Fibreoptic phototherapy in the management of jaundice in low birthweight neonates

New high intensity fibreoptic phototherapy devices in healthy newborns: a single pad wrapped around the neonate body in comparison with a double pad device

Background

Fibreoptic Phototherapy (FPT) allows to lower total serum bilirubin (TSB) levels in healthy neonates maintained in rooming-in with their mothers. The 2004 Cochrane review showed that, differently from preterm neonates, FPT was not as effective as traditional phototherapy in term neonates (TN), unless the simultaneous utilization of two FPT devices. Aim of this study was to compare the efficacy of two FPT devices, both equipped with a single light-emitting diode (LED): the first one has a single large pad wrapped around the infant body (Bilisoft, GE Health Care) (device A), the second one is a double-pad phototherapy device (BiliCocoon, CremascolieIris) (device B).

Methods

We studied 172 healthy neonates with non-hemolytic hyperbilirubinaemia: 57 TN and 57 late preterm neonates (LPN) treated with device A (Group 1); 47 TN and 11 LPN treated with device B (Group 2). We evaluated the differences between groups by the Student’s t-test for continuous variables and by chi square test for categorical data. A two tailed p < 0.05 was considered significant.

Results

There were no differences in term of duration of FPT, TSB hourly reduction, percentage of TSB reduction after FPT, TSB maximum rebound, percentage of TSB increase after FPT discontinuation and number of after-discharge checks. Two neonates treated with device B showed no decrease in TSB values during FPT. Seven infants treated with device B experienced hyperpyrexia.

Conclusions

The two LED FPT devices were both effective in lowering TSB either in TN or LPN. Device A was effective in all treated neonates without negative side effects during treatment; device B was effective in all but 2 infants and 12% of the neonates in the same group experienced hyperpyrexia. According to our results, the single big pad wrapped around the infant body has the same efficacy as a double FPT device in TN and LPN.

Heating of Newborn Infants due to Blue Light-Emitting Diode Fibreoptic Phototherapy Pads

BACKGROUND

Surface temperatures of fibreoptic phototherapy pads using a high intensity blue light-emitting diode (LED) light source have not been studied.

OBJECTIVES

The aim of this study was to measure the temperature of LED fibreoptic phototherapy pads during phototherapy in a bench-top study, and to determine temperature effects on babies during phototherapy.

METHODS

A commercially available LED fibreoptic phototherapy system was tested. In a bench-top setting, pad surface temperatures were measured before, during and after a 12-h period of phototherapy (10 different LED light box-pad combinations). A prospective, cohort study of well babies at >34 weeks' gestation receiving phototherapy was then conducted to determine changes in pad and body temperatures during a 90-min phototherapy period.

RESULTS

In the bench-top study, the mean (95% CI) pad temperature was 21.8°C (21.5-22.1) before lights, 27.0°C (26.5-27.5) after 12 h of lights, and 22.1°C (21.9-22.4) 8 h after turning off the lights (F = 366.1, p < 0.0005). The magnitude of change in pad temperature with phototherapy was linearly correlated with irradiance (r = 0.89, p < 0.0005). The pad plastic covering absorbed 13% of blue light from fibres. In the clinical study, the warmest pad temperature during phototherapy was 38.9°C. Axillary temperature increased by a mean (95% CI) of 0.3°C (0.1-0.5), p < 0.019, and exceeded 37.5°C in 4 babies.

CONCLUSIONS

LED fibreoptic phototherapy pads are heated by high-intensity blue light. The thermal environment and temperature of babies should be monitored closely during LED fibreoptic phototherapy. A temperature probe placed between the skin and the pad will not accurately reflect the core temperature during fibreoptic phototherapy.

Efficacy of phototherapy devices and outcomes among extremely low birth weight infants: multi-center observational study

OBJECTIVE

Evaluate the efficacy of phototherapy (PT) devices and the outcomes of extremely premature infants treated with those devices.

