Prophylactic Phototherapy Research Articles

Investigations and treatment of photodermatoses

The photodermatoses comprise of a miscellaneous set of photosensitive disorders with abnormal cutaneous response to sunlight. The diagnosis is mostly clinical and is augmented by methods such as phototesting, photoprovocation testing, and photopatch testing, which are discussed below. Treatment includes photoprotection, prophylactic phototherapy, as well as topical and systemic immunosuppression to varying extents. Various newer modalities for photoprotection as well as treatment are being explored.

Effectiveness and safety of prophylactic phototherapy to prevent jaundice in premature newborns: Systematic review and meta-analysis.

To determine the effectiveness and safety of prophylactic phototherapy compared with conventional phototherapy for the prevention of neonatal jaundice. We included clinical trials comparing prophylactic phototherapy to conventional phototherapy to prevent jaundice in premature newborns. We searched Embase, MEDLINE, LILACS, Central, and others. The statistical analysis was performed in RevMan (Review Manager 5.3). Outcomes were analyzed according to the type of variable: risk difference (RD) and mean difference (MD). A random effects model was used due to heterogeneity. We reported results in forest plots. Risk of bias was evaluated, and a sensitivity analysis was made. 1127 articles were found, and six studies (2332 patients) were included in the meta-analysis. Five studies evaluated the need for exchange transfusion as the primary outcome RD -0.01, 95% CI [-0.05 to 0.03]. One study evaluated bilirubin encephalopathy RD -0.04, 95% CI [-0.09 to 0.00]. Five studies evaluated the duration of phototherapy, MD 38.47, 95% CI [1.28 to 55.67]. Four studies evaluated levels of bilirubin (MD -1.23, 95% CI [-2.25 to -0.21]. Two studies evaluated mortality, RD 0.01, 95% CI [-0.03 to 0.04]. As a conclusion, compared to conventional phototherapy, prophylactic phototherapy decreases the last measured level of bilirubin, as well as the probability of neurodevelopmental disturbances. However, it increases phototherapy duration.

Use of prophylactic phototherapy for RhD neonatal disease in a referral service

ObjectiveThis study aimed to describe the effect of prophylactic phototherapy in the treatment of infants with Neonatal Hemolytic Disease. MethodA retrospective cohort study was carried out with 199 RhD-positive infants, born to RhD-negative mothers, alloimmunized for RhD antigen, between January 2009 and December 2018. ResultsThe incidence of exchange transfusions in the study population was 9.5%, with a mean maximum bilirubin value of 11.3 mg % (± 4.3mg %). Bilirubin's maximum peak was achieved with a mean of 119.2 life hours (± 70.6h). ConclusionThe low incidence of exchange transfusion, the extended maximum bilirubin peak for later ages, and the low mean of the maximum bilirubin values may indicate a positive effect of prophylactic phototherapy in the treatment of this disease. Further studies must be carried out to confirm these findings.

A new approach to actinic folliculitis: prophylactic narrowband ultraviolet B phototherapy

We have observed an increasing number of patients referred to the Scottish Photobiology Service (SPS), who were later diagnosed with actinic folliculitis (AF) and had positive phototesting results. Treatment options for AF are limited, with only a few reports in the literature. The use of prophylactic narrowband ultraviolet B (NB-UVB) phototherapy for AF has not previously been described, and we report on this for the first time. To analyse the clinical characteristics, phototesting results and responses to treatment for patients with AF diagnosed by the SPS. We undertook a retrospective review over 10years of all case notes of patients who were assessed and diagnosed with AF through the SPS, based at the Photobiology Unit, Dundee, UK. All 10 patients were women. Mean age of onset was 25years and mean time to referral for investigation was 7years. The commonest site involved was the face, with the main clinical feature being monomorphic pustules appearing after sunlight exposure. The eruption could be provoked with iterative doses of broadband UVA irradiation in five patients. All patients were offered photoprotective advice and prophylactic NB-UVB phototherapy. Five patients proceeded with phototherapy; four of these completed the desensitization course and all four reported either a delay in symptom onset or total prevention of rash induction, with complete efficacy of desensitization maintained for 3years in one patient. We demonstrate the successful use of UVA provocation testing as a diagnostic tool in AF. Additionally, we recommend the use of prophylactic NB-UVB phototherapy in AF as an effective and well-tolerated approach.

