Transcutaneous bilirubin nomogram for healthy term and late preterm neonates in first 96 hours of life

Objective

To develop nomogram of Transcutaneous Bilirubin among healthy term and late-preterm neonates during first 96 hours of age.

Design

Longitudinal observational study.

Setting

Neonatal unit of a tertiary care Hospital of Central Gujarat, India.

Participants

1075 healthy term and late preterm neonates (≥35weeks).

Intervention

Six-hourly transcutaneous bilirubin was obtained from birth to 96 hour of life using Drager JM 103 Transcutaneous Bilirubinometer.

Main outcome measures

Nomogram of Transcutaneous Bilirubin with percentile values was obtained, rate of rise of bilirubin was calculated and predictive ability of normative data was analyzed for subsequent need of phototherapy.

Results

The age-specific percentile curves and nomogram were developed from the transcutaneous bilirubin readings of 1,010 neonates. Rate of rise in first 12 hour was 0.2 mg/dL and was 0.17 mg/dL in 12 to 24 hour of life which decreased on second day of life. Neonates who required phototherapy had consistently higher readings of transcutaneous bilirubin and also higher rate of rise in first 48 hrs.

Conclusion

Neonates whose transcutaneous bilirubin is above the 50th percentile should be monitored for the development of significant hyperbilirubinemia.

     

Comparison of transcutaneous bilirubin measurement with total serum bilirubin levels in preterm neonates receiving phototherapy

Objective

To compare transcutaneous bilirubin with total serum bilirubin in preterm neonates after initiation of phototherapy.

Methods

Jaundice was assessed in 30 preterm neonates with transcutaneous bilirubin and total serum bilirubin before initiation of phototherapy and at 12 hr after initiation of phototherapy. A photo-occlusive patch was applied over the sternum.

Results

Transcutaneous bilirubin has a good correlation with total serum bilirubin after initiation of phototherapy. (r=0.918, P<0.001). Transcutaneous bilirubin at 28-32 weeks of gestation (r = 0.97) was better correlated with total serum bilirubin than those at 32-37 weeks (r =0.88). The correlation was better for neonates <72 hours old (r = 0.96) than those >72 hours of age (r = 0.82).

Conclusion

Transcutaneous bilirubin correlates significantly with total serum bilirubin at the patched sternal site after initiation of phototherapy in preterm neonates.

     

Incidence and risk factors of post-phototherapy neonatal rebound hyperbilirubinemia

Background

To determine the incidence and risk factors of post-phototherapy rebound hyperbilirubinemia because data about bilirubin rebound in neonates are lacking and few studies have concerned this condition.

Methods

A prospective observational study was conducted on 500 neonates with indirect hyperbilirubinemia who were treated according to standard guidelines. Total serum bilirubin (TSB) was measured at 24–36 h after phototherapy; significant bilirubin rebound (SBR) is considered as increasing TSB that needs reinstitution of phototherapy.

Results

A total of 124 (24.9%) neonates developed SBR with TSB increased by 3.4 (2.4–11.2) mg/dL after stopping phototherapy. Multiple logistic regression model revealed the following significant risk factors for rebound: low birth weight (B = 1.3, P < ?0.001, OR 3.5), suspected sepsis (B = 2.5, P < ?0.001, OR 12.6), exposure to intensive phototherapy (B = ?0.83, P = ?0.03, OR 2.3), hemolysis (B = ?1.2, P < ?0.001, OR 3.1), high discharge bilirubin level (B = ?0.3, P = ?0.001, OR 1.3), and short duration of conventional phototherapy (B = ?? 1.2, P < ?0.001, OR 0.3).

Conclusions

SBR should be considered in neonates with hemolysis, low birth weight, suspected sepsis, short duration of conventional phototherapy, exposure to intensive phototherapy, and relatively high discharge TSB. These risk factors should be taken into account when planning post-phototherapy follow-up.

     

Pain Control Interventions in Preterm Neonates: <Emphasis Type="Italic">A Randomized Controlled Trial</Emphasis>

Objectives

To compare individual efficacy and additive effects of pain control interventions in preterm neonates.

Design

Randomized controlled trial

Setting

Level-3 University affiliated neonatal intensive care unit.

Participants

200 neonates (26-36 wk gestational age) requiring heel-prick for bedside glucose assessment. Exclusion criteria were neurologic impairment and critical illness precluding study interventions.

