Phototherapy For Neonatal Jaundice Research Articles

Efficacy of phototherapy for neonatal jaundice is increased by the use of low-cost white reflecting curtains

Efficacy of phototherapy for neonatal jaundice is increased by the use of low-cost white reflecting curtains

Efficacy of phototherapy for neonatal jaundice is increased by the use of low-cost white reflecting curtains

Efficacy of phototherapy for neonatal jaundice is increased by the use of low-cost white reflecting curtains

Efficacy of phototherapy for neonatal jaundice is increased by the use of low-cost white reflecting curtains

Objective: To determine whether the addition of low-cost reflecting curtains to a standard phototherapy unit could increase effectiveness of phototherapy for neonatal jaundice. Design: Randomised controlled clinical trial. Setting: Level-one...

Conical intersection in a bilirubin model – A possible pathway for phototherapy of neonatal jaundice

Phototherapy of neonatal jaundice involves Z– E-isomerisation around an exocyclic double bond in bilirubin. Our results of a CASSCF study on dipyrrinone, a bilirubin model, show a conical intersection between the ground and first excited singlet states associated with the Z– E-isomerisation. The conical intersection, located ca. 50 kJ/mol below the Franck–Condon-point, together with the S 1 minimum, ca. 50 kJ/mol below the conical intersection, are able to explain the available time-resolved spectroscopic data (the very short lifetime of the initially excited state and transient ‘dark state’ intermediate) as well as bilirubin’s very low fluorescence quantum yield and the medium-efficient photoisomerisation reaction.

Usefulness of the transcutaneous bilirubinometer during phototherapy in neonatal jaundice

Purpose:We studied the usefulness of transcutaneous bilirubinometers in follow-up of bilirubin levels during phototherapy in neonatal jaundice patients. Methods:Transcutaneous bilirubin (TcB) was measured twice per day on 90 neonatal jaundice patients without risk factors of jaundice by transcutaneous bilirubinometer JM-103(Minolta/Hill-Rom Air-shields, Japan). TcB was measured simultaneously on the patched-forehead (TcB-PF), patched- chest(TcB-PC), unpatched-forehead (TcB-UF) and unpatched-chest (TcB-UC) of infants with neonatal jaundice. Plasma bilirubin (PB) was measured by American Optical bilirubinometer (American Optical Co, Buffalo, USA) within 30 minutes after transcutaneous bilirubinometer measurement. Each TcB was compared with PB. Results:In the study group, the mean gestational age was 38.6±1.3 wk, the mean birthweight was 3,207.0±472.1 g, the mean age at start of phototherapy was 4.9±0.9 days and the mean duration of phototherapy was 1.3±0.6 days. The correlation between TcB and PB level was observed. The correlation between TcB of the patched part (TcB-PF, TcB-PC) and PB was more significant than that of the unpatched part (TcB-UF, TcB-UC) and PB. The most significant correlation was between PB and TcB-PC. Conclusion:TcB was useful in the follow-up of jaundice during phototherapy as well the screening of jaundice in neonatal jaundice patients. TcB of patched-chest area was the most reliable site in transcutaneous bilirubinometer examination in neonatal jaundice patients

In vitro and in vivo Efficacy of New Blue Light Emitting Diode Phototherapy Compared to Conventional Halogen Quartz Phototherapy for Neonatal Jaundice

High intensity light emitting diodes (LEDs) are being studied as possible light sources for the phototherapy of neonatal jaundice, as they can emit high intensity light of narrow wavelength band in the blue region of the visible light spectrum corresponding to the spectrum of maximal bilirubin absorption. We developed a prototype blue gallium nitride LED phototherapy unit with high intensity, and compared its efficacy to commercially used halogen quartz phototherapy device by measuring both in vitro and in vivo bilirubin photodegradation. The prototype device with two focused arrays, each with 500 blue LEDs, generated greater irradiance than the conventional device tested. The LED device showed a significantly higher efficacy of bilirubin photodegradation than the conventional phototherapy in both in vitro experiment using microhematocrit tubes (44±7% vs. 35±2%) and in vivo experiment using Gunn rats (30±9% vs. 16±8%). We conclude that high intensity blue LED device was much more effective than conventional phototherapy of both in vitro and in vivo bilirubin photodegradation. Further studies will be necessary to prove its clinical efficacy.