Comparison of Efficacy of Prophylactic versus Therapeutic Phototherapy in Preterm Neonates

Background: Jaundice neonatorum may predisposes preterm to develop bilirubin induced neurologic dysfunction even at lower total serum bilirubin level than term infant. Prophylactic phototherapy helps to maintain a lower serum bilirubin level may reduce the need for exchange transfusion in order to prevent kernicterus. Objective: To compare the efficacy of prophylactic versus therapeutic phototherapy among preterm neonates in reducing the frequency of exchange transfusion. Study Design: Randomized Controlled Trial. Settings: Neonatal Unit of Pediatrics department, Sir Ganga Ram Hospital Lahore-Pakistan. Duration: September 2018 to June 2019. Methodology: Two hundred preterm admitted in neonatal unit were enrolled and divided into 2 groups (A and B) using random numbers. Prophylactic phototherapy was initiated in Group A neonates within first 6 hours of life while it was applied when the serum bilirubin has reached to a pre-specified level in Group B. Daily total serum bilirubin level (also direct and indirect) was measured. Efficacy was measured in terms of preventing exchange transfusion. Data was entered and analyzed with SPSS version 21. Chi square was applied to compare efficacy between two groups with p ˂ 0.05 as significant. Results: Mean gestational age was 35.4 0.9 weeks in group A and 35.6 0.7 weeks in group B. There were 54% males and 46% females in group A while 51% males and 49% females in group B. The peak mean serum bilirubin level was observed on 3rd and 4th days in groups A and B respectively. Jaundiced neonates who received exchange transfusion in group A and B were 3% and 8% respectively (p=0.1209). Prophylactic phototherapy found efficacious in 97% preterm although, they received it for longer duration (147 34.25 vs 98 27.10 hours) (p 0.00001). Conclusion: Neonates received prophylactic phototherapy required less exchange transfusions compared to therapeutic group.

Role of Prophylactic Phototherapy in the Management of very Low Birth weight Newborns with Hyperbilirubinemia in Comparison to Therapeutic Phototherapy with their Gender

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.

How does prophylactic phototherapy compare with standard phototherapy for preterm or low birth weight infants?

How does prophylactic phototherapy compare with standard phototherapy for preterm or low birth weight infants?

Transcutaneous bilirubinometer use and practices surrounding jaundice in 150 California newborn intensive care units.

Transcutaneous bilirubin measurements (TcBs) provide a noninvasive method for screening infants for hyperbilirubinemia and have been used extensively in term and late preterm newborns in well baby nurseries, offices, and outpatient clinics. Several studies have also demonstrated the utility of TcBs as a screening tool for infants > 28 weeks' gestation and their ability to reduce the need for blood sampling. The objectives of this study are to identify how often TcBs are used among California Newborn Intensive Care Units (NICUs) in preterm, late preterm and term infants, and other aspects of jaundice management. We conducted a survey on TcB use and practices relating to jaundice management in 150 California NICUs between April and October 2016. TcB screening is routinely used in 28% (42/150) of NICUs. Only 7% (11/150) of NICUs use TcB in preterm infants < 28 weeks. Practice varied similarly across NICU levels of care. Among the subset of NICUs that responded to questions related to phototherapy and screening practices, prophylactic phototherapy was used in 38% (23/59) and 90% (55/61) screened for glucose-6-phosphate dehydrogenase deficiency based on race, ethnicity, and/or family history. Despite studies validating the accuracy of TcB in preterm infants > 28 weeks, only 28% of California NICUs routinely use TcB devices. TcB screening in infants < 28 weeks gestation is not widely used and no recommendation can be made in this regard until there is more experience with its application using a standardized protocol in these infants and on a large scale.

