Efficacy of double and triple phototherapy in term newborns with hyperbilirubinemia: the first clinical trial

Effectiveness of Dual-Blanket Phototherapy Compared With Combination Phototherapy on Rate of Bilirubin Decline and Treatment Duration

INTRODUCTION

The purpose of this study was to evaluate the effectiveness of dual light-emitting diode (LED) blanket phototherapy compared with combination LED phototherapy on the rate of total serum bilirubin (TSB) decline and treatment duration among full-term neonates with hyperbilirubinemia.

METHODS

A retrospective chart review of 255 newborns with hyperbilirubinemia admitted to a free-standing, university-affiliated, nonprofit, tertiary care Children's Hospital was conducted. Phototherapy type, duration, and rate of TSB decline were compared.

RESULTS

The rate of TSB decline was significantly higher among neonates treated with combination LED phototherapy than neonates treated with dual-blanket phototherapy (p <.0001). There was no significant difference in phototherapy duration.

DISCUSSION

Combination phototherapy resulted in a more rapid decline in TSB but did not shorten phototherapy duration compared to dual-blanket phototherapy. Phototherapy duration may have been confounded by variability in the timing of TSB laboratory draws. Further comparative effectiveness studies are recommended.

Icterus Neonatorum in Near-Term and Term Infants: An overview

Neonatal jaundice is the yellowish discoloration of the skin and/or sclerae of newborn infants caused by tissue deposition of bilirubin. Physiological jaundice is mild, unconjugated (indirect-reacting) bilirubinaemia, and affects nearly all newborns. Physiological jaundice levels typically peak at 5 to 6 mg/dL (86 to 103 μmol/L) at 72 to 96 hours of age, and do not exceed 17 to 18 mg/dL (291-308 μmol/L). Levels may not peak until seven days of age in Asian infants, or in infants born at 35 to 37 weeks' gestation. Higher levels of unconjugated hyperbilirubinaemia are considered pathological and occur in a variety of conditions. The clinical features and management of unconjugated hyperbilirubinaemia in healthy near-term and term infants, as well as bilirubin toxicity and the prevention of kernicterus, are reviewed here. The pathogenesis and aetiology of this disorder are discussed separately.

An evidence-based view on hyperbilirubinaemia

INTRODUCTION

We conducted a review of the evidence which contributes to the current care of jaundiced newborn infants.

METHODS

Literature was searched for reviews and randomized controlled trials (RCTs).

RESULTS

Six Cochrane reviews and eight other reviews and eighteen recent RCTs are discussed.

CONCLUSIONS

Many children still suffer life-long consequences of severe hyperbilirubinaemia, which could almost always have been prevented relatively easily. Up to date, guidelines summarizing the available evidence into unambiguous recommendations are needed to guide healthcare professionals in the prevention, diagnosis and treatment for infants with hyperbilirubinaemia.