1
|
Demirel HN, Ozumut SS, Ovalı HF. Continuous versus intermittent phototherapy in treatment of neonatal jaundice: a randomized controlled trial. Eur J Pediatr 2024; 183:3389-3396. [PMID: 38767694 DOI: 10.1007/s00431-024-05610-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
Phototherapy (PT) is a widely used treatment for neonatal jaundice, yet the ideal model of application remains controversial. In this study, the effects of continuous phototherapy (CPT) and intermittent phototherapy (IPT) models were compared in the treatment of neonatal indirect hyperbilirubinemia (IHB) and whether IPT is a superior modality is investigated. Single-centre parallel randomized controlled open label trial. A computer-based table of random numbers was used to allocate treatments. Newborns ≥ 34 weeks' gestation who received phototherapy in our neonatal intensive care unit (NICU) between July 2022 and April 2023 were included. CPT was applied continuously for 6 h, and IPT was applied as 2 cycles of 1 h on and 2 h off in a 6-h session. Rebound TSB was measured 8 h after phototherapy was stopped in both groups. Phototherapy duration, TSB reduction rate and rebound bilirubin rate were compared between intervention groups. One hundered and four neonates met the inclusion criteria during the study period. CPT and IPT were each used in 52 newborns. Demographic characteristics of the study groups, including sex, mode of delivery, birth weight, admission weight, age at postnatal presentation, diet, discharge weight, and history of PT in siblings, were similar (p > 0.05). The most common cause of IHB in both groups was ABO incompatibility. The median phototherapy time was 12 h (6-15) in the CPT group and 4 h (2-4) in the IPT group (p < 0.001). The mean rate of bilirubin decrease was 1.12 ± 0.73 mg/dl/h in those who underwent IPT and 0.51 ± 0.33 mg/dl/h in those who underwent CPT (p < 0.001). The mean rebound bilirubin rate 8 h after phototherapy was 0.08 ± 0.28 mg/dl/h in the CPT group, and -0.01 ± 0.17 mg/dl/h in the IPT group (p = 0.039). The length of hospital stay was longer in the CPT group (p = 0.032). Skin rash, diarrhoea and increased body temperature were less frequent in the IPT group (p < 0.001). CONCLUSIONS In this study, IPT was found to be at least as effective as CPT in reducing total serum bilirubin. Even though the duration of PT is shorter in IPT, the slower rate of rebound bilirubin, shorter hospital stays and lower incidence of side effects indicated that intermittent phototherapy is superior to continuous phototherapy. Choosing IPT over CPT is a more rational approach in neonatal jaundice. CLINICALTRIALS gov Identifier: NCT06386731 (registered retrospectively on 23/04/2024) What is Known: • PT is common used in the treatment of neonatal jaundice. • There is no standard model of application for PT. WHAT IS NEW • The IPT model is as effective as CPT. • Newborns are discharged faster with IPT.
Collapse
Affiliation(s)
- Hande Nur Demirel
- Goztepe Prof. Dr Suleyman Yalcın City Hospital, Department of Paediatrics, Barbaros Mah, Ardic sokak Kentplus F3/23, 34746, Atasehir, Istanbul, Turkey
| | - Sibel Sevuk Ozumut
- Goztepe Prof. Dr Suleyman Yalcın City Hospital, Department of Paediatrics, Barbaros Mah, Ardic sokak Kentplus F3/23, 34746, Atasehir, Istanbul, Turkey.
| | - Husnu Fahri Ovalı
- Istanbul Medeniyet University, Goztepe Prof. Dr Suleyman Yalcın City Hospital, Department of Paediatrics and Neonatology, Istanbul, Turkey
| |
Collapse
|
2
|
Abdellatif M, Tawfik GM, Makram AM, Abdelsattar MK, Dobs M, Papadopoulos DN, Hoang-Trong BL, Mostafa EM, Duong PDT, Huy NT. Association between neonatal phototherapy and future cancer: an updated systematic review and meta-analysis. Eur J Pediatr 2023; 182:329-341. [PMID: 36352244 DOI: 10.1007/s00431-022-04675-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/11/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022]
Abstract
Phototherapy is the main treatment of neonatal hyperbilirubinemia to prevent encephalopathy. It is generally believed to be safe; however, some studies have shown it might be associated with cancer development. In this systematic review and meta-analysis, we aimed to assess the effect of neonatal phototherapy on future cancer risk. A systematic search in 13 databases was conducted in December 2018 and updated in August 2022 to identify studies that report cancer development after exposure to phototherapy. Throughout the study period, regular manual searches were also conducted to include new studies. A meta-analysis using R programming language was done in which the odds ratios (ORs) with 95% confidence intervals (CIs) were estimated and pooled using the reported adjusted and unadjusted data. Fifteen studies were included. A statistically significant association was detected between neonatal phototherapy and any type of cancer (OR 1.24; 95% CI 1.1, 1.4), any hematopoietic cancer (OR 1.49; 95% CI 1.17, 1.91), any leukemia (OR 1.35; 95% CI 1.08, 1.67), and myeloid leukemia (OR 2.86; 95% CI 1.4, 5.84). The other investigated cancers (lymphoid leukemia, Hodgkin's lymphoma, kidney cancer, nervous system cancer, and skin cancer) were not associated with phototherapy. Conclusions: Phototherapy may carry a possible risk of future cancers. Future research is needed to quantify the magnitude of the cancer risk. These future studies should consider predictors of preterm birth or exclude premature babies from their analysis. What is Known • There were various reports about the possible association between phototherapy in neonates and the increased risk of cancer in the future. What is New • A statistically significant association between phototherapy and various hematopoietic cancers (especially myeloid leukemia) was recorded. • The effect of the duration of phototherapy on the increased risk of hematopoietic cancers is yet unclear.
