Phototherapy for neonatal hyperbilirubinemia[1][edit | edit source]
Abstract[edit | edit source]
Approximately 60 years ago in England, phototherapy for neonatal hyperbilirubinemia was used in clinical practice. It was introduced in Japan approximately 50 years ago. At that time, the mechanism underlying the serum bilirubin concentration decrease by phototherapy was still unknown. The mechanism was identified by chemists, biochemists, and pediatricians. Clarification started with the report that unconjugated bilirubin was excreted into bile after photoirradiation in Gunn rats. After confirmation of the molecular structure of bilirubin on X-ray analysis, the mechanism for bile excretion of unconjugated bilirubin was verified based on geometric configurational photoisomers in the Gunn rat. Finally, the reaction and excretion of structural bilirubin photoisomers was proved to be the main mechanism for the decrease in serum bilirubin during phototherapy for neonatal hyperbilirubinemia, which differs from the mechanism in the Gunn rat. The most effective and safest light source and the optimal method to evaluate phototherapy, however, remain unknown. Moreover, as for bronze baby syndrome, which is a well-known adverse reaction to phototherapy, the etiology is unclear. Hence, we review phototherapy for hyperbilirubinemia including a fundamental understanding of the bilirubin photochemical reactions, and discuss the subclinical carcinogenic risk of phototherapy and the increased mortality rate of extremely low-birthweight infants due to aggressive phototherapy, which is becoming an increasing problem.
Key Takeaways[edit | edit source]
- Introduction
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Phototherapy to Prevent Severe Neonatal Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation[2][edit | edit source]
Abstract[edit | edit source]
OBJECTIVE: To standardize the use of phototherapy consistent with the American Academy of Pediatrics clinical practice guideline for the management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. METHODS: Relevant literature was reviewed. Phototherapy devices currently marketed in the United States that incorporate fluorescent, halogen, fiber-optic, or blue light-emitting diode light sources were assessed in the laboratory. RESULTS: The efficacy of phototherapy units varies widely because of differences in light source and configuration. The following characteristics of a device contribute to its effectiveness: (1) emission of light in the blue-to-green range that overlaps the in vivo plasma bilirubin absorption spectrum (�460 – 490 nm); (2) irradiance of at least 30 uW/cm^2/nm^1 (confirmed with an appropriate irradiance meter calibrated over the appropriate wavelength range); (3) illumination of maximal body surface; and (4) demonstration of a decrease in total bilirubin concentrations during the first 4 to 6 hours of exposure. RECOMMENDATIONS (SEE APPENDIX FOR GRADING DEFINITION): The intensity and spectral output of phototherapy devices is useful in predicting potential effectiveness in treating hyperbilirubinemia (group B recommendation). Clinical effectiveness should be evaluated before and monitored during use (group B recommendation). Blocking the light source or reducing exposed body surface should be avoided (group B recommendation). Standardization of irradiance meters, improvements in device design, and lower-upper limits of light intensity for phototherapy units merit further study. Comparing the in vivo performance of devices is not practical, in general, and alternative procedures need to be explored. Pediatrics 2011;128:e1046–e1052
Key Takeaways[edit | edit source]
- Introduction
- Used AAP standard, 460-490 nm
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- Methods
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- Results and Discussion
- 460-490 nm wavelength, irradiance > 30uW/cm^2/nm, maximise body exposure
confirmation of ligth intensity by irradiance meter.
- Conclusions
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Can sunlight replace phototherapy units in the treatment of neonatal jaundice? An in vitro study[3][edit | edit source]
Abstract[edit | edit source]
Background/aim: Light can be efficiently used for the treatment of neonatal jaundice. Sunlight, which covers a large portion of the light spectrum including the bilirubin-absorbing range, is abundant in the Middle East. Such advantages prompted the present study to investigate the efficiency of sunlight in isomerizing bilirubin. This may introduce a practical source of light for the treatment of hyperbilirubinic infants in areas where phototherapy units are not available.
Methods: The efficiency of sunlight was quantified by a comparison with a phototherapy unit. Aqueous bilirubin solutions were exposed to periodic sunlight over the entire year and the reduction of bilirubin concentration was monitored spectrophotometrically. Bilirubin solutions were also exposed to a phototherapy unit intensity comparable to that of sunlight (17 cm away from the source).
