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Berta DM, Woldu B, Yalew A, Chane E, Tamir M, Cherie N, Angelo AA, Mulatie Z, Alemayehu E, Kassie A, Teketelew BB. Hematological abnormality and associated factors in newborns with hyperbilirubinemia before and after phototherapy at University of Gondar Comprehensive Specialized Hospital. Sci Rep 2024; 14:18210. [PMID: 39107448 PMCID: PMC11303718 DOI: 10.1038/s41598-024-68871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
This study aimed to assess the magnitude of hematological toxicity and associated factors in newborns with hyperbilirubinemia. A cross-sectional study was conducted from April to December 2023. A total of 247 newborns were included. The data were collected using questionnaires and a data extraction sheet. Four 4 ml of blood was collected. A Sysmex KX-21 analyzer was used for blood analysis, and a Mindray BS-240 analyzer was used for bilirubin measurement. The data were entered into Epi-data and analyzed by SPSS. The logistic regression was used. The P value was set at 0.05. Before phototherapy, the hematological toxicities, such as anemia, leucopenia, and thrombocytopenia, were 45.7%, 22.2%, and 6.1%, respectively, whereas after phototherapy, anemia and thrombocytopenia, significantly increased, but the leucopenia, significantly decreased. The risk of developing anemia increased, 3.5, 2.7, and 2.1-fold among newborns with bilirubin > 18 mg/dl, with Rh blood group incompatibility, and treated with intensive phototherapy, respectively. Both low birth weight and intensive phototherapy increased the incidence of thrombocytopenia by 2 and 3.4-fold, respectively. Hematological toxicity was found to be a severe public health issue in newborns. Thus, strict follow-up and early detection of toxicity by considering aggravation factors are necessary.
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Affiliation(s)
- Dereje Mengesha Berta
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
| | - Berhanu Woldu
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Aregawi Yalew
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Elias Chane
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mebratu Tamir
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Negesse Cherie
- Department of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abiy Ayele Angelo
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewudu Mulatie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Adamu Kassie
- Department of Medical Laboratory, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Bisrat Birke Teketelew
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
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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.
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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
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Gottimukkala SB, Lobo L, Gautham KS, Bolisetty S, Fiander M, Schindler T. Intermittent phototherapy versus continuous phototherapy for neonatal jaundice. Cochrane Database Syst Rev 2023; 3:CD008168. [PMID: 36867730 PMCID: PMC9979775 DOI: 10.1002/14651858.cd008168.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
BACKGROUND Phototherapy is a widely accepted, effective first-line therapy for neonatal jaundice. It is traditionally used continuously but intermittent phototherapy has been proposed as an equally effective alternative with practical advantages of improved maternal feeding and bonding. The effectiveness of intermittent phototherapy compared with continuous phototherapy is unknown. OBJECTIVES To assess the safety and effectiveness of intermittent phototherapy compared with continuous phototherapy. SEARCH METHODS Searches were conducted on 31 January 2022 in the following databases: CENTRAL via CRS Web, MEDLINE and Embase via Ovid. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. SELECTION CRITERIA We included RCTs, cluster-RCTs and quasi-RCTs comparing intermittent phototherapy with continuous phototherapy in jaundiced infants (both term and preterm) up to the age of 30 days. We compared intermittent phototherapy with continuous phototherapy by any method and at any dose and duration as defined by the authors. DATA COLLECTION AND ANALYSIS Three review authors independently selected trials, assessed trial quality and extracted data from included studies. We performed fixed-effect analyses and expressed treatment effects as mean difference (MD), risk ratio (RR) and risk difference (RD) with 95% confidence intervals (CIs). Our primary outcomes of interest were rate of decline of serum bilirubin, and kernicterus. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 12 RCTs (1600 infants) in the review. There is one ongoing study and four awaiting classification. There was little or no difference between intermittent phototherapy and continuous phototherapy with respect to rate of decline of bilirubin in jaundiced newborn infants (MD -0.09 micromol/L/hr, 95% CI -0.21 to 0.03; I² = 61%; 10 studies; 1225 infants; low-certainty evidence). One study involving 60 infants reported no incidence of bilirubin induced brain dysfunction (BIND). It is uncertain whether either intermittent or continuous phototherapy reduces BIND because the certainty of this evidence is very low. There was little or no difference in treatment failure (RD 0.03, 95% CI 0.08 to 0.15; RR 1.63, 95% CI 0.29 to 9.17; 1 study; 75 infants; very low-certainty evidence) or infant mortality (RD -0.01, 95% CI -0.03 to 0.01; RR 0.69, 95% CI 0.37 to 1.31 I² = 0%; 10 studies, 1470 infants; low-certainty evidence). AUTHORS' CONCLUSIONS: The available evidence detected little or no difference between intermittent and continuous phototherapy with respect to rate of decline of bilirubin. Continuous phototherapy appears to be more effective in preterm infants, however, the risks of continuous phototherapy and the potential benefits of a slightly lower bilirubin level are unknown. Intermittent phototherapy is associated with a decrease in the total number of hours of phototherapy exposure. There are theoretical benefits to intermittent regimens but there are important safety outcomes that were inadequately addressed. Large, well designed, prospective trials are needed in both preterm and term infants before it can be concluded that intermittent and continuous phototherapy regimens are equally effective.