Intervention

Neonates were randomly assigned to Kangaroo mother care with Music therapy, Music therapy, Kangaroo Mother care or Control (no additional intervention) groups. All groups received expressed breast milk with cup and spoon as a baseline pain control intervention.

Main outcome measure

Assessment of pain using Premature Infant Pain Profile (PIPP) score on recorded videos.

Results

The mean (SD) birth weight and gestational age of the neonates was 1.9 (0.3) kg and 34 (2.3) wk, respectively. Analysis of variance showed significant difference in total PIPP score across groups (P<0.001). Post-hoc comparisons using Sheffe’s test revealed that the mean (SD) total PIPP score was significantly lower in Kangaroo mother care group [7.7 (3.9) vs. 11.5 (3.4), 95% CI(–5.9, –1.7), P<0.001] as well as Kangaroo mother care with Music therapy group [8.5 (3.2) vs. 11.5 (3.4), 95%CI (–5.1, –0.9), P=0.001] as compared to Control group. PIPP score was not significantly different between Control group and Music therapy group.

Conclusions

Kangaroo mother care with and without Music therapy (with expressed breast milk) significantly reduces pain on heel-prick as compared to expressed breast milk alone. Kangaroo mother care with expressed breast milk should be the first choice as a method for pain control in preterm neonates.

     

Comparison of Temporal Artery Thermometry with Axillary and Rectal Thermometry in Full Term Neonates

Objective

To assess the efficacy of temporal artery thermometer in febrile and hypothermic neonates in comparison to axillary thermometer.

Methods

It was a cross sectional observational study. Study participants included 210 neonates admitted in neonatal intensive care unit of a tertiary care teaching hospital, divided into three groups of 70 each, namely normothermic, febrile and hypothermic. Temperatures were measured using temporal artery, axillary and rectal thermometers in each patient.

Results

Mean rectal temperature was found to be comparable to mean temporal artery temperature in normothermic babies. Temporal artery thermometer had a better sensitivity to diagnose fever, than hypothermia. Also, temporal artery temperature showed a good correlation with rectal temperature in normothermic and febrile group and not in hypothermic neonates.

Conclusions

Temporal artery thermometer can accurately detect temperature in febrile and normothermic fullterm neonates but not in hypothermic neonates. Further studies are required before advocating temporal artery thermometry as a replacement of rectal thermometry among this group of population.

     

Quality Improvement Initiative to Improve the Screening Rate of Retinopathy of Prematurity in Outborn Neonatal Intensive Care Graduates

Objective

To improve the screening rate of Retinopathy of prematurity (ROP) in the outborn neonatal intensive care unit, using the quality improvement method.

Methods

40 neonatal nurses, 89 parents from an outborn neonatal intensive care unit of a tertiary-care hospital were included in the study between May 2017 and March 2018. Universal sampling method was used.

Results

In 345 neonates, ROP screening rate increased from 10.7% in the pre-intervention phase to 45.5% and 87.3% in the intervention and post-intervention phase, respectively.

Conclusion

Point of care quality improvement (POCQI) method can be effectively used to improve ROP screening rate in outborn neonates.

     

Family-centered care to complement care of sick newborns: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective

To assess the impact of family-centered care in delivery of care to sick newborns, on nosocomial infection rate.

Design

Randomized controlled trial

Setting

Tertiary referral nursery (October 2010 to March 2012).

Participants

295 neonates randomized at the time of hospitalization in neonatal intensive care unit.

Intervention

Parent-attendant of intervention group were trained using an indigenously developed and pretested, culturally sensitive, simple audio-video tool that covered domains of personal hygiene, hand washing, danger signs recognition and feeding of sick neonate. Control group received routine care by nurses and doctors.

Outcome measure

Primary: culture positive nosocomial infection rate. Secondary: culture negative nosocomial infection rate, duration of hospitalization, mortality and breastfeeding rate.

Results

Two-thirds of family caregivers were fathers/ mothers and about 20% were grandparents. About 60% of family care givers were either illiterate (25%) or primary/middle pass (34%). Incidence of nosocomial episodes of sepsis was not different between groups (incidence rate difference 0.74, 95 % CI -4.21, 5.6, P = 0.76). Pre-discharge exclusive breastfeeding rates were significantly higher in intervention group [80.4% vs 66.7% (P=0.007)].

