use, economical, removable and appropriate for newborns, causing no discomfort, and its effectiveness has been proved through radiance tests.

Control of Jaundice in Preterm Newborns by an Inhibitor of Bilirubin Production: Studies With Tin-Mesoporphyrin

Studies in vitro, in animal models, and in adult and newborn humans have demonstrated that certain tin(Sn)-porphyrins that competitively inhibit the activity of heme oxygenase, the rate-limiting enzyme in heme catabolism, reduce production of bilirubin and can thereby substantially diminish plasma levels of the bile pigment. To assess the effectiveness of increasing doses of the heme oxygenase inhibitor, Sn-mesoporphyrin (SnMP), in moderating the development of significant hyperbilirubinemia and thus the requirements for phototherapy in preterm newborns. In five randomized, blinded, placebo-controlled trials, SnMP in increasing doses from 1 mumol to 6 mumol/kg body weight was administered intramuscularly in the first 24 hours of life in preterm newborns of 210 to 251 days gestational age. "Special blue" lamps (Phillips F20T12/BB) were used for phototherapy in newborns exceeding a predetermined plasma bilirubin concentration, irrespective of study group. A total of 517 newborns were randomized in the five trials carried out sequentially over a 4-year period. SnMP in a dose-related manner significantly ameliorated the course of hyperbilirubinemia in the treated newborns of all gestational ages. With a SnMP dose of 6 mumol/kg body weight, the mean peak incremental plasma bilirubin concentration was reduced by 41% and the phototherapy requirements were decreased by 76% compared to control subjects. Erythema observed in a few SnMP-treated newborns who required phototherapy was mild, transient, and without sequelae. No other untoward effects were observed during hospitalization or at a follow-up at post-term age of 3 and 18 months. SnMP, by inhibiting the production of bilirubin, substantially moderates the development of hyperbilirubinemia in preterm newborns. This compound and similarly acting enzyme inhibitors merit further clinical study as agents for controlling neonatal hyperbilirubinemia, particularly in neonatal populations for whom other treatment modalities are not available.