Phototherapy for neonatal jaundice-still in need of fine tuning

Acta PaediatricaVolume 89, Issue 7 p. 770-772 Phototherapy for neonatal jaundice–still in need of fine tuning TWR Hansen, TWR Hansen Section on Neonatology, Department of Pediatrics, Rikshospitalet, Oslo, Norway (Tel. +47 2307 4573, fax. +47 2307 2960, e-mail. t.w.r.hansen@klinmed.uio.no)Search for more papers by this author TWR Hansen, TWR Hansen Section on Neonatology, Department of Pediatrics, Rikshospitalet, Oslo, Norway (Tel. +47 2307 4573, fax. +47 2307 2960, e-mail. t.w.r.hansen@klinmed.uio.no)Search for more papers by this author First published: 02 January 2007 https://doi.org/10.1111/j.1651-2227.2000.tb00382.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume89, Issue7July 2000Pages 770-772 RelatedInformation

Phototherapy for neonatal jaundice - still in need of fine tuning

Phototherapy for neonatal jaundice - still in need of fine tuning

Home phototherapy for neonatal jaundice--technology and teamwork meeting consumer and service need.

32 babies with uncomplicated physiological jaundice received home phototherapy from a hospital/community team in southern Brisbane. All babies showed acceptable reductions in their serum bilirubin on home therapy, and none required hospital re-admission for phototherapy. Their families were highly satisfied with the home program, and recorded high levels of confidence in their therapeutic responsibilities. Community providers were able to deliver a high quality 24-hour service, integrated with appropriate neonatology support. The cost of delivering the home program was significantly less than a comparable hospital stay.

A New Photoisomerization of Bilirubin

Photoirradiation of solutions of natural (4Z,15Z)-bilirubin-IX alpha in chloroform with approximately 366 nm UV light leads rapidly to a new photoisomer that has been characterized by NMR spectroscopy and by its (ground-state reaction) adducts with methanol and other protic nucleophiles. Unlike the previously described Z-->E geometric isomerization important in phototherapy of neonatal jaundice, the new photoisomerization involves regiospecific photoautomerization to afford 2-ethenyl-18-ethylidene- 1,10,19,22,24-pentahydro-2,7,13,17-tetramethyl-1,19- dioxo-21H-biline-8,12-dipropanoic acid.

Concerning the Hypericin Sensitized Photooxidation of Bilirubin IXα

In aerated protic solvents like ethanol or 80% aqueous ethanol, bilirubin IXα was found to undergo a hypericin sensitized oxidative photodestruction. By means of quenching experiments it was deduced that this was mainly due to the sensitized production of singlet oxygen, but also to some extent to the sensitized formation of superoxide radicals which then react with bilirubin IXα. In absence of oxygen, a photochemically induced disproportionation reaction of hypericin may lead to the oxidative degradation of bilirubin IXα. Upon selective binding of the two pigments to human serum albumin the photosensitized bilirubin IXα destruction was found to be compeletely retarded. Accordingly, the presence of bilirubin IXα within the realm of hypericin assisted photodynamic therapy should have no adverse effects, and neonatal jaundice phototherapy would not benefit from an administration of hypericin.

Responsiveness of cutaneous vasculature to thermal stimulation during phototherapy in neonatal jaundice.

The present study was performed to measure the vasoregulatory reactions to dynamic changes in local skin temperature during open bed phototherapy. Periodic thermal stimulation using warm and cool air currents was applied to the skin of ten term infants with physiological jaundice, before and during open bed phototherapy. The reactivity of skin blood flow (SBF) and heart rate was measured using laser Doppler flowmetry and power spectral analysis. The baseline SBF increased significantly by 70% (P = 0.008) during phototherapy without any significant change in skin or rectal temperature. Before phototherapy, the rhythmic (0.08 Hz) thermal skin stimulation increased the oscillations of SBF (from 89 +/- 26 au to 213 +/- 37 au, P = 0.02) at the stimulation frequency band. This response was further increased (P = 0.03) during phototherapy (from 198 +/- 54 au to 658 +/- 115 au, P = 0.004). Phototherapy increased SBF in icteric otherwise healthy neonates. The cutaneous vasodilatation augments the cardiovascular responsiveness to thermal stimulation. These results suggest that open bed phototherapy does not inhibit the cardiovascular responsiveness to local thermal skin stimulation in healthy term infants.