Conclusions

There was no significant difference in nosocomial infection rate between the two groups. Translating and adapting principles of family-centered care was feasible, and improved the pre-discharge exclusive breastfeeding rates.

     

Optimizing Utilization of Laboratory Investigations in Neonatal Intensive Care Unit

Objective

To optimize utilization of laboratory tests by measuring baseline rates and appropriateness of investigations, assessing the barriers to rational use, and developing and implementing an educational package for resident doctors.

Design

Quality improvement study.

Setting

Neonatal intensive care unit (NICU) from August, 2015 to December, 2016.

Participants

All neonates admitted in NICU and resident doctors working in NICU.

Intervention

Addressing barriers, educational package, posters and group discussions.

Main outcome measures

Laboratory test rates for hematology, biochemistry and blood gas. Proportion of tests judged to be inappropriate.

Results

At the baseline, median (IQR) laboratory test rate patient/day was 0.6 (0.2–1.5) and one-fifth of tests were classified as inappropriate. Mechanical ventilation and sepsis were independent predictors of laboratory test rates but could explain only 35% of the disparities, indicating variations in clinical practice. Following a short period of intervention, hematology investigations showed a trend towards reduction, though overall test rates did not change significantly.

Conclusions

Addressing barriers, creating awareness and educational interventions were able to bring down hematology laboratory test rates in a short period. A longer period of sustained intervention is required to demonstrate significant effects on test ordering behavior.

     

A safe and efficacious preventive strategy in the high-risk surgical neonate: cycled total parenteral nutrition

Introduction

Hepatic dysfunction in patients reliant on total parenteral nutrition (TPN) may benefit from cycled TPN. A concern for neonatal hypoglycemia has limited the use of cycled TPN in neonates less than 1 week of age. We sought to determine both the safety and efficacy of cycled TPN in surgical neonates less than 1 week of age.

Methods

A retrospective chart review was conducted on surgical neonates placed on prophylactic and therapeutic cycled TPN from January 2013 to March 2016. Specific emphasis was placed on identifying incidence of direct hyperbilirubinemia and hypoglycemic episodes.

Results

Fourteen neonates were placed on cycled TPN; 8 were prophylactically cycled and 6 were therapeutically cycled. Median gestational age was 36 weeks (34, 37). Sixty-four percent (n?=?9) had gastroschisis. There was no difference between the prophylactic and therapeutic groups in incidence of hyperbilirubinemia?>?2 mg/dL (3 (37%) vs 5 (83%), p?=?0.08) or the length of time to development of hyperbilirubinemia [24 days (4, 26) vs 27 days (25, 67), p?=?0.17]. Time on cycling was similar though patients who were prophylactically cycled had a shorter overall time on TPN. Three (21%) infants had documented hypoglycemia, but only one infant became clinically symptomatic.

Conclusion

Prophylactic TPN cycling is a safe and efficacious nutritional management strategy in surgical neonates less than 1 week of age with low rates of hypoglycemia and a shorter total course of TPN; however, hepatic dysfunction did not appear to be improved compared to therapeutic cycling.

     

Hyperthyroxinemia at birth: a cause of idiopathic neonatal hyperbilirubinemia?

Background

Some neonates develop idiopathic hyperbilirubinemia (INHB) requiring phototherapy, yet with no identifiable causes. We searched for an association between abnormal thyroid levels after birth and INHB.

Methods

Of 5188 neonates, 1681 (32.4%) were excluded due to one or more risk factors for hyperbilirubinemia. Total thyroxine (TT4) and thyroid stimulating hormone values were sampled routinely at 40–48 hours of age and measured in the National Newborn Screening Program.

Results

Of the 3507 neonates without known causes for hyperbilirubinemia, 61 (1.7%) developed INHB and received phototherapy. Univariate analyses found no significant association between mode of delivery and INHB (vacuum-delivered neonates were a priori excluded). Nonetheless, in cesarean-delivered (CD) neonates, two variables had significant association with INHB: TT4 ≥ 13 µg/dL and birth at 38–38.6 weeks. In vaginally delivered (VD) born neonates, INHB was associated with weight loss > 7.5% up to 48 hours of age. Multivariate logistic regression analysis showed a strong effect of mode of delivery on possible significant association with INHB. In CD neonates, such variables included: TT4 ≥ 13 µg/dL [P = 0.025, odds ratio (OR) 5.49, 95% confidence interval (CI) 1.23–24.4] and birth at 38–38.6 weeks (P = 0.023, OR 3.44, 95% CI 1.19–9.97). In VD neonates, weight loss > 7.5% (P = 0.019, OR 2.1, 95% CI 1.13–3.83) and 1-min Apgar score < 9 (P < 0.001, OR 3.8, 95% CI 1.83–7.9), but not TT4, showed such an association.