Results: The data indicated that at this comparable light intensity, the phototherapy unit was as effective as sunlight. However, for the treatment of neonatal jaundice, phototherapy units are usually operated at a distance of 50 cm (where the light intensity is six times less than that of sunlight). When this distance was tested, only 16% of bilirubin was isomerized in the first 5 min of exposure. In contrast, about 65% of bilirubin was isomerized when the phototherapy unit was placed at a distance of 17 cm and when the bilirubin solutions were exposed to sunlight for the same time period. The hourly and seasonal changes in sunlight intensity affected the reduction in bilirubin concentration significantly.
Conclusion: Data revealed that sunlight is almost 6.5 times more effective than a phototherapy unit when operating at the ward geometry after taking isomerization efficiency and area of exposure into consideration. Moreover, sunlight is still more effective during the winter season, when its intensity is lower. Thus, sunlight may be considered an alternative phototherapy source for the treatment of neonatal jaundice, particularly in areas where conventional phototherapy units are unavailable.
Key Takeaways[edit | edit source]
- Results and Discussion
- Sunlight and LED source equally effective as same intensity, 17cm more effective than typical 50 cm
- Conclusions
- Sunlight more effective(6.5x) due to greater intensity, light source needs to be placed closer for equivalent effect
Light Emitting Diode (LED) Phototherapy versus Conventional Phototherapy in Neonatal Hyperbilirubinemia: A Single Blinded Randomized Control Trial from Coastal India[4][edit | edit source]
Abstract[edit | edit source]
Neonatal hyperbilirubinemia is a common problem with potentiality to cause irreversible brain damage. Reduction of serum bilirubin level is essential to minimize such damage. Compact fluorescent tubes, halogen bulbs, fiber optic blankets, and LEDs are commonly used light sources for phototherapy with varying efficacies. This study aimed at evaluating the effect of LED versus conventional phototherapy on (a) rate of reduction in total serum bilirubin levels, (b) effect on urinary lumirubin excretion, and (c) comparing side effects of phototherapies among neonates with hyperbilirubinemia. In this randomized control trial, 166 neonates ≥ 35 weeks of age requiring phototherapy were recruited and further divided into 2 groups [LED (83) and conventional (83)] by using computer generated random numbers. Serial total serum bilirubin levels and random urinary lumirubin levels were collected and side effects of phototherapy were noted. Rate of fall in total serum bilirubin levels (TSB, 𝜇mol/L/hour) and random urinary lumirubin levels were computed. Data were collected using a pretested proforma. Analysis was done with Statistical Package for Social Sciences (SPSS) version 11.5. Independent sample “t” test and Chi-square tests were used with p value of <0.05 being significant. Significant difference was documented in mean rate of decrease of TSB (𝜇mol/L/hour) in LED group (5.3 ± 2.91) when compared to conventional group (3.76 ± 2.39) (p <0.001). A significant increase in mean random urinary lumirubin levels (arbitrary units) was observed in LED group (129.01 ± 33.18) when compared to conventional group (114.44 ± 44.84) (p = 0.021). Side effects were minimal and comparable in both groups. This study concludes the rates of decrease in total serum bilirubin levels and increase in urinary lumirubin levels were significant with LED when compared with conventional phototherapy, implying LED to be more efficacious.
Key Takeaways[edit | edit source]
- Methods
- NOTE: irradiance of tubelamps << irradiance of LEDs
- Results and Discussion
- LED better than conventional tube lamps.
