新生儿高胆红素血症光疗的副作用

自上世纪50年代以后，蓝光被广泛使用于新生儿高胆红素血症的治疗中。新生儿光疗可有效降低血清未结合胆红素,预防胆红素脑病的发生，极大地降低了交换输血疗法的使用频率。普遍认为光疗副作用轻微并且容易控制。但是最近研究提供了光疗副作用的新证据。光疗近期副作用包括影响母婴互动、体温失衡和水分丢失、电解质紊乱、生理节律紊乱和青铜症等。此外，光疗可能与黑素痣和皮肤癌、动脉导管未闭、视网膜损伤及成年生殖能力受损等远期副作用相关。因此，需要制定完善的循证指南，发展包括光导纤维光毯和发光二极管在内的新设备，以及光疗替代制剂，并在此基础上探讨个体化治疗，以最大程度减少光疗副作用。

Side effects of phototherapy for neonatal hyperbilirubinemia

Blue light has been widely used for the treatment of neonatal hyperbilirubinemia since the 1950s. Neonatal phototherapy can decrease plasma unconjugated bilirubin level, thus preventing bilirubin encephalopathy, and greatly reduces the exchange transfusion rate. Generally, it is accepted that the side effects of neonatal phototherapy are not serious and seem to be well controlled, however recent research has provided new evidence. The short-term side effects of phototherapy include interference with maternal-infant interaction, imbalance of thermal environment and water loss, electrolyte disturbance, bronze baby syndrome and circadian rhythm disorder. In addition, phototherapy may be associated with some long-term side effects such as melanocytic nevi and skin cancer, allergic diseases, patent ductus arteriosus and retinal damage. Therefore, it is necessary to develop evidence-based guidelines, new light devices and alternative agents, as well as individualized treatments, to minimize the side effects of phototherapy.