STUDY DESIGN

This substudy of the National Institute of Child Health and Human Development Neonatal Research Network PT trial included 1404 infants treated with a single type of PT device during the first 24±12 h of treatment. The absolute (primary outcome) and relative decrease in total serum bilirubin (TSB) and other measures were evaluated. For infants treated with one PT type during the 2-week intervention period (n=1223), adjusted outcomes at discharge and 18 to 22 months corrected age were determined.

RESULT

In the first 24 h, the adjusted absolute (mean (±s.d.)) and relative (%) decrease in TSB (mg dl(-1)) were: light-emitting diodes (LEDs) -2.2 (±3), -22%; Spotlights -1.7 (±2), -19%; Banks -1.3 (±3), -8%; Blankets -0.8 (±3), -1%; (P<0.0002). Some findings at 18 to 22 months differed between groups.

CONCLUSION

LEDs achieved the greatest initial absolute reduction in TSB but were similar to Spots in the other performance measures. Long-term effects of PT devices in extremely premature infants deserve rigorous evaluation.

Critical overview of the management of neonatal jaundice in the UK

AIM

To determine the current management of early neonatal jaundice in the UK and to evaluate whether the current practices are evidence based.

METHODS

A questionnaire survey was carried out among identified lead paediatricians of neonatal intensive care units.

RESULTS

The survey found markedly differing practices for the recognition, investigation and treatment of neonatal jaundice. This applies particularly to confirmation of the clinical suspicion of jaundice; use of invasive and non-invasive technologies for diagnosis; preferred wavelength and intensity of light used for treatment; and whether birth weight, gestational age and postnatal age should influence treatment.

CONCLUSION

The study found a lack of consistency in the management of jaundiced infants in the UK. The evidence-based practice currently available does not appear to have been incorporated into treatment protocols.

Which phototherapy system is most effective in lowering serum bilirubin in very preterm infants?

OBJECTIVE

To compare the effectiveness of various phototherapy systems in lowering serum bilirubin levels in preterm infants.

METHODS

This randomized clinical trial enrolled 140 preterm infants with gestational age < or =30 weeks and presenting nonhemolytic hyperbilirubinemia. When total serum bilirubin level reached 6.0 mg/dl (102.6 micromol/l), eligible infants were randomly assigned to four study groups: conventional, fiberoptic Wallaby, fiberoptic Biliblanket, and combined phototherapy. Efficacy was assessed by comparing highest serum bilirubin levels, duration of treatment, and number of infants requiring exchange transfusion.

RESULTS

Our results confirm that fiberoptic phototherapy, both Wallaby and Biliblanket, had the same effectiveness of conventional phototherapy. The best results have been obtained using combined phototherapy, which allowed to reach lower serum bilirubin levels, a shorter duration of treatment and a significant reduction of exchange transfusions.

CONCLUSION

Our data suggest that combined phototherapy should be the method of choice in treating hyperbilirubinemia in very preterm infants.

Effects of phototherapy on newborn rat testicles

Phototherapy is the most widespread treatment for lowering bilirubin concentration in neonates. In the routine, phototherapy has some side effects including skin eruption, fluid loss, abdominal distention, mild hemolysis and mild thrombocytopenia. The aim of the study was to investigate the possible mutagenic and gametocidal side effects of 72 h continuous phototherapy on the rat testicle. We observed decreases in spermatogonia numbers per tubule (S/T values), tubular fertilization index (TFI) and sperm sertoli cell index (SSCI), which are the most reliable methods in estimating future fertility potential, due to sensitivity to phototherapy. The differences between study and control groups for S/T, TFI and SSCI values were statistically significant (p = 0.008, p = 0.02 and p = 0.004, respectively). There were significant differences in seminiferous tubule diameters between the control and study groups (p < 0.005), but no significant difference in DNA index values between the control (0.66 +/- 0.12) and study (0.59 +/- 0.05) groups (p > 0.05). As a conclusion, phototherapy seems to have some side effects on the newborn rat testicle. Further studies with larger groups, designed for investigation of the effects of phototherapy on seminiferous tubules, may give more beneficial results.