Decreased Response to Phototherapy for Neonatal Jaundice in Breast-Fed Infants

Objective To evaluate the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in breast-fed and formula-fed infants and infants receiving formula and breast milk. Design Prospective study. Setting Nursery for healthy infants. Method Full-term healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 µmol/L [14.9 mg/dL] or 222 µmol/L [13.0 mg/dL] at ages younger than 48 hours) were treated with conventional phototherapy by using daylight fluorescent lamps. Three groups of infants were studied: group 1, formula-fed infants; group 2, breast-fed infants; and group 3, infants receiving formula and breast milk. All patterns of feeding started at birth. Phototherapy was terminated only when bilirubin concentrations had decreased to less than 185 µmol/L (10.8 mg/dL); the minimum exposure period was 24 hours. Results A total of 163 infants were studied: group 1, 79; group 2, 34; and group 3, 50. The age at the start of exposure was comparable in all groups. The mean±SD weight loss as a percentage of birth weight was as follows: group 1, 2.8%±5.0%; group 2, 6.1%±3.4%; and group 3, 3.2%±2.6%. The duration of exposure to phototherapy was as follows: group 1, 54.1±20.8 hours; group 2, 64.6±25.1 hours; and group 3, 54.9±21.5 hours; the 24-hour rate of decrease in the bilirubin concentration was as follows: group 1, 18.6%±11.7%; group 2, 17.1%±9.6%; and group 3, 22.9%±9.4%. The overall rate of decrease in the bilirubin concentration for the duration of exposure to phototherapy was as follows: group 1, 0.8%±0.3% per hour; group 2, 0.6%±0.3% per hour; and group 3, 0.8%±0.3% per hour. Weight loss at the start of phototherapy was significantly greater in group 2 compared with group 1( P P P =.06); however, the duration ofexposure of group 2 infants was 10 hours more than that of the other 2 groups. The 24-hour rate of decrease in the bilirubin concentration in group 3 was significantly better than that of group 2 ( P =.007) and group 3 ( P =.02); the rates of decrease for groups 2 and 3 were similar ( P =.52). The overall rate of decrease in the bilirubin concentration during the duration of exposure to phototherapy in group 2 was significantly less than that of group 1 ( P =.002) and group 3 ( P P =.35). The postexposure rebound bilirubin concentrations were comparable in all groups during the first 2 days; however, the duration of moderate jaundice in group 2 was more prolonged. Conclusions The response to phototherapy of group 2 infants was significantly slower than that of group 3 and group 1 infants; this response was still of adequate efficacy. The addition of formula to the feedings for totally breast-fed infants, without suspension of breast-feeding, would enhance the efficacy of phototherapy and reduce exposure time.

Decreased response to phototherapy for neonatal jaundice in breast-fed infants.

