Home phototherapy treatment of neonatal jaundice

A home phototherapy program for healthy, term newborns with hyperbilirubinemia (n = 62) was implemented, and results were compared prospectively with a group of term neonates who met enrollment criteria but were treated in-hospital (n = 55). The purpose of the study was to prospectively assess the feasibility, safety, and effectiveness of home phototherapy in treating uncomplicated neonatal jaundice. Infants were required to be greater than 24 hours old and to weigh at least 2,270 g (5 lb). Enrolling physicians were instructed to select infants whose clinical diagnoses and bilirubin levels allowed an adequate margin of error for a trial of home phototherapy and whose parents were capable of managing the added responsibilities of home therapy. At the time the phototherapy equipment was delivered and set up in their home, parents received extensive instruction, including how to record pertinent ongoing data on a home flow sheet. Serum bilirubin levels were measured at least daily. The preponderant diagnosis listed by enrolling physicians was "physiologic jaundice." No parent reported significant complications, and no infant required rehospitalization. Bilirubin levels decreased as rapidly in the home group as in the hospitalized control group, and duration of treatment averaged 2.8 days. About $18,000 was saved by treating these 62 infants at home compared with in-hospital costs in our community. We found home phototherapy to be a feasible, safe, and effective alternative to in-hospital phototherapy for otherwise healthy, jaundiced infants with motivated and capable parents.     

A new device for phototherapy of neonatal jaundice]

The effectiveness of a new device for phototherapy in the treatment of nonhemolytic hyperbilirubinemia (Wallaby Phototherapy System) was evaluated. 46 healthy term infants, appropriate for gestational age and with serum bilirubin > 12 mg/dl in the first 3 days of life or > 15 mg/dl after 3rd day were randomly assigned to a treatment group (24 hours of light exposure with Wallaby Phototherapy System) and to a control group (any treatment for hyperbilirubinemia). Body temperature, weight, feeding and hydration were recorded during the study period. Serum bilirubin and haematocrit were done every 12 hours in all babies. In the treated group we found a decrease of 5.1% and of 7.8% at 12 and 24 hours, while an increase of 3.37% and of 2.9% at 12 and 24 hours was found in the control group. After 24 hours the serum bilirubin level was significantly lower in the treated group than in the control group (p < 0.05). No newborn of the treated group needed conventional phototherapy versus 4 control infants (17.4%). The conclusion of our study is that the Wallaby System is useful in the treatment of neonatal nonhemolytic hyperbilirubinemia even if its effectiveness for higher bilirubin levels has still to be tested.     

Absence of bilirubin binding competitors during phototherapy for neonatal jaundice

Bilirubin-albumin binding was quantitated (peroxidase method) before, during, and after phototherapy in 21 jaundiced infants. Binding was analyzed at two different serum dilutions (1: 1.8 and 1 : 57) to determine whether binding competitors are present during phototherapy. No significant changes in binding were found at either dilution during phototherapy, regardless of birthweight, gestational age, or illness. Serum binding of bilirubin does not appear to be altered during phototherapy.     

Comparison of the effectiveness of single-direction and double-direction phototherapy for neonatal jaundice.

Two matched groups of Chinese infants with "idiopathic" jaundice were subjected to phototherapy, one group to "single-direction" phototherapy and the other to "double-direction" phototherapy. The total energy output on the skin of the infants was similar in both groups. The 24-hour fall in bilirubin levels was almost identical in the two groups; the number of infants in each group achieving bilirubin levels less than 11 mg/100 ml at 24, 48, and 72 hours was statistically very similar too. Where the energy output can be adjusted to supply a constant dose on the infant (by varying the energy output in inverse proportion to the skin area exposed), the effect of varying the skin area under phototherapy is minimal. However, the total area of skin exposed to phototherapy under uniform lighting conditions is important because it determines the dose of energy output acting on it, and hence the effectiveness of the procedure.     