Randomized controlled trial of light-emitting diode phototherapy[5][edit | edit source]
Abstract[edit | edit source]
Key Takeaways[edit | edit source]
- Results and Discussion
- Used AAP standard, 460-490 nm
- Conclusions
- LED produce equal results to tube florescence
Design and analysis of a solar powered phototherapy device[6][edit | edit source]
Abstract[edit | edit source]
This study was carried out to design and construct a cost-effective and efficient solar-powered phototherapy device which can be implemented in areas where there are inadequate electricity and rural environment. Neonatal jaundice is the yellowish condition due to high-level bilirubin in a new born baby. This condition must be treated if the bilirubin level above 12 mg/dL. One of the common treatments is by using red and blue light phototherapy to convert bilirubin become more soluble in the water then easily excreted from the body. A microcontroller was used to regulate the radiation of light in the device and make it safe for the treatment of jaundice in a new baby. The device is powered by solar energy generated from the 24-volt monocrystalline solar panel, for charging deep cycle batteries via a charge controller. The wavelength of light is 460-490 nm with a minimum intensity of 30 μW/cm2. In this study, the phototherapy device is designed and tested. The red and blue light source consisted of thirty-six (36) high power Light emitting diode LED. Heat sink and fan are employed for the LED package cooling system. Solar power meter and spectrometer are used to analyze the intensity and wavelength produced by the LED.
Key Takeaways[edit | edit source]
- Introduction
- 430-490 nm, 30 uW/cm2/nm
Neonatal phototherapy – today’s lights, lamps and devices[7][edit | edit source]
Abstract[edit | edit source]
Neonatal phototherapy is a widely used and accepted form of treatment for neonatal hyperbilirubinaemia. Effective phototherapy needs to satisfy three important criteria identified in the literature: effective spectrum, sufficiently high irradiance and large effective treatment area. This article looks at how technology for delivering light therapy varies, considers the safety aspects and compares the devices available and in use in the NHS today, against the identified effective criteria.
[Link Title][edit | edit source]
Abstract[edit | edit source]
Key Takeaways[edit | edit source]
- Introduction
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- Goal: ...
- Methods
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- Results and Discussion
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- Conclusions
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Search Terms[edit | edit source]
Jaundice, Neonatal Hyperbilirubinemia, Neonatal Phototherapy, Phototherapy for Jaundice, Phototherapy for neonatal hyperbilirubinemia, Neonatal hyperbilirubinemia treatment, Bili-Lights, LED phototherapy, Open-source phototherapy, Blue light treatment for jaundice
References[edit | edit source]
- ↑ Maisels, M. Jeffrey, and Antony F. McDonagh. ‘Phototherapy for Neonatal Jaundice’. New England Journal of Medicine 358, no. 9 (28 February 2008): 920–28. https://doi.org/10.1056/NEJMct0708376.
- ↑ Bhutani, Vinod K. and the Committee on Fetus and Newborn. ‘Phototherapy to Prevent Severe Neonatal Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation’. Pediatrics 128, no. 4 (1 October 2011): e1046–52. https://doi.org/10.1542/peds.2011-1494.
- ↑ Salih, F. M. ‘Can Sunlight Replace Phototherapy Units in the Treatment of Neonatal Jaundice? An in Vitro Study’. Photodermatology, Photoimmunology & Photomedicine 17, no. 6 (December 2001): 272–77. https://doi.org/10.1034/j.1600-0781.2001.170605.x.
- ↑ Gutta, Sreesravya, Janardhan Shenoy, Sowmini P. Kamath, Prasanna Mithra, B. Shantharam Baliga, Muralikeshava Sarpangala, and Mukund Srinivasan. ‘Light Emitting Diode (LED) Phototherapy versus Conventional Phototherapy in Neonatal Hyperbilirubinemia: A Single Blinded Randomized Control Trial from Coastal India’. BioMed Research International 2019 (11 April 2019): 1–6. https://doi.org/10.1155/2019/6274719.
- ↑ Maisels, M. J., E. A. Kring, and J. DeRidder. ‘Randomized Controlled Trial of Light-Emitting Diode Phototherapy’. Journal of Perinatology 27, no. 9 (1 September 2007): 565–68.
- ↑ Mayowa, Abioye, and E Abioye Abiodun. ‘Design and Analysis of a Solar Powered Phototherapy Device’. Journal of Physics: Conference Series 1378, no. 3 (1 December 2019): 032041. https://doi.org/10.1088/1742-6596/1378/3/032041.
- ↑ Wentworth, S.D. ‘Neonatal Phototherapy–Today’s Lights, Lamps and Devices.’ Infant 1, no. 1 (2005): 14–19.