Conclusions

INHB was significantly associated with birth on 38–38.6 week and TT4 (≥ 13 µg/dL) in CD neonates, and with a weight loss > 7.5% in VD neonates. We herein highlight some acknowledged risk factors for neonatal hyperbilirubinemia, and thus minimize the rate of INHB.

     

Comparative efficacy and safety of caffeine and aminophylline for apnea of prematurity in preterm (≤34 weeks) neonates: A randomized controlled trial

Objective

To compare the efficacy and safety of standard doses of Caffeine and Aminophylline for Apnea of prematurity.

Study design

Randomized controlled trial.

Setting

Tertiary-care referral centre and a teaching institution in Southern India. Trial was conducted from February 2012 to January 2015.

Participants

240 preterm (≤34 wk) neonates with apnea of prematurity.

Interventions

Neonates randomized into two groups: Caffeine group received loading dose of caffeine citrate (20 mg/kg) followed by 5 mg/kg/day maintenance dose every 24 hour. Aminophylline group received loading dose of Aminophylline–5 mg/kg and maintenance dose of 1.5 mg/kg 8-hourly.

Outcome measures

Difference in apneic spells, associated respiratory morbidity, and acute adverse events were assessed. Association of efficacy with therapeutic drug levels was also evaluated.

Results

Infants on aminophylline experienced less apnea spells in 4-7 days of therapy (P=0.03). Mean apnea rate and isolated desaturations were similar in 1-3, 4-7 and 8-14 days of therapy. No difference was noted in duration of Neonatal Intensive Care Unit stay and hospital stay. Mean heart rate was significantly high in Aminophylline group (P<0.001). Risk of developing tachycardia was less (RR 0.30; 95% CI range 0.15 to 0.60; P<0.001) in Caffeine- over Aminophylline-treated infants.

Conclusion

Aminophylline is as effective as caffeine for prevention of apneic spells in preterm neonates; however, dosage optimization needs to be done to reduce toxicity.

     

Outcome of antenatally presenting posterior urethral valves (PUV) in children

Objective

To analyze the outcome of children with posterior urethral valves who presented with antenatal hydronephrosis.

Methods

A 10-year retrospective review of records of 70 children with posterior urethral valves.

Results

The mean (SD) gestational age at diagnosis was 34 (4.48) weeks, and age at intervention was 130.5 (170.9) days. The nadir creatinine was significantly raised (>1.2 mg/dl) in children with oligohydramnios and diversion.

Conclusion

All boys with antenatally detected hydronephrosis need postnatal evaluation to rule out posterior urethral valves. Short term outcome is improved with postnatal treatments, and longer follow-up is needed to ensure a favourable outcome.

     

A Quality Improvement Initiative for Early Initiation of Emergency Management for Sick Neonates

Objective

To determine efficacy of Point-of-care Quality improvement (POCQI) in early initiation (within 30 minutes) of emergency treatment among sick neonates.

Design

Quality improvement project over a period of twenty weeks.

Setting

Special Newborn Care Unit (SNCU) of a tertiary care center of Eastern India.

Participants

All consecutive sick neonates (≥ 28 wk gestation) who presented at triage during morning shift (8 am to 2 pm).

Intervention

We used a stepwise Plan-do-study-act (PDSA) approach to initiate treatment within 30 min of receiving sick newborns. After baseline phase of one month, a quality improvement (QI) team was formed and conducted three PDSA cycles (PDSA I, PDSA II and PDSA III) of 10 d each, followed by a post-intervention phase over 3 months.

Main outcome measure(s)

Percentage of sick babies getting early emergency management at SNCU triage.