Collapse
Affiliation(s)
| | - Gehad Mohamed Tawfik
- Online Research Club, Nagasaki, Japan.,.,Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdelrahman M Makram
- Online Research Club, Nagasaki, Japan.,.,Faculty of Medicine, October 6 University, Giza, Egypt.,School of Public Health, Imperial College London, London, UK
| | | | - Monica Dobs
- Online Research Club, Nagasaki, Japan.,.,Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Dimitrios N Papadopoulos
- Online Research Club, Nagasaki, Japan.,.,Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Bao-Long Hoang-Trong
- Online Research Club, Nagasaki, Japan.,.,Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Esraa Mahmoud Mostafa
- Online Research Club, Nagasaki, Japan.,.,Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Pham Diep Thuy Duong
- Pediatric Department, Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Nguyen Tien Huy
- Online Research Club, Nagasaki, Japan. .,, . .,School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| |
Collapse
|
3
|
Wang J, Guo G, Li A, Cai WQ, Wang X. Challenges of phototherapy for neonatal hyperbilirubinemia (Review). Exp Ther Med 2021; 21:231. [PMID: 33613704 PMCID: PMC7859475 DOI: 10.3892/etm.2021.9662] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022] Open
Abstract
Phototherapy is universally recognized as the first option for treating neonatal jaundice due to its unparalleled efficiency and safety in reducing the high serum free bilirubin levels and limiting its neurotoxic effects. However, several studies have suggested that phototherapy may elicit a series of short- and long-term adverse reactions associated with pediatric diseases, including hemolysis, allergic diseases, DNA damage or even cancer. The aim of the present review was to summarize the etiology, mechanism, associated risks and therapeutic strategies for reducing high neonatal serum bilirubin levels. In order to shed light on the negative effects of phototherapy and to encourage implementation of a reasonable and standardized phototherapy scheme in the clinic, the present review sought to highlight the current understanding of the adverse reactions of phototherapy, as it is necessary to further study the mechanism underlying the development of the adverse effects of phototherapy in infants in order to explore novel therapeutic alternatives.
Collapse
Affiliation(s)
- Juan Wang
- Department of Biochemistry and Molecular Biology, Health Science Center, Yangtze University, Jingzhou, Hubei 434023, P.R. China.,Department of Pediatrics, The Second School of Clinical Medicine and Jingzhou Central Hospital, Yangtze University, Jingzhou, Hubei 434023, P.R. China
| | - Genxin Guo
- Department of Thoracic Surgery, Xiantao First People's Hospital of Yangtze University, Xiantao, Hubei 433000, P.R. China
| | - Aimin Li
- Department of Pediatrics, The Second School of Clinical Medicine and Jingzhou Central Hospital, Yangtze University, Jingzhou, Hubei 434023, P.R. China
| | - Wen-Qi Cai
- Department of Biochemistry and Molecular Biology, Health Science Center, Yangtze University, Jingzhou, Hubei 434023, P.R. China
| | - Xianwang Wang
- Department of Biochemistry and Molecular Biology, Health Science Center, Yangtze University, Jingzhou, Hubei 434023, P.R. China
| |
Collapse
|
4
|
Chu L, Xue X, Qiao J. Efficacy of Intermittent Phototherapy versus Continuous Phototherapy for Treatment of Neonatal Hyperbilirubinaemia: A Systematic Review and Meta-analysis. J Adv Nurs 2020; 77:12-22. [PMID: 33150664 DOI: 10.1111/jan.14535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/25/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
AIMS We review the current literatures to determine whether intermittent phototherapy is more effective than continuous phototherapy in treating neonatal hyperbilirubinaemia. DESIGN The systematic review is a systematic review and meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for reporting methods and results of synthesis with meta-analysis. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis. DATA SOURCE Pubmed, Embase, Cochrane library, China National Knowledge Infrastructure, China Biology Medicine, VIP Database, and Wanfang Database. REVIEW METHODS PICOS eligibility criteria were used to select original studies published from 1984 through 2019. Data were statistically extracted and evaluated using RevMan 5.3 software. RESULTS A total of 416 records were identified through database searching. Four studies (three randomized studies and one retrospective study) meet the final inclusion criteria. Seven hundred and sixteen neonates were included in the meta-analysis. There was no difference in the treatment efficacy and total serum bilirubin (TSB), while there was a significant difference in phototherapy duration and side effects after treatment of intermittent phototherapy and continuous phototherapy for neonatal hyperbilirubinaemia. CONCLUSION Intermittent phototherapy appeared to be as effective as continuous phototherapy for the treatment of neonatal hyperbilirubinaemia and is safer than continuous phototherapy. Healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinaemia. IMPACT Intermittent phototherapy is an effective, feasible, and safer treatment method for the infants with hyperbilirubinaemia in paediatric department. Healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinaemia.
