Phototherapy for neonatal jaundice

Application of machine learning algorithms for accurate determination of bilirubin level on in vitro engineered tissue phantom images

Neonatal Jaundice is a common occurrence in neonates. High excess bilirubin would lead to hyperbilirubinemia, leading to irreversible adverse damage such as kernicterus. Therefore, it is necessary and important to monitor neonates' bilirubin levels in real-time for immediate intervention. However, current screening protocols have their inherent limitations, necessitating more convenient measurements. In this proof-of-concept study, we evaluated the feasibility of using machine learning for the screening of hyperbilirubinemia in neonates from smartphone-acquired photographs. Different machine learning models were compared and evaluated to gain a better understanding of feature selection and model performance in bilirubin determination. An in vitro study was conducted with a bilirubin-containing tissue phantom to identify potential biological and environmental confounding factors. The findings of this study present a systematic characterization of the confounding effect of various factors through separate parametric tests. These tests uncover potential techniques in image pre-processing, highlighting important biological features (light scattering property and skin thickness) and external features (ISO, lighting conditions and white balance), which together contribute to robust model approaches for accurately determining bilirubin concentrations. By obtaining an accuracy of 0.848 in classification and 0.812 in regression, these findings indicate strong potential in aiding in the design of clinical studies using patient-derived images.

Optoacoustic monitoring of bilirubin photodegradation

Hematomas resulted from trauma are very common, and the efficacy of existing treatment techniques is limited. Phototherapy can be used to expedite healing and improve the appearance of the damaged tissue. Efficient phototherapy requires determination of chromophore composition in hematoma, which can be provided by the optoacoustic (OA) technique, as it combines high spatial resolution and optical contrast. Here, we conducted experiments on photodegradation of bilirubin in gelatin slin phantoms. We have demonstrated that the OA technique allows monitoring of bilirubin concentration during photodegradation, and also distinguishing bilirubin concentration in depth. The obtained results suggest that OA monitoring may be used for efficient hematoma phototherapy.

Noninvasive, continuous fluorescence monitoring of bilirubin photodegradation

Nowadays phototherapy is widely used for treatment of various diseases. However, efficient application of phototherapy requires an understanding of light interactions with main endogenous chromophores (e.g., hemoglobin, bilirubin, and water) in tissue. In particular, bilirubin is the target chromophore in the treatment of neonatal jaundice, which is the most common disease affecting up to 80% of preterm infants. The most frequently recommended treatment technique for this disease is phototherapy with blue light in combination with conventional drug therapy. To follow threshold total serum bilirubin (TSB) concentration guidelines, it is essential to estimate TSB concentration accurately. The gold standard biochemical analysis is invasive and bulky. Moreover, noninvasive methods do not provide sufficient reproducibility and accuracy. In this research, the fluorescence sensing of bilirubin with human serum albumin complexes was studied. The fluorescence time course during light irradiation (central wavelength: 467 nm and power density: 12.13 mW cm^-2) was demonstrated to depend on the initial concentration. Specifically, for the bilirubin concentration C = 18.65 μM, an insignificant fluorescence signal increase was observed during the first 30 minutes of light irradiation, while for bilirubin concentration C = 373 μM, the fluorescence signal did not reach maximum during 2.5 hours of light irradiation. Thus, fluorescence sensing might show increased accuracy when used with other noninvasive bilirubin sensing methods.

Solvent Effect on the Photolysis of Riboflavin

The kinetics of photolysis of riboflavin (RF) in water (pH 7.0) and in organic solvents (acetonitrile, methanol, ethanol, 1-propanol, 1-butanol, ethyl acetate) has been studied using a multicomponent spectrometric method for the assay of RF and its major photoproducts, formylmethylflavin and lumichrome. The apparent first-order rate constants (k obs) for the reaction range from 3.19 (ethyl acetate) to 4.61 × 10(-3) min(-1) (water). The values of k obs have been found to be a linear function of solvent dielectric constant implying the participation of a dipolar intermediate along the reaction pathway. The degradation of this intermediate is promoted by the polarity of the medium. This indicates a greater stabilization of the excited-triplet states of RF with an increase in solvent polarity to facilitate its reduction. The rate constants for the reaction show a linear relation with the solvent acceptor number indicating the degree of solute-solvent interaction in different solvents. It would depend on the electron-donating capacity of RF molecule in organic solvents. The values of k obs are inversely proportional to the viscosity of the medium as a result of diffusion-controlled processes.

Design and characterization of a novel indicator dosimeter for blue-light radiation

Optical absorption and fluorescence measurements have been done on poly[2-methoxy-5-(2'-ethyl-hexyloxy)-1,4-phenylene vinylene]/[aluminum-tris(8-hydroxyquinoline)] solutions. The authors show that there is a visible response that covers the electronic absorption of bilirubin (350-500 nm), and hence, this material is applicable for managing the radiation doses planning before treatment of jaundice of neonates, which is one of the most common reasons of hospital readmission of newborns infants. The results show that the material presents a gradation of color from orange to yellow clearly, while its peak position emission shifts from orange-red (lambda(max) = 571 nm) to green (lambda(max) = 540 nm) with the radiation exposure time. The rate of these changes can be altered by manipulations of organic solution concentration and they are usually slow (from 2 to 8 h), suggesting these color and emission changes can be used to design an easy to make, easy to read, easy to operate, low cost (< US $0.50) and accuracy for individual monitoring indicator dosimeter in order to represent easily the radiation exposure time usually used in management of neonatal jaundice.

