Effect of infants’ position on serum bilirubin level during conventional phototherapy

Donneborg, Mette Line; Knudsen, Kim; Ebbesen, Finn

doi:10.1111/j.1651-2227.2010.01885.x

Cited by 32 publications

(43 citation statements)

References 9 publications

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“…This agrees with the findings of Donneborg et al (17), who showed that changing the position of infants during phototherapy, as is common practice, does not increase the effect of phototherapy. They inferred that the effect of phototherapy is in the capillary circulation near the skin surface.…”

Section: Discussionsupporting

confidence: 83%

Early formation of bilirubin isomers during phototherapy for neonatal jaundice: effects of single vs. double fluorescent lamps vs. photodiodes

et al. 2015

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Background:In neonatal jaundice, phototherapy converts bilirubin to more polar photoisomers which can be excreted without conjugation. We measured changes in the concentration of bilirubin Z,E-photoisomer during the first 4 h of intensive phototherapy using single fluorescent lights as a reference, compared to double fluorescent lights, and a single unit of photodiodes. Methods: Neonates (N = 42; birth weight: 1,200-4,690 g; gestational age: 28-42 wk) were studied during phototherapy. Infants were randomized to: (i) single, or (ii) double fluorescent phototherapy; or (iii) single unit photodiodes. Irradiance was measured. Serum bilirubin (by cooximetry) and Z,E bilirubin (by high-pressure liquid chromatography) were measured at 0,15, 30, 60, 120, and 240 min after the start of phototherapy. Data were analyzed with a linear mixed model. results: There was a highly significant increase of Z,E-bilirubin over time (P < 0.0001), starting at 15 min. Photoisomers reached ~25% of total bilirubin concentration after 4 h. However, there were no significant differences between the three randomized groups in spite of significantly higher irradiance using double fluorescent lights vs. single fluorescent or photodiodes. conclusion: Formation of bilirubin photoisomers is rapid, and occurs early during intensive phototherapy for neonatal jaundice. The rate and level of photoisomerization was not influenced by irradiance and light source. P hototherapy is the standard treatment for hyperbilirubinemia in newborns, and is administered to prevent kernicterus and other sequelae of bilirubin neurotoxicity (1).It is effective and considered safe. However, a recent report suggests that "aggressive" phototherapy in the smallest infants of birth weight 501-750 g may be associated with increased risk of death (2).When native bilirubin IXα (Z,Z) in neonates is exposed to light, a rapid photochemical reaction produces water-soluble configurational (4Z,15E; 4E,15Z; 4E,15E) and structural (Z-lumirubin; E-lumirubin) isomers (3,4). Photooxidation may also occur (5,6). Due to increased polarity, these isomers can be excreted in bile and urine, bypassing the need for conjugation. It has recently been suggested that these isomers, because of their polarity, should be less able to cross the bloodbrain barrier (1,7). If this is correct, photoisomer formation might be directly neuroprotective, irrespective of the effect on excretion. Experimental data suggest that bilirubin photoisomers are less toxic than the native IX α (Z,Z), but there are methodological weaknesses in these studies (1). Thus, experimental proof of the hypothesized direct neuroprotective effects of photoisomerization is still needed. Both different light qualities and variable light irradiance are commonly employed in practical phototherapy. Herein we have investigated whether such factors may impact on photoisomer formation.The common light sources used in phototherapy are either fluorescent, or tungsten-halogen lamps with wide emission spectrum, or light-emitting diodes (LEDs) wi...

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Section: Discussionsupporting

confidence: 83%

Early formation of bilirubin isomers during phototherapy for neonatal jaundice: effects of single vs. double fluorescent lamps vs. photodiodes

et al. 2015

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“…With reference to a 24-h decrease of TSB in a previous study (22), the sample size was calculated to demonstrate a 6% difference in the decrease of TSB between the groups after 24 h of phototherapy, a difference judged as clinically relevant. Determining a significance level of 0.05 and a power of 0.8, the required sample size should be at least 36 infants in each group.…”

Section: Subjectsmentioning

confidence: 99%

Effect of phototherapy with turquoise vs. blue LED light of equal irradiance in jaundiced neonates

et al. 2015

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“…13 Changing position has been known to maximize the area exposed to light resulting the reduction of phototherapy duration. 7 Our findings the decreasing amount of serum bilirubin levels before and after 24 hours of phototherapy showed a statistically no significant result between the alternating positioned group and the supine only positioned group (P=0.751). A randomized study in Israel on 30 aterm infants reported that total serum bilirubin level decreased significantly in infants with supine position.…”

Section: Discussionmentioning

confidence: 58%

“…7 The assessment of baseline characteristics in both groups from this study includes gender, birth weight, gestational age, body temperature, feeding, hemoglobin, hematocrit, leucocytes, platelets, reticulocyte, CRP, Coomb tests, and light irradiance. The average age of neonatal phototherapy began at age 4 to 5 days, this is related to an increase in bilirubin levels peak at age 3 to 5 days.…”

Section: Discussionmentioning

confidence: 99%

Changes on Total Serum Bilirubin and Infant’s Position during Phototherapy

2018

ARC Journal of Pediatrics

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Effect of infants’ position on serum bilirubin level during conventional phototherapy

Abstract: The decrease in TSB was not significantly associated with positioning of the infant during conventional phototherapy. Alternating exposure is widely practiced in Scandinavia but is unnecessary.

Cited by 32 publications

References 9 publications

Early formation of bilirubin isomers during phototherapy for neonatal jaundice: effects of single vs. double fluorescent lamps vs. photodiodes

Early formation of bilirubin isomers during phototherapy for neonatal jaundice: effects of single vs. double fluorescent lamps vs. photodiodes

Effect of phototherapy with turquoise vs. blue LED light of equal irradiance in jaundiced neonates

Changes on Total Serum Bilirubin and Infant’s Position during Phototherapy

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