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Affiliation(s)
| | - Lisha Lobo
- Central Coast Health District, Gosford, Australia
| | | | | | | | - Tim Schindler
- Newborn Care, Royal Hospital for Women, Randwick, Australia
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Ivanova N, Leite ALJ, Vieira MB, Silva OHCE, Mota LWR, Costa GDP, de Azevedo CS, Auharek SA, Novaes RD, Pinto KMDC, Bianchi RF, Talvani A. New Insights Into Blue Light Phototherapy in Experimental Trypanosoma cruzi Infection. Front Cell Infect Microbiol 2021; 11:673070. [PMID: 34722326 PMCID: PMC8549511 DOI: 10.3389/fcimb.2021.673070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
The search for an effective etiologic treatment to eliminate Trypanosoma cruzi, the causative agent of Chagas disease, has continued for decades and yielded controversial results. In the 1970s, nifurtimox and benznidazole were introduced for clinical assessment, but factors such as parasite resistance, high cellular toxicity, and efficacy in acute and chronic phases of the infection have been debated even today. This study proposes an innovative strategy to support the controlling of the T. cruzi using blue light phototherapy or blue light-emitting diode (LED) intervention. In in vitro assays, axenic cultures of Y and CL strains of T. cruzi were exposed to 460 nm and 40 µW/cm2 of blue light for 5 days (6 h/day), and parasite replication was evaluated daily. For in vivo experiments, C57BL6 mice were infected with the Y strain of T. cruzi and exposed to 460 nm and 7 µW/cm2 of blue light for 9 days (12 h/day). Parasite count in the blood and cardiac tissue was determined, and plasma interleukin (IL-6), tumoral necrosis factor (TNF), chemokine ligand 2 (CCL2), and IL-10 levels and the morphometry of the cardiac tissue were evaluated. Blue light induced a 50% reduction in T. cruzi (epimastigote forms) replication in vitro after 5 days of exposure. This blue light-mediated parasite control was also observed by the T. cruzi reduction in the blood (trypomastigote forms) and in the cardiac tissue (parasite DNA and amastigote nests) of infected mice. Phototherapy reduced plasma IL-6, TNF and IL-10, but not CCL2, levels in infected animals. This non-chemical therapy reduced the volume density of the heart stroma in the cardiac connective tissue but did not ameliorate the mouse myocarditis, maintaining a predominance of pericellular and perivascular mononuclear inflammatory infiltration with an increase in polymorphonuclear cells. Together, these data highlight, for the first time, the use of blue light therapy to control circulating and tissue forms of T. cruzi. Further investigation would demonstrate the application of this promising and potential complementary strategy for the treatment of Chagas disease.