Results

309 neonates were enrolled in the study (56 in baseline phase, 88 in implementation phase and 212 in post-intervention phase). Demographic characteristics including birthweight and gestational age were comparable among baseline and post intervention cohorts. During implementation phase, successful early initiation of management was noted among 47%, 69% and 80% neonates following PDSA I, PDSA II and PDSA III, respectively. In comparison to baseline phase, the percentage of neonates receiving treatment within 30 minutes of arrival at triage increased from 20% to 76% (P<0.001) and the mean (SD) time of initiation of treatment decreased from 80.8 (21.0) to 19.8 (5.6) min (P<0.001) during post-implementation phase. Hospital mortality (33% vs 15%, P=0.004) and need for ventilator support (44% vs 18%, P<0.001) were also significantly lower among post intervention cohort in comparison to baseline cohort.

Conclusion

Stepwise implementation of PDSA cycles significantly increased the percentage of sick newborns receiving early emergency management at the SNCU triage, thereby resulting in better survival.

     

Improving First-hour Breastfeeding Initiation Rate After Cesarean Deliveries: A Quality Improvement Study

Objective

To improve the rates of first hour initiation of breastfeeding in neonates born through cesarean section from 0 to 80% over 3 months through a quality improvement (QI) process.

Design

Quality improvement study.

Setting

Labor Room-Operation Theatre of a tertiary care hospital.

Participants

Stable newborns ≥35 weeks of gestation born by cesarean section under spinal anesthesia.

Procedure

A team of nurses, pediatricians, obstetricians and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by Process flow mapping and Fish bone analysis. Various change ideas were tested through sequential Plan-Do- Study-Act (PDSA) cycles.

Outcome measure

Proportion of eligible babies breast fed within 1 hour of delivery.

Results

The rate of first-hour initiation of breastfeeding increased from 0% to 93% over the study period. The result was sustained even after the last PDSA cycle, without any additional resources.

Conclusions

A QI approach was able to accomplish sustained improvement in first-hour breastfeeding rates in cesarean deliveries.

     

Cytomegalovirus Enterocolitis in a Term Neonate

Background

Cytomegalovirus (CMV) enterocolitis is rare in term neonates.

Case characteristics

A term newborn with persistent pneumonia from birth developed enterocolitis on day 18 of life.

Outcome

Polymerase chain reaction (PCR) for CMV DNA was positive in urine sample. Antiviral therapy for six weeks resulted in successful treatment without any stricture formation.

Message

CMV enterocolitis should be considered as a differential diagnosis in atypical cases of necrotizing enterocolitis in neonates.

     

Effect of delayed cord clamping on hematocrit,and thermal and hemodynamic stability in preterm neonates: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective

To evaluate the short term clinical effects of delayed cord clamping in preterm neonates.

Design

Randomized controlled trial.

Setting

A tertiary care neonatal unit from October 2013 to September 2014.

Participants

78 mothers with preterm labor between 27 to 31^6/7 weeks gestation.

Intervention

Early cord clamping (10 s), delayed cord clamping (60 s) or delayed cord clamping (60 s) along with intramuscular ergometrine (500 μg) administered to the mother.

Main outcome measures

Primary: hematocrit at 4 h after birth; Secondary: temperature on admission in neonatal intensive care unit, blood pressure (non-invasive) at 12 h, and urinary output for initial 72 h.

Results

Mean (SD) hematocrit at 4 h of birth was 58.9 (2.4)% in delayed cord clamping group, and 58.7 (2.1)% in delayed cord clamping with ergometrine group as compared to 47.6 (1.3)% in early cord clamping group. Mean (SD) temperature on admission in NICU was 35.8 (0.2)ºC, 35.8 (0.3)ºC, and 35.5 (0.3)ºC, respectively in these three groups. The mean (SD) non-invasive blood pressure at 12 h of birth was 45.8 (7.0) mmHg, 45.8 (9.0) mmHg, and 35.5 (8.6) mmHg, respectively in these three groups. Mean (SD) urinary output on day 1 of life was 1.1 (0.2) mL/kg/h, 1.1 (0.2) mL/kg/hr and 0.9 (0.2) ml/kg/h, respectively.

Conclusion

In preterm neonates delayed cord clamping along with lowering the infant below perineum or incision site and administration of ergometrine to mother has significant benefits in terms of increase in hematocrit, higher temperature on admission, and higher blood pressure and urinary output during perinatal transition.