An Overview of Neonatal Unconjugated Hyperbilirubinemia and It’s Management

Neonatal hyperbilirubinemia is the most common clinical condition in the newborn requiring hospital readmission. About 60% of term and 80% of preterm infants develop jaundice during 1st week of life. Unconjugated hyperbilirubinemia occurs mostly due to increased hemolysis, decreased hepatic clearance, enterohepatic circulation, immaturity, blood group incompatibility and infections. Evaluation of neonatal jaundice is done based on history, age of onset of jaundice and physical examination findings which is necessary for proper management. Otherwise significant hyperbilirubinemia may endanger life of the baby and may lead to acute and subsequently chronic bilirubin encephalopathy. There are many diagnostic tools those help to detect jaundice such as Kramer’s rule, transcutaneous bilirubinometer, Bilichecker apps and smartphone apps. Besides these BIND score added a new dimension in diagnosis of acute bilirubin encephalopathy which can be confirmed by measuring bilirubin – albumin ratio in blood. Management of unconjugated hyperbilirubinemia includes: Phototherepy, Exchange transfusion are two major effective therapeutic modalities available today. Additional options include Pharmacotherapy in the form of phenobarbital and intravenous immunoglobulin. Each therapy has its pros and cons. Even there is dilemma in many therapeutic conditions like role of prophylactic phototherapy in preterm neonates, role of sunlight etc. As pediatricians have to deal cases with unconjugated hyperbilirubinemia frequently, so an updated knowledge is required. From this concern we reviewed issues on neonatal unconjugated hyperbilirubinemia and compiled for better understanding of the condition.Bangladesh J Child Health 2018; VOL 42 (1) :30-37

Phototherapy Induced Hypocalcemia : A Jordanian and Saudi Experience

Background: neonatal hyperbilirubinemia is a common condition in the first few days of life (1) and it can be divided into: pathological and physiological and indirect (unconjugated) and direct (conjugated) hyperbilirubinemia. Objective: This paper aimed to evaluate the effect of different types of phototherapy on serum calcium of both preterm and full-term infants with indirect hyperbilirubinemia, in either supine or prone position. Methods: data were taken from 100 newborns candidate by divided them into two groups. Blue and white light phototherapy were equally used for different infants of both groups. Results: the results showed that 31% developed hypocalcemia, 20% preterm and 11% full term infants. 38% developed hypocalcemia, where among infants who received prophylactic phototherapy 24% developed hypocalcemia. 60% of infants who received extensive phototherapy developed hypocalcemia, where 27.7% of infants who managed with single phototherapy developed hypocalcemia. Seventeen of the infants who managed in prone position and 14 infants of those who received phototherapy in supine position developed hypocalcemia. Conclusion: all in all, 19 infants developed hypocalcemia under blue light and 12 received white light phototherapy. Phototherapy induced hypocalcemia in both full term and premature infants. In addition to the common practice of monitoring the total serum bilirubin and PCV in all newborns on phototherapy, it is important to monitor the total serum calcium on daily base.

Evaluation of narrow band ultraviolet B phototherapy in the treatment of chronic actinic dermatitis in Chinese patients.

Few studies have been conducted in chronic actinic dermatitis (CAD) treated with narrowband ultraviolet B (NB UVB) phototherapy, especially in Asian patients. We aim to evaluate the efficacy and safety of NB UVB phototherapy in Chinese patients with CAD. 19 CAD patients of Fitzpatrick skin phototype IV received NB UVB phototherapy in spring and treatments were given 3 times weekly with incremental dose and maintenance therapy was given twice weekly for 3-4 weeks. The mean initial, endpoint, and cumulative dose of NB UVB was 0.08, 0.33, and 6.0 J/cm2 , respectively. Patients totally received 27 times of treatments in average. 87.5% of previously ultraviolet B（UVB） sensitive patients and 75% of previously ultraviolet A（UVA） sensitive patients had normal or improved MED after phototherapy. The percentage of patients returned to normal UVB phototesting was higher than that of patients returned to normal UVA phototesting (68.8% vs. 37.5%). The mean 1-week DLQI and the need for using immunosuppressive agents and antihistamines were significantly reduced after treatment (p < .01 or p < .05). In conclusion, prophylactic NB UVB phototherapy is effective and safe in treatment of CAD in Chinese patients with Fitzpatrick skin phototype IV.

