Challenges of phototherapy for neonatal hyperbilirubinemia (Review)

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.

Highly Emissive Biological Bilirubin Molecules: Shedding New Light on the Phototherapy Scheme

“…Despite the effectiveness of the phototherapy to treat excess levels of BR, 8 , 47 these present findings may shed new light on the current understanding of the phototherapy for the excretion of BR. Previously, no significant efficiency differences have been detected upon using blue light (∼460 nm) or green light (∼500 nm).…”

“… 7 The current established mechanism for BR excretion is that blue-to-green light converts the insoluble BR isomers, through the isomerization process, into soluble ones that can be excreted. 8 BR is a highly nonpolar molecule that tends to interact with lipids rather than with physiological water molecules. 9 Despite several studies about the photodynamics of BR, many processes are not well understood yet because of the complexity of the BR chemical structure.…”

Significance of Heme and Heme Degradation in the Pathogenesis of Acute Lung and Inflammatory Disorders

“…Mild elevations in unconjugated serum bilirubin are associated with reduction of cardiovascular disease (CVD) risk, where high serum bilirubin may pose a risk for neurological sequelae, leading to acute and chronic (kernicterus) bilirubin encephalopathy [ 71 , 72 ]. Phototherapy to remove bilirubin remains the current clinical mainstay [ 73 , 74 ]. Treatment with metalloporphyrin inhibitors (i.e., SnPPIX) have been explored as alternate therapy [ 75 ].…”

Yinzhihuang Oral Liquid Ameliorates Hyperbilirubinemia Induced by δ‐Aminolevulinic Acid and Novobiocin in Neonatal Rats

“…Intestinal bilirubin is deconjugated by β‐glucuronidase and then reduced by bacteria to form bilinogen, the majority of which is oxidized and excreted into the feces, whereas a small portion is reabsorbed from the intestine into the enterohepatic circulation. It should be noted that newborns have more reabsorption of U‐Bil due to a paucity of gut flora [5] . The low rate of bilirubin glucuronidation by the liver is thought to be the key factor causing neonatal hyperbilirubinemia.…”

“…The low rate of bilirubin glucuronidation by the liver is thought to be the key factor causing neonatal hyperbilirubinemia. Additionally, neonatal hyperbilirubinemia may be associated with pathological factors, such as infection, hemolysis, internal bleeding, hypoxia, hypoglycemia, and genetic factors [5,6] …”