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.     

Bilirubin rebound after intensive phototherapy for neonatal jaundice

This study was conducted to determine the incidence and magnitude of postphototherapy bilirubin rebound in neonates. Subjects included inborn neonates needing phototherapy for hyperbilirubinemia. Standard guidelines were used to start and stop phototherapy. Rebound bilirubin was measured 24±6 h after stopping phototherapy. Significant bilirubin rebound (SBR) was defined as postphototherapy bilirubin level needing reinstitution of phototherapy. Among 245 neonates with hyperbilirubinemia, post-phototherapy bilirubin estimation was done in 232 neonates. A total of 17 (7.3%) neonates developed SBR. In neonates with SBR, bilirubin increased by 2.3 mg/dL (95% CI 1.6–3.0) after stopping phototherapy. Risk factors for SBR included birth at <35 weeks of gestation (RR 4.3, 95% CI 1.5–12.0), birthweight <2000 g (RR 3.2, 95% CI 1.0–10.3) and onset of jaundice at <60 h of age (RR 3.3, 95% CI 1.2–9.0). Post-phototherapy discharge and follow-up planning should take into account these risk factors.     

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.     

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.     

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     

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.     

Clinical usefulness of high intensity green light phototherapy in the treatment of neonatal jaundice

Two matched groups of term newborn infants with idiopathic jaundice were subjected to intensive double direction green or blue light phototherapy (PT). The efficacy of treatment was expressed as rate of decline of serum bilirubin concentration after 6, 12 and 24 h of light exposure. More rapid response was obtained using conventional blue lamps (Philips TL/20W/52) than green lamps (Sylvania F20T12/G). Whole duration of PT was significantly shorter using blue lamps (P<0.05). However, less postphototherapy rebound was observed in babies treated with green light PT. It can be concluded that green light PT is useful but not preferable to blue light PT for clinical use in the treatment of neonatal jaundice.     

A new device for diagnosis and treatment of neonatal pneumothorax.

A new closed-system device for the diagnosis and treatment of pneumothorax was evaluated in ten New Zealand white rabbits and compared with and open-system needle. The closed-system device proved to be safe for diagnostic thoracentesis. There were no pneumothoraces as a result of the procedure with the closed-system device as confirmed by chest roentgenograms and pleural pressure measurements. In contrast, 70% of the diagnostic thoracenteses with the open-system needle were associated with pneumothorax documented by x-ray films and a significant increase in mean pleural pressure. The new apparatus was more efficacious for evacuation of pneumothoraces because complete air removal occurred in 90% of the rabbits as compared with 60% of trials with the open-system needle. If the efficacy of the new closed-system device proves to be good in human infants, the pediatrician encountering a tension pneumothorax in the newborn can use a completely assembled system that is safe for diagnosing and treating this acute life-threatening condition.