A Prospective Randomized Controlled Study of Phototherapy Using Blue and Blue-Green Light-Emitting Devices, and Conventional Halogen-Quartz Phototherapy

Seidman, Daniel S.; Mertens, Jonathan; Ergaz, Zivanit; Laor, Arie; Vreman, Hendrik J.; Stevenson, David K.; Gale, Rena

doi:10.1038/sj.jp.7210862

Cited by 80 publications

(106 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although Hb competition has been recognized and used, in part, to predict the action spectrum for phototherapy (3,4), explicit reference to Hb competition appears to be absent from the recent literature. The reports of clinical studies showing that blue-green or green light may be more effective than blue light (5,6) generally rationalize these observations on the general notion that the longer wavelengths "penetrate deeper into the skin" without specific reference to Hb absorbance.…”

mentioning

confidence: 91%

See 1 more Smart Citation

The effect of hematocrit on the efficacy of phototherapy for neonatal jaundice

et al. 2013

View full text Add to dashboard Cite

Background:The therapeutic phototherapy action spectrum ranges from 420 to 500 nm. However, a recent report of improved efficacy of fluorescent "turquoise" light (~490 nm) as compared with blue light (~450 nm) underscores the need to define an optimal action spectrum for precision-targeted phototherapy using very narrow wavelength ranges. Methods: We used a current semi-empirical model of the optical properties of skin for robust calculations of the fraction of light absorbed by bilirubin at various wavelengths that could be confounded by hemoglobin (Hb), melanin, and skin thickness. Applying assumptions regarding the wavelength dependence of bilirubin photochemistry, "action spectra" were assembled from the calculated values. results: All the calculated action spectra displayed a peak between 472 and 480 nm (most at 476 nm), which is a significant shift from the well-reported 460 nm absorption peak of bilirubin. Of note, the relative amplitudes of the action spectra showed an inverse relationship with hematocrit (Hct). conclusion: We speculate that a narrow range of light at 476 nm would be 60% more effective than blue (broadband) fluorescent lamps. Because Hb serves as a major competitor of bilirubin for light absorption, the calculations also predict that the efficacy of phototherapy is dependent on the Hct. A high Hct could reduce therapeutic efficiency. a n in vivo model to better define the optimal wavelength range for precision-targeted phototherapy has been elusive. Advances in understanding of skin optical properties have provided an optical model of neonatal skin in the therapeutic range (400-520 nm) that allows facile calculation of the influences of skin structure, melanin pigmentation, and cutaneous hemoglobin (Hb) on the action spectrum for phototherapy. Of these, Hb absorbs most of the visible light in the skin (1,2). As a result, competition from Hb with bilirubin for light should strongly affect the wavelength region of light that is most effective for phototherapy of neonatal jaundice. Although Hb competition has been recognized and used, in part, to predict the action spectrum for phototherapy (3,4), explicit reference to Hb competition appears to be absent from the recent literature. The reports of clinical studies showing that blue-green or green light may be more effective than blue light (5,6) generally rationalize these observations on the general notion that the longer wavelengths "penetrate deeper into the skin" without specific reference to Hb absorbance.Furthermore, significant competition for light by skin Hb also implies that the hematocrit (Hct) may in turn affect the efficacy of phototherapy. This possibility was recognized in 1974 by Lucey and Hewitt (7), who conjectured that the Hct "may be a contributing factor to the differences in response of serum bilirubin to light that one observes in different infants. " They observed in in vitro irradiation studies that changes in the Hct affect diazo-reactive bilirubin disappearance in blood. Almost a decade elapsed before a clinical st...

show abstract

mentioning

confidence: 91%

“…Clinical studies comparing the efficacy of phototherapy systems (5,6,29,30) exhibit quite "noisy" data. There are many clinical parameters that may be associated with this variation.…”

Section: Effect Of Hct On Required Irradiancementioning

confidence: 99%

The effect of hematocrit on the efficacy of phototherapy for neonatal jaundice

et al. 2013

View full text Add to dashboard Cite

show abstract

“…1,2 Thus, special blue fluorescent (BB) tubes that have their output primarily in the blue spectrum (430 to 490 nm) are recommended by the American Academy of Pediatrics (AAP) as the most effective light source for lowering the serum bilirubin. 3 Prototype light-emitting diode (LED) lights have been developed and tested in clinical and laboratory studies, [4][5][6] and a commercially available LED device is being used, currently, in nurseries in the United States. The LED device consists of gallium nitride LEDs.…”