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.

Unconjugated bilirubin from cord blood; an indicator for prophylactic phototherapy

Neonatal hyperbilirubinemia is a cause of concern for the parents as well as for the pediatricians as it is a leading cause behind readmission to hospital after the early discharge of mother-baby dyad.

Management of hyperbilirubinemia in preterm infants in Turkey.

Prematurity is a significant risk factor for developing unconjugated hyperbilirubinemia. This study investigated the current approach to managing hyperbilirubinemia in preterm newborns in Turkey. A study-specific questionnaire on the management of jaundice in preterm infants was sent to 100 level III neonatal intensive care units in Turkey. Responses were obtained from 84 centers from all regions of Turkey. Of the centers, 75.3% used the Turkish Neonatology Society guidelines for deciding to start phototherapy, and 24.7% used different guidelines. The monitoring of bilirubin varied among the participants. Of the participants, 53.6% believed that prophylactic phototherapy was necessary if the infant's birth weight was below 1000 g. The participants reported 6 cases of kernicterus in preterm infants in recent years. There is no single standard approach for managing neonatal hyperbilirubinemia in preterm infants in Turkey. Prophylactic phototherapy for extremely low birth-weight infants might be added to the guidelines for Turkey.

Prophylactic Versus Therapeutic Phototherapy in Very Low Birth Weight Infants

Background: Preterm and very low birth weight (VLBW) infants are at great risk of hyperbilirubinemia and bilirubin-associated brain damage. Objectives: The aim of this study was to compare the efficacy of prophylactic versus therapeutic phototherapy in VLBW infants. Patients and Methods: Fifty VLBW infants were randomly assigned to receive either phototherapy from the first day of life regardless of their serum bilirubin level for up to five days (prophylactic group) or phototherapy when their bilirubin level reached half the exchange transfusion level (therapeutic group). All data, including gestational age, gender, birth weight, serum bilirubin level on the first day, peak serum bilirubin concentration, the age at which the peak serum bilirubin level was reached, duration of phototherapy, and the number of exchange transfusions, were studied and analyzed. Results: The mean bilirubin level on the first day in both groups exhibited no significant difference. The peak serum bilirubin was 7.7 ± 1.4 and 8.5 ± 2.1 mg/dL in the prophylactic and therapeutic group, respectively, and there was no significant difference in the age at which the peak serum bilirubin levels were reached in both groups (2.4 ± 1.2 vs. 2.1 ± 1 days in the prophylactic and the therapeutic group, respectively). The mean duration of phototherapy in the prophylactic group was 84 ± 43 hours, while for the therapeutic group it was 72 ± 39 hours, and hence the difference was not significant. The need for an exchange transfusion was lower in the prophylactic group compared to the therapeutic group (33% vs. 7%), although the difference was not statistically meaningful (P < 0.112). Conclusions: According to our study, phototherapy should not be used as prophylactic therapy for all VLBW infants, but rather it should be individualized in order to maintain low bilirubin levels.

Prophylactic Interventions in Neonatology: How Do They Fare in Real Life?

