Phototherapy and risk of childhood cancer: A systematic review and meta-analysis

ObjectiveThis study aims to conduct a systematic review and meta-analysis of the scientific studies on the associations between phototherapy and risk of childhood cancer.MethodsElectronic databases including PubMed, Scopus, and Web of Science were searched until March 28, 2020. In general, 11 studies were included in the meta-analyses. Subgroup analyses were performed on the types of cancers and children's age, and the sensitivity analysis was done to search for heterogeneity sources.ResultsThe findings of the meta-analysis show that phototherapy was significantly associated with an increased risk of all types of cancers (RR = 1.28; 95% CI (1.08, 1.51)).ConclusionThis systematic review and meta-analyses indicated that neonatal phototherapy might be a possible risk factor for childhood cancer in general, and leukemia in particular. However, as the role of confounding factors were not controlled in many studies, future large cohorts are necessary in this regard. The findings of this study underscore the importance of greater adherence to scientific guidelines for thresholds of bilirubin for minimizing unnecessary exposure to phototherapy.     

不同剂量丙种球蛋白治疗ABO溶血病疗效比较

目的比较不同剂量静脉注射用丙种球蛋白(IVIG)治疗新生儿ABO血型不合溶血病的疗效。方法将出生后2 d内确诊的新生儿ABO血型不合溶血病患儿随机分为单剂组(70例)和多剂组(66例),单剂组静脉滴注IVIG 1 g/(kg.d),1 d;多剂组剂量500 mg/(kg.d),共3 d。生后第42天随访血红蛋白及生长发育等情况。结果单剂组需要双面光疗时间较多剂组短(P<0.01),两组患儿第42天血红蛋白水平、贫血发生率差异无显著性,两组患儿均不需换血治疗,均未发生胆红素脑病。结论单次大剂量IVIG(1 g/kg)治疗新生儿ABO血型不合溶血病是一种高效、经济、安全的治疗方法。     

Reversibility of acute intermediate phase bilirubin encephalopathy

Aim:  To show the potential for reversing acute intermediate to advanced phase bilirubin encephalopathy.
Methods:  Case studies.
Results:  Six extremely jaundiced infants had symptoms of intermediate to advanced phase acute bilirubin encephalopathy. The infants were treated aggressively. Two patients had brain magnetic resonance imaging showing increased signals in the globus pallidus. On follow-up, all infants are neurologically normal.
Conclusions:  Intermediate-to-advanced stage acute bilirubin encephalopathy may occasionally be reversible. These cases provide a strong argument in favour of rapid and aggressive intervention in infants presenting with extreme jaundice and neurological symptoms.     

EFFECT OF LIGHT EXPOSURE ON GUT TRANSIT TIME IN JAUNDICED NEWBORNS

In order to elucidate the mechanism by which phototherapy induces loose stools in newborns, studies were performed on the speed of gut transit by performing the Carmine Red test on normal newborn, on jaundiced newborns before and after phototherapy. A statistically accelerated intestinal transit was observed in jaundiced newborns treated with phototherapy. The increased rate of intestinal transit produced by phototherapy is probably due to the action of the photo-decomposition derivatives of bilirubin, which are excreted during phototherapy.     

Haemodynamic consequences of phototherapy in term infants

The effect of blue-light phototherapy on cardiac output and brain and kidney perfusion was studied in 12 term infants with pulsed Doppler ultrasound. Mean (±SD) gestational age and birth weight were 39.0 (±1.6) weeks and 3438 (±533) g respectively. Mean (±SD) age of the infants at which phototherapy was initiated was 3.5 (±0.8) days. Left ventricular output (LVO), mean left pulmonary artery blood flow (LPA), mean blood flow velocities of the internal carotid (CBFV) and renal (RBFV) arteries were studied in all infants prior to the onset of phototherapy, 30 min, 2 h, and 12 h after initiation of phototherapy, and before and 12–24 h after discontinuation of phototherapy. LVO decreased immediately after the onset of phototherapy. However, after 12 h, LVO returned to pre-phototherapy values. LPA increased significantly after 12 h of exposure. LPA returned to pre-phototherapy values after discontinuation of phototherapy. CBFV increased, whereas RBFV decreased significantly after 2 h of exposure. After discontinuation of phototherapy CBFV as well as RBFV values returned to pre-phototherapy values. Conclusion Phototherapy does affect cardiac output and organ blood flow velocity in term infants. After termination of phototherapy the effect of phototherapy disappears. Received: 14 August 1997 / Accepted in revised form: 17 May 1998     