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Affiliation(s)
- Natália Ivanova
- Laboratório de Imunobiologia da Inflamação, Departamento de Ciências Biológicas, Instituto de Ciências Exatas e Biológicas (ICEB), Universidade Federal de Ouro Preto, Ouro Preto, Brazil.,Programa de Pós Graduação em Ecologia de Biomas Tropicais, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Ana Luísa Junqueira Leite
- Laboratório de Imunobiologia da Inflamação, Departamento de Ciências Biológicas, Instituto de Ciências Exatas e Biológicas (ICEB), Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Marcel Barbosa Vieira
- Laboratório de Polímerose Propriedades Eletrônicas de Materiais, Departamento de Física, ICEB, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Otto Henrique Cezar E Silva
- Laboratório de Polímerose Propriedades Eletrônicas de Materiais, Departamento de Física, ICEB, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Ludmilla Walter Reis Mota
- Laboratório de Imunobiologia da Inflamação, Departamento de Ciências Biológicas, Instituto de Ciências Exatas e Biológicas (ICEB), Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Guilherme de Paula Costa
- Laboratório de Imunobiologia da Inflamação, Departamento de Ciências Biológicas, Instituto de Ciências Exatas e Biológicas (ICEB), Universidade Federal de Ouro Preto, Ouro Preto, Brazil.,Programa de Pós-graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | | | - Sarah Alves Auharek
- Faculdade de Medicina do Mucuri, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Teofilo Otoni, Brazil
| | - Romulo Dias Novaes
- Departamento de Biologia Estrutural, Universidade Federal de Alfenas, Alfenas, Brazil
| | - Kelerson Mauro de Castro Pinto
- Laboratório de Imunobiologia da Inflamação, Departamento de Ciências Biológicas, Instituto de Ciências Exatas e Biológicas (ICEB), Universidade Federal de Ouro Preto, Ouro Preto, Brazil.,Escola de Educação Física, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Rodrigo Fernando Bianchi
- Laboratório de Polímerose Propriedades Eletrônicas de Materiais, Departamento de Física, ICEB, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - André Talvani
- Laboratório de Imunobiologia da Inflamação, Departamento de Ciências Biológicas, Instituto de Ciências Exatas e Biológicas (ICEB), Universidade Federal de Ouro Preto, Ouro Preto, Brazil.,Programa de Pós Graduação em Ecologia de Biomas Tropicais, Universidade Federal de Ouro Preto, Ouro Preto, Brazil.,Programa de Pós-graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, Brazil.,Programa de Pós-graduação em Infectologia e Medicina Tropical, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Indirect neonatal hyperbilirubinemia and associated risk factors for long phototheraphy duration in a baby-friendly hospital in Konya, Turkey. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.910028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Thomas N, Abiramalatha T. Phototherapy for neonatal hyperbilirubinaemia: Unresolved aspects & future directions. Indian J Med Res 2021; 153:409-412. [PMID: 34380785 PMCID: PMC8354049 DOI: 10.4103/ijmr.ijmr_1628_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Niranjan Thomas
- Department of Neonatology, Joan Kirner Women's & Children's at Sunshine Hospital, Victoria 3033, Australia
| | - Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education & Research, Chennai 600 116, Tamil Nadu, India
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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.
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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
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Bahr TM, Shakib JH, Stipelman CH, Kawamoto K, Cail K, Lauer S, Christensen RD. Improving the Bilirubin Management Program in the Newborn Nursery: Background, Aims, and Protocol. Neonatology 2020; 117:358-364. [PMID: 32036378 DOI: 10.1159/000505818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Practices to detect and manage hyperbilirubinemia in newborn nurseries are highly variable. American Academy of Pediatrics guidelines in 1999, 2004, and 2009 have generated, perhaps unintentionally, divergent practices that might not all be of equivalent value. Evidence-based progress is needed to define less invasive, less expensive, uniform, and safe methods to reduce ER visits and hospital readmissions for jaundice treatment and bilirubin encephalopathy. OBJECTIVES This research briefing is intended to inform readers of a new prospective quality improvement program aimed at testing the value of specific changes in newborn nursery hyperbilirubinemia detection and management. This new program includes predetermined means of assessing those specific changes, which relate to diagnosis, safety, outcomes, and cost. METHODS In this briefing, we present the perceived problems in our present bilirubin management system, as voiced by stakeholders. We report our proposed means to test minimization of those problems utilizing already acquired data on approximately 400,000 well babies in the Intermountain Healthcare system of hospitals in the western USA. We then describe our methods of assessing specific outcomes in a pre- versus postpractice change analysis. RESULTS AND CONCLUSIONS The University of Utah Newborn Nursery will implement a quality improvement project in bilirubin management during 2020 to test the feasibility and effectiveness of several changes to our current bilirubin management program. We maintain that the improved understanding generated by this project will be a step toward new evidence-based strategies for reducing ER visits and hospital readmissions for jaundice treatment and preventing bilirubin encephalopathy.
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Affiliation(s)
- Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA,
| | - Julie H Shakib
- Division of General Pediatrics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Carole H Stipelman
- Division of General Pediatrics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah Health, Salt Lake City, Utah, USA
| | - Kelly Cail
- Transfusion Medicine, ARUP Laboratories and University of Utah Hospital, Salt Lake City, Utah, USA
| | - Sara Lauer
- Department of System Quality, University of Utah Health, Salt Lake City, Utah, USA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
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