To evaluate the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in breast-fed and formula-fed infants and infants receiving formula and breast milk. Prospective study. Nursery for healthy infants. Full-term healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 micromol/L [14.9 mg/dL] or 222 micromol/L [13.0 mg/dL] at ages younger than 48 hours) were treated with conventional phototherapy by using daylight fluorescent lamps. Three groups of infants were studied: group 1, formula-fed infants; group 2, breast-fed infants; and group 3, infants receiving formula and breast milk. All patterns of feeding started at birth. Phototherapy was terminated only when bilirubin concentrations had decreased to less than 185 micromol/L (10.8 mg/dL); the minimum exposure period was 24 hours. A total of 163 infants were studied: group 1, 79; group 2, 34; and group 3, 50. The age at the start of exposure was comparable in all groups. The mean+/-SD weight loss as a percentage of birth weight was as follows: group 1, 2.8%+/-5.0%; group 2, 6.1%+/-3.4%; and group 3, 3.2%+/-2.6%. The duration of exposure to phototherapy was as follows: group 1, 54.1+/-20.8 hours; group 2, 64.6+/-25.1 hours; and group 3, 54.9+/-21.5 hours; the 24-hour rate of decrease in the bilirubin concentration was as follows: group 1, 18.6%+/-11.7%; group 2, 17.1%+/-9.6%; and group 3, 22.9%+/-9.4%. The overall rate of decrease in the bilirubin concentration for the duration of exposure to phototherapy was as follows: group 1, 0.8%+/-0.3% per hour; group 2, 0.6%+/-0.3% per hour; and group 3, 0.8%+/-0.3% per hour. Weight loss at the start of phototherapy was significantly greater in group 2 compared with group 1 (P<.001) and group 3 (P<.001), although the hemoglobin and hematocrit values were comparable. The duration of exposure to phototherapy was not significantly different in the 3 groups (P=.06); however, the duration of exposure of group 2 infants was 10 hours more than that of the other 2 groups. The 24-hour rate of decrease in the bilirubin concentration in group 3 was significantly better than that of group 2 (P = .007) and group 3 (P = .02); the rates of decrease for groups 2 and 3 were similar (P = .52). The overall rate of decrease in the bilirubin concentration during the duration of exposure to phototherapy in group 2 was significantly less than that of group 1 (P = .002) and group 3 (P<.001); the rates for groups 1 and 3 were similar (P = .35). The postexposure rebound bilirubin concentrations were comparable in all groups during the first 2 days; however, the duration of moderate jaundice in group 2 was more prolonged. The response to phototherapy of group 2 infants was significantly slower than that of group 3 and group 1 infants; this response was still of adequate efficacy. The addition of formula to the feedings for totally breast-fed infants, without suspension of breast-feeding, would enhance the efficacy of phototherapy and reduce exposure time.

On the Effect of Visible Light Irradiation on Bilirubin and Bilirubin bound to Serum Albumins : An Insight into the Phototherapy of Neonatal Jaundice

On the Effect of Visible Light Irradiation on Bilirubin and Bilirubin bound to Serum Albumins : An Insight into the Phototherapy of Neonatal Jaundice

Die Phototherapie des Neugeborenenikterus in der geburtshilflichen Klinik

Fragestellung: In der vorliegenden Studie werden die Ergebnisse der Phototherapie des Neugeborenenikterus in der geburtshilflichen Klinik dargestellt. Patienten und Methoden: Es wurden retrospektiv die Daten von 289 hyperbilirubinämischen Neugeborenen (>37. SSW) in bezug auf Geburtsgewicht, Gestationsalter, Geschlecht, Blutgruppe, Rhesusfaktor, Blutgruppenkonstellation, Ergebnis des direkten Coombs-Tests, Inzidenz mütterlicher Antikörper, Nabelschnur-Arterien-pH, Apgar-Werte und die Serumbilirubinkonzentration vor und nach Therapie ausgewertet. Ergebnisse: Kinder mit niedrigem Geburtsgewicht bzw. Neugeborene mit hoher Kalorienzufuhr während der Therapie zeigten eine signifikant niedrigere Gesamttherapiedauer und einen rascheren Abfall der Bilirubinserumkonzentration pro Stunde. Insgesamt mußten nur 19% der hyperbilirubinämischen Neugeborenen aus der geburtshilflichen Klinik in die Kinderklinik verlegt werden. Schlußfolgerung: Durch enge Kooperation zwischen Geburtshelfern und Neonatologen kann die Überwachung und ggf. Therapie des physiologischen Neugeborenenikterus in der geburtshilflichen Klinik erfolgen. Damit entfällt die räumliche Trennung zwischen Mutter und Kind.