     

Assisted Physical Exercise for Improving Bone Strength in Preterm Infants Less than 35 Weeks Gestation: <Emphasis Type="Italic">A Randomized Controlled Trial</Emphasis>

Objective

To compare the efficacy of daily assisted physical exercise (starting from one week of postnatal age) on bone strength at 40 weeks of post menstrual age to no intervention in infants born between 27 and 34 weeks of gestation.

Design

Open-label randomized controlled trial.

Setting

Tertiary-care teaching hospital in northern India from 16 May, 2013 to 21 November, 2013.

Participants

50 preterm neonates randomized to Exercise group (n=26) or Control group (n=24).

Intervention

Neonates in Exercise group underwent one session of physical exercise daily from one week of age, which included range-of-motion exercises with gentle compression, flexion and extension of all the extremities with movements at each joint done five times, for a total of 10-15 min. Infants in Control group underwent routine care and were not subjected to any massage or exercise.

Outcome measures

Primary: Bone speed of sound of left tibia measured by quantitative ultrasound at 40 weeks post menstrual age. Secondary: Anthropometry (weight length and head circumference) and biochemical parameters (calcium, phosphorus, alkaline phosphatase) at 40 weeks post menstrual age.

Results

The tibial bone speed of sound was comparable between the two groups [2858 (142) m/s vs. 2791 (122) m/s; mean difference 67.6 m/s; 95% CI -11 to 146 m/s; P=0.38]. There was no difference in anthropometry or biochemical parameters.

Conclusion

Daily assisted physical exercise does not affect the bone strength, anthropometry or biochemical parameters in preterm (27 to 34 weeks) infants.

     

Hämorrhagischer Schock im frühen Kindesalter – Besonderheiten der Kreislaufregulation

Background

Acute hemorrhages in neonates and young children can be compensated for a long period of time until a decrease in blood pressure and manifest shock occur.

Objective

To determine the characteristics of the pathophysiology of the circulation in children and to recognize critical signs and symptoms of hemorrhage.

Material and methods

Pathophysiology and discussion of the literature

Results

Shock in neonates and children can be present long before a decrease in blood pressure occurs. It is characterized by tachycardia, tachy(dys)pnea, prolonged capillary refilling time, disorders of consciousness (apathy), disturbance of temperature regulation and reduced urine output. Laboratory markers are metabolic acidosis and elevated lactate and a normocytic anemia earlier than in adults.

Conclusion

In contrast to adults a decrease in blood pressure in neonates and young children is a late sign of shock, whereas normocytic anemia occurs earlier than in adults.

     

Outcomes of Children with Severe Acute Malnutrition in a Tribal Daycare Setting

Objective

To describe the nutritional outcomes of children with severe acute malnutrition (SAM) in a village-level intervention.

Methods

This observational longitudinal study on 179 children aged <3 years was conducted in seven tribal blocks of Central and Eastern India with SAM managed in a comprehensive day care program.

Results

76% children with SAM showed improvement over a 4-6 months period, with 37% shifting to normal anthrometric status. There was a significant shift in Z scores.

Conclusions

This community-based intervention showed fair results for management of children with SAM at village level.

     

Effect of conventional and LED phototherapy on the antioxidant-oxidant status in preterm neonates with jaundice

Objective

To compare oxidative stress due to conventional and LED phototherapy among jaundiced preterm neonates.

Methods

Cross-sectional study conducted in NICU on 82 neonates (equal numbers received conventional and LED phototherapy). Total antioxidant capacity (TAC), total oxidant status (TOS) and Oxidative stress index (OSI) were assessed.

Results

Post-phototherapy, mean (SD) OSI increased significantly compared to baseline in both conventional [0.26 (0.24) vs. 0.61 (0.41); P <0.001] and LED groups [0.24 (0.20) vs. 0.32 (0.23); P <0.001]. Across groups, mean (SD) TAC was lower [0.28 (0.16) vs. 0.53 (0.27); P <0.001] mmol Trolox equiv/L; mean (SD) TOS higher [15.6 (10.9) vs. 14.6 (10.2); P=0.711] μmol H₂O₂/L and mean (SD) OSI higher [0.61 (0.42) vs. 0.33 (0.23); P <0.001] in conventional as compared to LED phototherapy.

Conclusion

Both modes increased oxidative stress index; however, conventional phototherapy resulted in higher oxidative stress.