This study aims to evaluate the association of prophylactic antenatal steroids, indomethacin, and phototherapy with extremely preterm infant outcomes in a pragmatic setting. Retrospective study of infants born at <28 weeks gestation and admitted to 26 Canadian Neonatal Network neonatal intensive care units between 2010 and 2012. Mortality, severe neurological injury, retinopathy, necrotizing enterocolitis, bronchopulmonary dysplasia, nosocomial infection, and patent ductus arteriosus ligation rates were compared between infants who received antenatal steroids, prophylactic indomethacin, and/or prophylactic phototherapy and those who did not. Of 3,465 eligible infants, 2,900 (84%) received antenatal steroids, 269 (8%) prophylactic indomethacin, and 403 (12%) prophylactic phototherapy. Associations were observed between antenatal steroids and mortality (adjusted odds ration [aOR] 0.47 [0.33-0.66]) and severe neurological injury (aOR 0.60 [0.46-0.77]), indomethacin and ductus arteriosus ligations (aOR 0.52 [0.31-0.87]), but not severe neurological injury (aOR 1.12 [0.81-1.54]), but phototherapy was not associated with any of the neonatal outcomes despite reductions in bilirubin. Antenatal steroids were associated with reduced mortality and neurological injury, prophylactic indomethacin was not associated with reduction in neurological injury and phototherapy was not associated with any improvement in neonatal outcomes. In a pragmatic setting, outside randomized controlled trials, the effectiveness and safety of prophylactic interventions in extremely preterm neonates vary; ongoing monitoring is warranted.

Cochrane Review: Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants

Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinaemia and jaundice that can lead to bilirubin encephalopathy. Phototherapy is the most common treatment for neonatal hyperbilirubinaemia and could be most effective in preventing the sequelae of hyperbilirubinaemia if initiated prophylactically. To evaluate the efficacy and safety of prophylactic phototherapy for preterm (< 37 weeks gestational age) or low birth weight infants (birth weight < 2500 g). We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3) on 31 March 2011, MEDLINE (1950 to 31 March 2011), EMBASE (1980 to 31 March 2011) and CINAHL (1982 to 31 March 2011). Randomised controlled trials or quasi-randomised controlled studies evaluating the effects of prophylactic phototherapy for preterm or low birth weight infants. Two authors independently obtained data from published articles. We performed fixed-effect meta-analysis for the outcomes: rate of exchange transfusion, cerebral palsy or other neurodevelopmental impairment, peak serum bilirubin level and all-cause mortality. Nine studies of 3449 participants were included. The rate of exchange transfusion was reduced in one study with liberal transfusion criteria (risk ratio (RR) 0.20; 95% confidence interval (CI) 0.13 to 0.31) but not in the other two more recent studies with stringent criteria (typical RR 0.66; 95% CI 0.19 to 2.28). There was no statistically significant difference in the rate of cerebral palsy (typical RR 0.96; 95% CI 0.50 to 1.85; two studies, 756 participants). However, one large study that reported on neurodevelopmental impairment (a composite outcome including cerebral palsy) found a slightly lower rate of neurodevelopmental impairment with prophylactic phototherapy (RR 0.85; 95% CI 0.74 to 0.99; 1804 participants). The prophylactic phototherapy group had lower peak bilirubin levels (mean difference (MD) -2.73; 95% CI -2.89 to -2.57; six studies, 2319 participants) and had fewer neonates with peak unconjugated serum bilirubin levels > 10 mg/dl (typical RR 0.27; 95% CI 0.22 to 0.33; three studies, 1090 participants) or peak unconjugated serum bilirubin levels > 15 mg/dl (typical RR 0.13; 95% CI 0.07 to 0.23; four studies, 1116 participants). There was no statistically significant difference in the rate of all-cause mortality between the two groups (typical RR 1.08; 95% CI 0.93 to 1.26; four studies, 3044 participants). Prophylactic phototherapy helps to maintain a lower serum bilirubin concentration and may have an effect on the rate of exchange transfusion and the risk of neurodevelopmental impairment. However, further well-designed studies are needed to determine the efficacy and safety of prophylactic phototherapy on long-term outcomes including neurodevelopmental outcomes.

