Phototherapy and its effect on some physiological functions in newborns

Splanchnic and cerebral oxygenation during cyclic phototherapy in preterm infants with hyperbilirubinemia

Cyclic phototherapy (cPT) can achieve a reduction in total serum bilirubin comparable to that achieved with standard continuous PT in preterm infants. Our aim was to assess the effect of cPT on splanchnic (rSO2S) and cerebral (rSO2C) oxygenation measured by near-infrared spectroscopy (NIRS). We prospectively studied 16 infants with a gestational age of 25-34 weeks with hyperbilirubinemia requiring PT. Splanchnic regional oxygenation (rSO2S), oxygen extraction fraction (FOES), and cerebro-splanchnic oxygenation ratio (CSOR) were recorded before, during, and after cPT discontinuation. We found that rSO2S, FOES, and CSOR did not change during the study period. The overall duration of single or multiple courses of PT was 6.5 (6.0-13.5) h, but by cycling PT, the actual exposure was 3.0 (1.5-4.9) h. Twelve patients (75%) required 15 min/h cPT, and four (25%) required prolonging cPT to 30 min/h. None of the patients developed enteral feeding intolerance. Conclusions: cPT treatment of hyperbilirubinemia in preterm infants does not affect splanchnic oxygenation or intestinal oxygen blood extraction, likely due to the short exposure to PT light, and it could contribute to decreasing the risk of feeding intolerance.

Breast Milk Management in the Efforts to Reduce Bilirubin Levels in Neonatal Jaundice

BACKGROUND: The baby’s delay in getting nutrition in the form of breast milk caused direct bilirubin that has reached the intestines not being bound by food and not taken out through the anus with food. In the intestine, this direct bilirubin is converted into indirect bilirubin which will be reabsorbed into the blood and this condition will cause a persistence hyperbilirubinemia condition. Hyperbilirubinemia becomes an emergency that often occurs in newborns and is characterized by the occurrence of neonatal icterus. AIM: The purpose of this study is to analyze the effect of breast milk management on the reduction of bilirubin levels in neonatal jaundiced infants that receive phototherapy. METHODS: The design of this study used a quasi-experimental with a pre-test and post-test design with a control group. Sampling was done by consecutive sampling and obtained 52 respondents. This research was conducted for 4 months from April 2021 to July 2021 at the Surabaya Ahmad Yani Islamic Hospital. This study was divided into two groups, namely, the intervention group which was given phototherapy therapy by maximizing breast milk management and the control group only undergoing phototherapy. Data analysis in this study used Chi-square test for univariate variables and bivariate variables using paired t-test and independent t-test. CONCLUSIONS: Good lactation management will have a major effect on bilirubin levels in infants receiving phototherapy. Hence, there needs a motivation for the parents, especially mothers, in exclusive breastfeeding without adding formula milk or using any breast milk substitutes so that the length of care for babies with neonatal icterus is faster and the baby’s nutrition can be fulfilled in a balanced way.

Determining the Effectivity of Infrared Distance to Eliminate Dental Pain Due to Pulpitis and Periodontitis

OBJECTIVE

 The infrared rays is one of the treatments to relief of dental pain due to pulpitis or periodontitis. The ability of infrared to increase the pain threshold which make eliminating P substance on the inflammation area and inducing Aβ and Aδ fibers to activate γ-aminobutyrate (GABA) and neuropeptides to decrease the pain. Hence, reducing or eliminating dental pain. This study to get information about effectively distance between patients and infrared rays which can reduce or eliminate dental pain.

MATERIALS AND METHODS

 The explorative experimental research to determine the effectivity of the infrared rays' distance: 45, 55, and 55 cm in reducing or eliminating dental pain. The material of infrared was tungsten with luminous light and the time for the lighting was 15 minutes.

STATISTICAL ANALYSIS

 The data were obtained and analyzed using Wilcoxon's signed rank test and Kruskal-Wallis test (α= 0.05).

RESULTS

  There were influenced of the infrared rays to reduce the dental pain as follow, distance 45 cm (p = 0.007), distance 55 cm (p = 0.026), and distance 65 cm (p = 0.007). The average scale reduction for distance 45 cm was 2.23 ± 0.83, the distance 55 cm was 3.33 ± 0.87, and the distance 65 cm was (1.78 ± 0.83). Therefore, according to Kruskal-Wallis test with p = 0.004 (p < 0.05) showed the significant difference between the scale to decrease of dental pain was the distance of 55.

CONCLUSION

 Infrared rays located at a distance of 55 cm from patients might be more effective in relieving dental pain, compared with other distances tested.

Cycled Phototherapy Dose-Finding Study for Extremely Low-Birth-Weight Infants: A Randomized Clinical Trial

Importance

Cycled (intermittent) phototherapy (PT) might adequately control peak total serum bilirubin (TSB) level and avoid mortality associated with usual care (continuous PT) among extremely low-birth-weight (ELBW) infants (401-1000 g).

Objective

To identify a cycled PT regimen that substantially reduces PT exposure, with an increase in mean peak TSB level lower than 1.5 mg/dL in ELBW infants.

Design, Setting, and Participants

This dose-finding randomized clinical trial of cycled PT vs continuous PT among 305 ELBW infants in 6 US newborn intensive care units was conducted from March 12, 2014, to November 14, 2018.

Interventions

Two cycled PT regimens (≥15 min/h and ≥30 min/h) were provided using a simple, commercially available timer to titrate PT minutes per hour against TSB level. The comparator arm was usual care (continuous PT).

Main Outcomes and Measures

Mean peak TSB level and total PT hours through day 14 in all 6 centers and predischarge brainstem auditory-evoked response wave V latency in 1 center. Mortality and major morbidities were secondary outcomes despite limited power.

Results

Consent was requested for 452 eligible infants and obtained for 305 (all enrolled) (mean [SD] birth weight, 749 [152] g; gestational age, 25.7 [1.9] weeks; 81 infants [27%] were multiple births; 137 infants [45%] were male; 112 [37%] were black infants; and 107 [35%] were Hispanic infants). Clinical and demographic characteristics of the groups were similar at baseline. After a preplanned interim analysis of 100 infants, the regimen of 30 min/h or more was discontinued, and the study proceeded with 2 arms. Comparing 128 infants receiving PT of 15 min/h or more with 128 infants receiving continuous PT among those surviving to 14 days, mean peak TSB levels were 7.1 vs 6.4 mg/dL (adjusted difference, 0.7; 95% CI, 0.4-1.1 mg/dL) and mean total PT hours were 34 vs 72 (adjusted difference, -39; 95% CI, -45 to -32). Wave V latency adjusted for postmenstrual age was similar in 37 infants receiving 15 min/h or more of PT and 33 infants receiving continuous PT: 7.42 vs 7.32 milliseconds (difference, 0.10; 95% CI, -0.11 to 0.30 millisecond). The relative risk for death was 0.79 (95% CI, 0.40-1.54), with a risk difference of -4.5% (95% CI, -10.9 to 2.0). Morbidities did not differ between groups.

Conclusions and Relevance

Cycled PT can substantially reduce total PT with little increase in peak TSB level. A large, randomized trial is needed to assess whether cycled PT would increase survival and survival without impairment in small, preterm infants.

Trial Registration

ClinicalTrials.gov Identifier: NCT01944696.