Section: Introductionmentioning

confidence: 99%

Randomized controlled trial of light-emitting diode phototherapy

2007

View full text Add to dashboard Cite

Objective: We wished to compare the efficacy of light-emitting diode (LED) phototherapy with special blue fluorescent (BB) tube phototherapy in the treatment of neonatal hyperbilirubinemia. Study design:We randomly assigned 66 infantsX35 weeks of gestation to receive phototherapy using an LED device or BB. In addition to phototherapy from above, all infants also received phototherapy from below using four BB tubes or a fiberoptic pad.Result: After 15±5 h of phototherapy, the rate of decline in the total serum bilirubin (TSB) was 0.35±0.25 mg/dl/h in the LED group vs 0.27±0.25 mg/dl/h in the BB group (P ¼ 0.20).Conclusion: LED phototherapy is as effective as BB phototherapy in lowering serum bilirubin levels in term and near-term newborns.

show abstract

“…22 did not report a higher efficacy when applied using relatively low irradiance levels 14,18 Seidmann et al compared the efficacy of LED phototherapy with an irradiance of >100 microwatts/cm 2 /nm to conventional phototherapy with 5-8 microwatts/cm 2 /nm and found that the mean TSB concentrations at initiation and termination of phototherapy treatment, and the duration of phototherapy, did not differ between newborns receiving LED and conventional phototherapy. 23,24 Uras et al compared LED and double standard conventional phototherapy for nonhemolytic anemia and found a marked decrease in bilirubin concentrations in the LED group, but that the duration of phototherapy was similar between the groups. 25 In this study, we did not aim compare the effect of different phototherapy types on duration of treatment, but the duration of treatment was similar between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Comparison of total oxidant/antioxidant status in unconjugated hyperbilirubinemia of newborn before and after conventional and LED phototherapy: A prospective randomized controlled trial

Demırel

Uraş²,

Çelik³

et al. 2010

CIM

View full text Add to dashboard Cite

Clin Invest Med 2010; 33 (5): E335-E341. AbstractPurpose: We evaluated and compared the oxidant and antioxidant status of hyperbilirubinemic infants before and after the two forms of phototherapy: conventional and LED phototherapy, in order to identify the optimal treatment method. Method: Thirty newborns exposed to conventional (Group I) phototherapy and 30 infants exposed to LED phototherapy (Group II) were studied. The serum total antioxidant capacity (TAC) and the total oxidant status (TOS) were assessed by EREL's method. Results: There were no statistically significant differences in TAC or TOS levels between Group I and Group II prior to phototherapy, and no statistically significant difference in TAC levels between the two groups after phototherapy; however, TOS levels were significantly lower in Group II compared to Group I after phototherapy. Oxidative stress index (OSI) increased after conventional phototherapy (p<0.05) Conclusion: The increase in TOS following conventional phototherapy was not not observed following LED phototherapy. This difference should be considered when using phototherapy.Most newborns become clinically jaundiced during the first week of life. Bilirubin is normally cleared from the body by hepatic conjugation with glucuronic acid and eliminated in bile in the form of bilirubin glucuronides, but since the neonatal liver can not adequately clear bilirubin, bilirubin accumulation is observed. High levels of bilirubin are toxic to the central nervous system, so rapid intervention is necessary.

show abstract

A Prospective Randomized Controlled Study of Phototherapy Using Blue and Blue-Green Light-Emitting Devices, and Conventional Halogen-Quartz Phototherapy

Cited by 80 publications

References 23 publications

The effect of hematocrit on the efficacy of phototherapy for neonatal jaundice

The effect of hematocrit on the efficacy of phototherapy for neonatal jaundice

Randomized controlled trial of light-emitting diode phototherapy

Comparison of total oxidant/antioxidant status in unconjugated hyperbilirubinemia of newborn before and after conventional and LED phototherapy: A prospective randomized controlled trial

Contact Info

Product

Resources

About