The Comparison of the Efficacy of Green Versus White Light in The Phototherapy of Neonatal Jaundice

This study was carried out to compare the effıcacy of white light to green light in the phototherapy of neona tal jaundice. 90 full-term, healthy newborns with neonatal jaundice who were over 2500 grams at birth, and had no any pathology such as malformations, contusions and cephalhematoma examination and did not have any problems in the antenatal, natal and postnatal periods, were included in this study in two groııps. 50 infants received phototherapy by white light and the other 40 infants by green light. The laboratory and clinical values of the rwo groups were simi/ar in ali parameters. The declination rate of decline of serum bilirubin concentrarions was 0,097 nıg/dl/hour in the white light group and O. J 9 nıgldl/hour in the greeıı light group. The duration of treatment in white light group was 58±12, 7 hours and 39±15 hours in green light group. Green light was observed to be faster and more effective than white light.

A Controlled Trial of High-Intensity Double-Surface Phototherapy on a Fluid Bed Versus Conventional Phototherapy in Neonatal Jaundice

To evaluate a simple, relatively inexpensive method using the fluid bed to provide high-intensity double-surface (HIDS) phototherapy and to confirm that the method described is more effective than conventional phototherapy (CPT) in the treatment of neonatal hyperbilirubinemia. Prospective controlled study. HIDS phototherapy (26 to 30 microW/cm2 per nanometer) on the fluid bed (n = 22) versus conventional (7 to 10 microW/cm2 per nanometer) phototherapy (n = 28) was used to treat neonates weighing more than 1500 g with hyperbilirubinemia. After 24 hours of therapy, the bilirubin in the group receiving HIDS phototherapy was significantly lower. The mean rate of fall of bilirubin was 5.34 mumol/L per hour in the group receiving HIDS phototherapy versus 0.7 mumol/L per hour in the group receiving CPT. HIDS phototherapy on a fluid bed was well tolerated. HIDS phototherapy on the fluid bed is significantly more effective in reducing bilirubin than CPT. It can be easily and economically provided using equipment currently available in most neonatal units.

Analytical model of phototherapy for neonatal jaundice. Influence of bilirubin kinetics on skin colour during phototherapy

Recent progress in diode-array detector technology and signal processing methods, and in the optical modelling of tissues allow: i) real-time, multispectral analysis of reflected spectra with relatively simple and compact devices; and ii) improved correlations between reflectance spectra and pigment distribution in tissues. Second-generation transcutaneous bilirubinometers relying on the changes in the optical properties of the skin at selected wavelengths due to changes in its optical components are being developed. To extend the use of transcutaneous bilirubinometry to the phototherapy cycle, the modelling of the complex mechanisms of bilirubin photochemistry and metabolism in the various body compartments is required. As a first step toward this aim, the influence of bilirubin photochemistry occurring during the initial stage of phototherapy on the reflectance spectrum of an icteric tissue is analysed. A four-layer model is assumed. The transformation of bilirubin into its configurational isomers is considered in detail, while the role of the structural isomer on bilirubin elimination is taken into account with a loss term in the equation of motion of bilirubin concentration. The phototherapeutic process makes the illumination in the bile pigment layer depend on time. However, in the specific cases here considered, this time variation is negligible, and the differential equations describing the time evolution of bile pigment concentrations can be solved in a closed form. The bilirubin kinetics produces significant changes of the diffuse reflectance spectra during phototherapy, and the difference of the colour after the phototherapeutic treatment of a known duration can be put in close correspondence with the model of the jaundiced skin and permits quantitative estimates of pigment concentrations.

Phototherapy and Patent Ductus Arteriosus

To the Editor.— Rosenfeld et al1 recently reported a positive relationship between phototherapy exposure and patent ductus arteriosus in small premature infants. In this study, 74 infants with birth weights less than 1,500 g with respiratory distress syndrome and prophylactic phototherapy for neonatal jaundice were randomly assigned to either receive chest shielding or full exposure to light. The two groups, which were otherwise similar with regard to size, gestational age, severity of respiratory distress syndrome, fluid intake, and duration of phototherapy, significantly differed with regard to the incidence of patent ductus arteriosus (shield group 11/36 v no shield group 23/38, P = .009).