Effects of phototherapy in neonates on circadian sleep-wake and saliva cortisol level rhythms

The influence of phototherapy treatment during the neonatal period on sleep-wake rhythm, and its long-term effects on biological rhythms, was evaluated in preterm and full-term infants. Forty-three infants treated with phototherapy during the neonatal period and 47 untreated infants were examined for entrainment of sleep-wake rhythms between 16 and 52 weeks and for sleep-wake and saliva cortisol rhythms at 2.5 years of age. The age of sleep-wake rhythm entrainment was not significantly different between the 2 groups. No correlations between duration of exposure to phototherapy and corrected age of entrainment of sleep-wake rhythm were observed. At follow-up, no significant differences in sleep-wake and saliva cortisol rhythms were observed between the 2 groups, indicating that circadian variations were similar to those in adults.

Kangaroo mother care during phototherapy: effect on bilirubin profile

PURPOSE

To determine the safety and efficacy of allowing kangaroo mother care (KMC) one hour per day during the course of phototherapy using a fiberoptic phototherapy panel.

SAMPLE

Thirty premature infants, 30-35 weeks gestation, <2,500 gm, who required phototherapy. Infants were randomized into three groups: (1) infants who received traditional bank or spotlight phototherapy 24 hours per day, (2) infants who received traditional phototherapy 23 hours per day and for the 24th hour lay prone on a fiberoptic phototherapy panel, and (3) infants who received traditional phototherapy 23 hours per day and for the 24th hour were given KMC with a fiberoptic phototherapy panel held against their back.

OUTCOME VARIABLES

Nonparametric statistics were used for between-group comparisons on number of days of phototherapy, daily bilirubin decrement, and bilirubin profiles over the course of phototherapy.

RESULTS

Groups did not differ in the number of days of phototherapy or in daily mean bilirubin decrement. The bilirubin profile for the KMC group showed a more shallow descent than did the profiles for the other groups, but a significant difference in decline was present only on day 4 of treatment (p = .05).

CONCLUSION

This pilot work suggests that KMC using a fiberoptic panel during phototherapy may be safe, but further study is needed.

Oxidative stress, phototherapy and the neonate

Phototherapy is the most widely used form of therapy for unconjugated hyperbilirubinaemia. Its non-invasive nature and few side effects reported earlier have led to the assumption that it is innocuous. Recent research has revealed that phototherapy is a photodynamic stress and can induce lipid peroxidation. There is increasing evidence that many severe diseases of the neonate are caused by oxidative injury and lipid peroxidation. In the present communique, we review the oxidative susceptibility of the neonate and the evidence now available that phototherapy induces oxidative stress. Although intensive phototherapy (up to 40 mwatt/cm2/nm) has been reported to be increasingly effective, a little caution, we believe is warranted, till more definite data in the human neonate, help resolve the issue.

[Management of hyperbilirubinemia of the term newborn in maternity wards]

Jaundice is a frequent clinical sign among healthy term newborns. A rigorous clinical assessment is crucial in order to recognise haemolytic, infectious and metabolic diseases. The use of the transcutaneous jaundice-meter in decision-making, and the phototherapy principles and applications, are discussed. Intensive phototherapy allows a rapid decrease in plasma bilirubin levels, so that it may used to treat even severe hyperbilirubinemia in the maternity ward.

Transcutaneous bilirubinometry in Chinese, Malay and Indian infants

The objective of this study was to investigate the correlation of transcutaneous bilirubinometry (TcB) and plasma bilirubin concentrations in full-term Chinese, Malay and Indian infants. TcB was performed with the Minolta Airshields bilirubinometer on Chinese, Malay and Indian fullterm infants. The readings were taken on the chest (sternum) and forehead (glabella) when capillary blood was sampled for bilirubin determination. Five hundred and forty TcB indices in 253 Chinese infants, 282 in 169 Malay infants, and 182 in 120 Indian infants were obtained over the sternum and forehead. A good correlation between the TcB indices and the bilirubin concentrations was observed in Chinese, Malay and Indian infants: r = 0.78 (chest), r = 0.73 (forehead); r = 0.86 (chest), r = 0.84 (forehead); and r = 0.84 (chest), r = 0.82 (forehead). The correlation was just as good when the combined values were evaluated together: r = 0.80 (chest) r = 0.75 (forehead). In Chinese infants, correlation at values below 250 mumol l-1 was significantly better than that at values over 250 mumol l-1 r = 0.80 versus r = -0.20, p < 0.00001 (chest), and r = 0.74 versus r = 0.07, p < 0.00001 (forehead). However, a safer cut-off point clinically would be 200 mumol l-1, since only relatively few higher bilirubin values were encountered when TcB indices were below 200 mumol l-1. The same pattern was noticed with the other two groups, and the combined group. Thus, TcB provides a non-invasive, cost-effective screening method for significant neonatal jaundice, sparing infants and parents physical and emotional stress, and medical and nursing personnel extra work and inconvenience.