Effect of publication of the "Practice Parameter for the management of hyperbilirubinemia" on treatment of neonatal jaundice

The aim of this study was to evaluate the change in the treatment of neonatal jaundice following introduction of the "American Academy of Pediatrics' Practice Parameter for the management of hyperbilirubinemia in the healthy term newborn". In a historical control observation cohort study, we examined the rate of phototherapy and exchange transfusions among full-term (> or = 37 wk gestation) and near-term (gestational age between 35 and 37 wk and birthweight > 2000 g) infants in two community hospitals. The study included all consecutive infants born during two 15-mo study periods immediately before and after the introduction of the new guidelines. Data were prospectively recorded in a computerized database. The rate of phototherapy significantly decreased in the second study period from 7.9% (514/6499) to 2.9% (251/8650) (p < 0.0001) among full-term infants, and from 20.9% (102/489) to 9.4% (47/502) (p < 0.0001) in near-term infants. The use of exchange transfusion was significantly higher (p < 0.001) in the first compared to the second period: 0.2% (15/6499) vs 0.03% (3/8650). A significant decrease was found when the data from each hospital were analyzed separately. CONCLUSION: A significant decrease in the use of phototherapy and exchange transfusion occurred after the publication of the new practice parameters. This trend was observed for both term and preterm newborns, although the new guidelines were not intended for infants born before term.     

Transcutaneous bilirubinometry in preterm infants

The aim of this study was to evaluate the accuracy and safety of transcutaneous bilirubinometry in preterm infants using the new bilirubin analyser BiliCheck^±. The study included 145 preterm children (23–36 wk gestation). Capillary blood sampling for determination of serum bilirubin (BS) was combined with transcutaneous bilirubin measurement (BTc) every morning until the sixth postnatal day and related to several clinical data (phototherapy (PT), infection signs, breathing disturbances, skin bleeding, etc.). Overall bilirubin concentration ranged from 17 to 371 μmol/l, and from 21 to 325 μmol/l for BS and BTc, respectively. Mean values obtained by BTc were significantly higher than BS values. The correlation coefficient between BS and BTc was r= 0.64 for the whole group, and r= 0.73 in infants without PT. As demonstrated by multiple regression analysis, BS‐BTc correlations were related only to gestational age (beta ‐0.32) and breathing disturbances (beta 0.29), indicating that the lower the gestational age and the more seriously ill the baby, the higher the incoherence between BS and BTc. Conclusion: BiliCheck^±provides a convenient, non‐invasive possibility for bilirubin estimation in preterm infants. However, there are limitations: the method gives reliable results only in newborns older than 30 wk gestation, without PT and artificial ventilation.     

痤疮的治疗进展

痤疮是一种毛囊皮脂腺的慢性炎症,因皮脂腺管与毛孔的堵塞,致使皮脂外流不畅所致。其主要发生于面、胸背等处,形成黑头、丘疹、脓疱、结节等损害,严重者可影响患者生活质量。正常人群的患病率很高,特别是青少年。痤疮不仅影响美观,而且严重者影响身心健康。因此,痤疮的治疗尤为重要。痤疮的治疗包括药物治疗和非药物治疗。目前,许多新药和新疗法不断应用于临床,取得了不错的疗效。     

改良护眼法在新生儿蓝光治疗中的应用

目的探讨改良护眼法在新生儿蓝光治疗中保护新生儿眼部的效果。方法选择新生儿病理性黄疸儿120例,随机分为改良组60例与对照组60例,改良组采用自制眼罩加用医用纱布敷料包裹,再在紧贴双眼部一面两侧各滴1²滴妥布霉素眼药水湿润后遮盖双眼部,对照组采用自制眼罩直接遮盖眼部,两组均采用3M胶布固定。对比2组患儿光疗24 h后眼部皮肤红肿、皮疹和眼睛分泌物的发生率。结果改良组的发生率明显低于对照组,2组差异具有统计学意义(p<0.05)。结论采用改良护眼法可有效保护眼睛,避免局部皮肤出现红肿、皮疹及眼部分泌物,提高患儿舒适感,推进优质护理服务。