Commentary on ‘Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants’

AbstractThis is a commentary on a Cochrane review, published in this issue of EBCH, first published as:Okwundu CI, Okoromah CAN, Shah PS. Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD007966. DOI: 10.1002/14651858.CD007966.pub2. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants

Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinaemia and jaundice that can lead to bilirubin encephalopathy. Phototherapy is the most common treatment for neonatal hyperbilirubinaemia and could be most effective in preventing the sequelae of hyperbilirubinaemia if initiated prophylactically. To evaluate the efficacy and safety of prophylactic phototherapy for preterm (< 37 weeks gestational age) or low birth weight infants (birth weight < 2500 g). We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3) on 31 March 2011,MEDLINE (1950 to 31 March 2011), EMBASE (1980 to 31 March 2011) and CINAHL (1982 to 31 March 2011). Randomised controlled trials or quasi-randomised controlled studiesevaluating the effects of prophylactic phototherapy for preterm or low birth weight infants. Two authors independently obtained data from published articles. We performed fixed-effect meta-analysis for the outcomes: rate of exchange transfusion, cerebral palsy or other neurodevelopmental impairment, peak serum bilirubin level and all-cause mortality. Nine studies of 3449 participants were included. The rate of exchange transfusion was reduced in one study with liberal transfusion criteria (risk ratio (RR) 0.20; 95% confidence interval (CI) 0.13 to 0.31) but not in the other two more recent studies with stringent criteria (typical RR 0.66; 95% CI 0.19 to 2.28). There was no statistically significant difference in the rate of cerebral palsy (typical RR 0.96; 95% CI 0.50 to 1.85; two studies, 756 participants). However, one large study that reported on neurodevelopmental impairment (a composite outcome including cerebral palsy) found a slightly lower rate of neurodevelopmental impairment with prophylactic phototherapy (RR 0.85; 95% CI 0.74 to 0.99; 1804 participants). The prophylactic phototherapy group had lower peak bilirubin levels (mean difference (MD) -2.73; 95% CI -2.89 to -2.57; six studies, 2319 participants) and had fewer neonates with peak unconjugated serum bilirubin levels > 10 mg/dl (typical RR 0.27; 95% CI 0.22 to 0.33; three studies, 1090 participants) or peak unconjugated serum bilirubin levels > 15 mg/dl (typical RR 0.13; 95% CI 0.07 to 0.23; four studies, 1116 participants). There was no statistically significant difference in the rate of all-cause mortality between the two groups (typical RR 1.08; 95% CI 0.93 to 1.26; four studies, 3044 participants). Prophylactic phototherapy helps to maintain a lower serum bilirubin concentration and may have an effect on the rate of exchange transfusion and the risk of neurodevelopmental impairment. However, further well-designed studies are needed to determine the efficacy and safety of prophylactic phototherapy on long-term outcomes including neurodevelopmental outcomes.

Survey of management of neonatal haemolytic jaundice in Australasia

Haemolytic jaundice is an important entity in neonatal clinical practice. Because of the decrease in rhesus isoimmunisation since the advent of anti-D immunoglobulin and improved antenatal management strategies, its management in the neonatal period has become less intensive and exchange transfusions rarely performed. We planned to review the practice of Australasian perinatal units in light of recent advances and recommendations. An electronic survey was sent to the directors of all 25 tertiary-level perinatal units across Australasia. The questionnaire comprised 20 questions dealing with the management of haemolytic jaundice. Twenty out of the 25 neonatal units responded. Most were aware of the recent American Academy of Pediatrics guidelines, but only eight (40%) based their practice on it. Fifty per cent of neonatal units had written protocols to manage such infants, but almost all had written guidelines for performing exchange transfusions. Seven (35%) units started prophylactic phototherapy; however, the criteria used for early exchange were variable, most related to cord haemoglobin or rate of rise of bilirubin. Few units used high-dose intravenous immunoglobulin in haemolytic jaundice. Average exchange rates (based on the last 2 years) were 3.5/year (0-10). Variable practice was noted across the Australasian units. Written protocols form the backbone of management of jaundice in such babies. The use of intravenous immunoglobulin is minimal, and the information available on its use needs to be critically appraised.