Collapse
Affiliation(s)
- Liangliang Chu
- Nursing, Shandong University, Qianfoshan Hospital, Jinan, China
| | - Xiujuan Xue
- Nursing, Shandong University, Qianfoshan Hospital, Jinan, China
| | - Jianhong Qiao
- Nursing, Shandong University, Qianfoshan Hospital, Jinan, China
| |
Collapse
|
5
|
Hansen TWR, Maisels MJ, Ebbesen F, Vreman HJ, Stevenson DK, Wong RJ, Bhutani VK. Sixty years of phototherapy for neonatal jaundice - from serendipitous observation to standardized treatment and rescue for millions. J Perinatol 2020; 40:180-193. [PMID: 31420582 DOI: 10.1038/s41372-019-0439-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/04/2019] [Accepted: 05/23/2019] [Indexed: 11/09/2022]
Abstract
A breakthrough discovery 60 years ago by Cremer et al. has since changed the way we treat infants with hyperbilirubinemia and saved the lives of millions from death and disabilities. "Photobiology" has evolved by inquiry of diverse light sources: fluorescent tubes (wavelength range of 400-520 nm; halogen spotlights that emit circular footprints of light; fiberoptic pads/blankets (mostly, 400-550 nm range) that can be placed in direct contact with skin; and the current narrow-band blue light-emitting diode (LED) light (450-470 nm), which overlaps the peak absorption wavelength (458 nm) for bilirubin photoisomerization. Excessive bombardment with photons has raised concerns for oxidative stress in very low birthweight versus term infants treated aggressively with phototherapy. Increased emphasis on prescribing phototherapy as a "drug" that is dosed cautiously and judiciously is needed. In this historical review, we chronicled the basic to the neurotoxic components of severe neonatal hyperbilirubinemia and the use of standardized interventions.
Collapse
Affiliation(s)
- Thor Willy Ruud Hansen
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children's Hospital, Royal Oak, MI, USA
| | - Finn Ebbesen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.,Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Hendrik J Vreman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Vinod K Bhutani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
6
|
Zhou S, Wu X, Ma A, Zhang M, Liu Y. Analysis of therapeutic effect of intermittent and continuous phototherapy on neonatal hemolytic jaundice. Exp Ther Med 2019; 17:4007-4012. [PMID: 30988782 PMCID: PMC6447920 DOI: 10.3892/etm.2019.7432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 12/04/2022] Open
Abstract
Clinical efficacy and adverse reaction rates of ABO hemolytic jaundice in patients with continuous and intermittent blue light irradiation were compared, to provide reference for clinical treatment of neonatal ABO hemolytic jaundice. A retrospective analysis of 307 patients with neonatal hemolytic jaundice admitted to Qilu Hospital of Shandong University (Qingdao) from January 2010 to December 2017 was undertaken. A total of 165 cases of children with continuous blue light irradiation and 142 cases of intermittent blue light irradiation were analyzed. Also the serum bilirubin levels, phototherapy time and frequency, treatment efficiency and adverse reaction rates were compared between the groups. The phototherapy time of children in the continuous phototherapy group was significantly higher from the intermittent phototherapy group, and the difference was statistically significant (t=26.800, P<0.001). Before treatment, there was no significant difference in serum bilirubin levels between continuous and intermittent phototherapy groups (P>0.050). Serum bilirubin levels of patients in continuous and intermittent phototherapy groups were lower than both previous and before treatment period, and differences were statistically significant (P<0.001). The overall effective rate of the continuous phototherapy group was higher than that of the intermittent phototherapy group (P>0.050). The adverse reaction rates after treatment in the continuous phototherapy group was significantly higher than the intermittent phototherapy group (P<0.050). After the symptomatic treatment in children, the adverse reactions ceased. The therapeutic effect of intermittent blue light irradiation on neonatal ABO hemolytic jaundice was consistent with the continuous blue light irradiation treatment, and the intermittent blue light irradiation treatment has a low adverse reaction rate, and is worth promotion in clinical practice.