Recooling for rebound seizures after rewarming in neonatal encephalopathy

Infants undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy are at risk for rebound seizures during and after the rewarming phase. We report a term male infant who was cooled for hypoxic ischemic encephalopathy. He developed electrographic seizures for the first time during the warming phase, which continued in the hours after rewarming. The seizures stopped within 30 minutes of recooling to 33.5°C without anticonvulsant medication. He was uneventfully cooled for an additional 24 hours and then rewarmed with no recurrence of seizures. Hypothermia appeared to have an antiepileptic effect in this case and may be worthy of additional investigation as an adjunct to antiepileptic drug therapy in newborns.     

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. Conclusions These results suggest that open bed phototherapy does not inhibit the cardiovascular responsiveness to local thermal skin stimulation in healthy term infants. Received: 30 March 1998 / Accepted in revised form: 10 September 1998     

Relative roles of phototherapy and phenobarbitone in treatment of nonhaemolytic neonatal jaundice

Trials were carried out on 61 infants with plasma bilirubin over 15 mg/100 ml to compare effects of phototherapy alone, phenobarbitone by injection, and both treatments combined. Infants above 2·5 kg birthweight treated with phenobarbitone only behaved like untreated controls up to 60 hours, and only at 84 hours was a significant fall seen. Infants of 2·5 kg birthweight or less treated with phenobarbitone had significantly higher levels throughout the 84 hours of study. Phototherapy, either alone or combined with phenobarbitone, had its expected significant effect from 24 hours onwards in both groups of infants. Combined phototherapy and phenobarbitone treatment showed no difference from phototherapy alone. Phenobarbitone has no place in the management of established jaundice. Risks of phenobarbitone therapy and a possible explanation of contradictory results in previous trials are discussed. No changes were found in packed cell volumes, plasma albumin level, or residual albumin binding capacity at 48 hours from onset of treatment or between groups.     

强光疗治疗新生儿高胆红素血症的疗效及安全性

目的 探讨采用强光疗治疗新生儿高胆红素血症的疗效及安全性。方法 对144 例新生儿高胆红素血症患儿进行前瞻性随机分组,其中强光疗组和传统光疗组各72 例,对两组疗效及并发症等情况进行比较。结果 光疗后12 h 内强光疗组患儿血总胆红素水平明显低于传统光疗组(P<0.05),且胆红素下降幅度明显高于传统光疗组(P<0.05)。强光疗组患儿总光疗时间明显短于传统光疗组(P<0.05)。两组患儿光疗后发热、腹泻、皮疹、低钙血症发生率及光疗后血钙水平和血红蛋白下降水平等比较差异均无统计学意义。结论 强光疗在光疗开始初期可迅速有效降低高胆红素血症患儿血中胆红素水平,缩短总光疗时间,且不增加不良反应的发生率,是一种优于传统光疗的治疗措施。     

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 nursery of the Hospital Universiti Sains Malaysia, Kelantan, Malayasia. PATIENTS: Term newborns with uncomplicated neonatal jaundice presenting in the first week of life. INTERVENTIONS: Phototherapy with white curtains hanging from the sides of the phototherapy unit (study group, n = 50) was compared with single phototherapy without curtains (control group, n = 47). MAIN OUTCOME MEASURES: The primary outcome was the mean difference in total serum bilirubin measured at baseline and after 4 h of phototherapy. The secondary outcome was the duration of phototherapy. RESULTS: The mean (standard deviation) decrease in total serum bilirubin levels after 4 h of phototherapy was significantly (p<0.001) higher in the study group (27.62 (25.24) micromol/l) than in the control group (4.04 (24.27) micromol/l). Cox proportional hazards regression analysis indicated that the median duration of phototherapy was significantly shorter in the study group (12 h) than in the control group (34 h; chi(2) change 45.2; p<0.001; hazards ratio 0.20; 95% confidence interval 0.12 to 0.32). No difference in adverse events was noted in terms of hyperthermia or hypothermia, weight loss, rash, loose stools or feeding intolerance. CONCLUSION: Hanging white curtains around phototherapy units significantly increases efficacy of phototherapy in the treatment of neonatal jaundice without evidence of increased adverse effects.