Treatment of jaundice in low birthweight infants

Exchange transfusion and phototherapy remain the staples of intervention for the jaundiced newborn. Clinical management of the jaundiced low birthweight infant is discussed.

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.

Fibreoptic phototherapy for neonatal jaundice

BACKGROUND

Phototherapy is used to treat newborn infants with hyperbilirubinaemia. Fibreoptic phototherapy is a new mode of phototherapy which is reported to lower serum bilirubin (SBR) while minimising disruption of normal infant care.

OBJECTIVES

To evaluate the efficacy of fibreoptic phototherapy.

SEARCH STRATEGY

The standard search strategy of the Cochrane Collaboration was used including searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE and discussion with experts in the field.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials evaluating the efficacy of fibreoptic phototherapy in the management of newborn infants with hyperbilirubinaemia.

DATA COLLECTION AND ANALYSIS

Thirty-one studies were identified of which 24 met inclusion criteria. They evaluated the efficacy of fibreoptic phototherapy in a number of different clinical situations and patient populations.

MAIN RESULTS

Fibreoptic phototherapy was more effective at lowering SBR than no treatment but less effective than conventional phototherapy (percentage change in SBR after 24 hours of treatment: WMD -10.7%, 95%CI -18.14, -3.26 and WMD 3.59%, 95%CI 1.27, 5.92 respectively). Fibreoptic phototherapy was equally as effective as conventional phototherapy in preterm infants and when two fibreoptic devices were used simultaneously (change in SBR after 24 hours of treatment: WMD 1.7%, 95%CI -2.65, 6.05 and change in SBR per day over whole treatment period: WMD 2.82%, 95%CI -1.84, 7.48 respectively). A combination of fibreoptic and conventional phototherapy was more effective than conventional phototherapy alone (duration of phototherapy: WMD -12.51 hr, 95%CI -16.00, -9.02, meta-analysis affected by heterogeneity). No conclusion can be made on the superiority of one fibreoptic device over another as the two studies comparing them (one favouring BiliBlanket, the other finding no difference) did not contain a common outcome measure.

REVIEWER'S CONCLUSIONS

Fibreoptic phototherapy has a place in the management of neonatal hyperbilirubinaemia. It is probably a safe alternative to conventional phototherapy in term infants with physiological jaundice. No trials have been identified which support the widely-held view that fibreoptic devices interfere less with infant care or impact less on parent-child bonding.

Changes in mesenteric blood flow response to feeding: conventional versus fiber-optic phototherapy

OBJECTIVE

To evaluate whether fiberoptic phototherapy influences the postprandial increase in mesenteric blood flow velocity similarly to conventional phototherapy in preterm infants.

PATIENTS AND METHODS

With the use of Doppler color ultrasonography, blood flow velocity in the superior mesenteric artery was measured both preprandially and postprandially in 19 preterm infants during and after conventional phototherapy, and in 20 preterm infants during and after fiber-optic phototherapy. The mean arterial blood pressure/mean flow velocity ratio was calculated as an estimate of relative vascular resistance of the superior mesenteric artery.

RESULTS

The study shows that conventional phototherapy blunts the postprandial mesenteric blood flow response to feeding in preterm infants. Furthermore, it shows that the postprandial increase in intestinal blood flow is not attenuated when fiber-optic phototherapy is administered, and that such postprandial increase of blood flow is significantly greater than in infants receiving conventional phototherapy. During and after fiber-optic phototherapy, a significant reduction in postprandial relative vascular resistance was found; such reduction was significantly greater than during conventional phototherapy.

CONCLUSIONS

Fiber-optic phototherapy is preferable to conventional phototherapy for the treatment of hyperbilirubinemia in preterm infants because it does not affect the physiologic postprandial redistribution of blood flow from the periphery to the gastrointestinal system as does conventional phototherapy.