Collapse
Affiliation(s)
- Shiying Zhou
- Department of Pediatric Internal Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266000, P.R. China
| | - Xiaoyan Wu
- Department of Pediatrics, People's Hospital of Chiping, Liaocheng, Shandong 252000, P.R. China
| | - Aihua Ma
- PIVAS, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Min Zhang
- Department of Stomatology, The People's Hospital of Zhangqiu Area, Jinan, Shandong 250200, P.R. China
| | - Yanli Liu
- Department of Pediatric Internal Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 266000, P.R. China
| |
Collapse
|
7
|
Mukherjee D, Coffey M, Maisels MJ. Frequency and duration of phototherapy in preterm infants <35 weeks gestation. J Perinatol 2018; 38:1246-1251. [PMID: 29915375 DOI: 10.1038/s41372-018-0153-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/18/2018] [Accepted: 05/17/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the frequency, age at phototherapy (PT) initiation, and duration of PT use in infants 230/7 to 346/7 weeks of gestation in two neonatal intensive care units (NICUs) over 4 time periods. STUDY DESIGN We reviewed the charts of all infants born at 230/7-346/7 weeks of gestational age (GA) and admitted to the NICUs of two hospitals between January 2009 and September 2015. We calculated the proportion of infants who received PT and the total duration of PT exposure. RESULTS Overall 2023 (81.8%) received PT, and PT use was inversely related to GA and birthweight. More infants received PT when GA was added as a criterion for initiating PT. The median duration (interquartile range (IQR)) of PT for all infants was 50 (27-85) h and in the lowest GA group was 74 (42-111) h. CONCLUSIONS Recent US consensus guidelines appear to have led to an increased use of PT in our NICUs and studies from Norway indicate that we use PT considerably more frequently and for longer durations than do our Norwegian colleagues.
Collapse
Affiliation(s)
- Devashis Mukherjee
- Beaumont Children's Hospital and Department of Pediatrics, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Mary Coffey
- Research Institute, Biostatistics, Beaumont Health, Royal Oak, MI, USA
| | - M Jeffrey Maisels
- Beaumont Children's Hospital and Department of Pediatrics, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA.
| |
Collapse
|
8
|
Mreihil K, Nakstad B, Stensvold HJ, Benth JŠ, Hansen TWR. Uniform national guidelines do not prevent wide variations in the clinical application of phototherapy for neonatal jaundice. Acta Paediatr 2018; 107:620-627. [PMID: 29119594 DOI: 10.1111/apa.14142] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/12/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
AIM This study compared the use of phototherapy for neonatal jaundice in all 21 Norwegian neonatal intensive care units (NICUs) from 2013-2014 to improve practice. METHODS Information on all types of phototherapy devices was collected, and irradiance was measured from random units at 20 cm and 50 cm from the light source. We gathered information on local practice rules, including the use of single, double or triple phototherapy, how infants were positioned, the frequency of blood sampling, rules for using reflective surfaces and interrupting phototherapy. In every NICU, we asked one nurse with more than five years of experience and one with less than one year to set up phototherapy equipment, then measured the irradiance and distance. RESULTS Photodiodes were the most common of the eight types of phototherapy devices used. Rules for the distance from the device to the infant varied from 10 to 40 cm and in practice they varied from 15 to 48 cm, with irradiance ranging from 11.1-56.1 W/m2 . There were significant variations between NICUs with regard to the overall treatment duration and duration in most birthweight categories. CONCLUSION There were considerable variations in phototherapy practices among Norwegian NICUs. In particular, the significant variations in duration need to be addressed.
Collapse
Affiliation(s)
- Khalaf Mreihil
- Department of Pediatric and Adolescent Medicine; Akershus University Hospital; Lørenskog Norway
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
| | - Britt Nakstad
- Department of Pediatric and Adolescent Medicine; Akershus University Hospital; Lørenskog Norway
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
| | - Hans Jørgen Stensvold
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
- HØKH, Research Center; Akershus University Hospital; Lørenskog Norway
| | - Thor Willy Ruud Hansen
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
- Division of Paediatric and Adolescent Medicine; Oslo University Hospital; Oslo Norway
| | | | | |
Collapse
|
9
|
Affiliation(s)
- M Jeffrey Maisels
- Beaumont Children's Hospital; Oakland University William Beaumont School of Medicine; Royal Oak MI USA
| |
Collapse
|