Insensible water loss from the skin during phototherapy in term and preterm infants

Kjartansson, Sveinn; Hammarlund, K; Sedin, Gunnar

doi:10.1111/j.1651-2227.1992.tb12099.x

Cited by 40 publications

(16 citation statements)

References 15 publications

(11 reference statements)

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“…IWL can be minimized by careful temperature control of the infant. On the other hand, Kjartansson et al [5] have reported unchanged surface temperature and IWL in term and preterm infants during phototherapy. Increased cutaneous vasodilatation and IWL could be caused by long UV wavelengths (360± 420 nm) [15] or by transfer of radiant energies from phototherapy lamps into heat.…”

Section: Discussionmentioning

confidence: 96%

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Responsiveness of cutaneous vasculature to thermal stimulation during phototherapy in neonatal jaundice

Jahnukainen¹,

Lindqvist

Jalonen³

et al. 1999

European Journal of Pediatrics

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The present study was performed to measure the vasoregulatory reactions to dynamic changes in local skin temperature during open bed phototherapy. Periodic thermal stimulation using warm and cool air currents was applied to the skin of ten term infants with physiological jaundice, before and during open bed phototherapy. The reactivity of skin blood flow (SBF) and heart rate was measured using laser Doppler flowmetry and power spectral analysis. The baseline SBF increased significantly by 70% (P = 0.008) during phototherapy without any significant change in skin or rectal temperature. Before phototherapy, the rhythmic (0.08 Hz) thermal skin stimulation increased the oscillations of SBF (from 89 +/- 26 au to 213 +/- 37 au, P = 0.02) at the stimulation frequency band. This response was further increased (P = 0.03) during phototherapy (from 198 +/- 54 au to 658 +/- 115 au, P = 0.004). Phototherapy increased SBF in icteric otherwise healthy neonates. The cutaneous vasodilatation augments the cardiovascular responsiveness to thermal stimulation. These results suggest that open bed phototherapy does not inhibit the cardiovascular responsiveness to local thermal skin stimulation in healthy term infants.

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Section: Discussionmentioning

confidence: 96%

“…The in¯uence of vasodilatation on a newborn's thermoregulation is unclear. Previous reports have suggested that insensible water loss (IWL) may increase or decrease during phototherapy in newborn infants [5,7,13]. There are no data about the responsiveness of cutaneous blood vessels to external thermal stimuli during phototherapy.…”

Section: Introductionmentioning

confidence: 99%

Responsiveness of cutaneous vasculature to thermal stimulation during phototherapy in neonatal jaundice

Jahnukainen¹,

Lindqvist

Jalonen³

et al. 1999

European Journal of Pediatrics

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“…This influences heat loss through radiation enormously. In previous studies, servocontrol on skin temperature lowered the ambient temperature of the incubator when the bank light was switched on (4,26). The use of halogen spotlights leads to smaller T amb adjustments and thus to a stable heat balance.…”

Section: Subjectsmentioning

confidence: 99%

“…The infants were born after a (mean Ϯ SD) gestational age of 30.6 Ϯ 1.6 wk (range 27-34 wk) and had a weight at birth of 1412 Ϯ 256 g (range 966 -1880 g). The Apgar score at 5 min had a median of 8 (range [3][4][5][6][7][8][9]. At the time of the measurements, the infants had a postnatal age of 5 Ϯ 3 d (range 1-11 d) and their weight had slightly diminished to 1367 Ϯ 308 g (range 1010 -2044 g).…”

Section: Subjectsmentioning

confidence: 99%

“…Although it has proven to be an effective and relatively safe treatment (1), uncertainty still exists about whether phototherapy influences the fluid balance of the infant. Previously, studies on the effect of phototherapy upon insensible water loss reported a range of extra water loss between 0 and well over 100% (2)(3)(4). All of these studies were using bank lights.…”

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Transepidermal Water Loss During Halogen Spotlight Phototherapy in Preterm Infants

et al. 2002

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Among preterm infants there is a relationship between skin blood flow and transepidermal water loss (TEWL). The aim of this study was to assess whether halogen spotlight phototherapy without significant heat stress increases TEWL and affects maintenance fluid requirements in preterm infants. TEWL was measured noninvasively before the start and after 1 h of halogen spotlight phototherapy in a group of preterm infants, nursed in double-walled incubators with moderately high relative humidity. Relative humidity and ambient temperature in the incubator were tightly controlled. Mean Ϯ SD birth weight of the 18 infants was 1412 Ϯ 256 g, gestational age 30.6 Ϯ 1.6 wk, and age at measurement 5 Ϯ 3 d. Nine infants received ventilatory assistance. Relative humidity was 40 -80% (mean 52%). Average TEWL increased from 13.6 to 16.5 g/m 2 /h during phototherapy. These data show that TEWL increases by approximately 20% during phototherapy despite constant skin temperature and relative humidity. Maintenance fluids of preterm infants should be increased by 0.35 mL/kg/h during exposure to halogen spotlight phototherapy. (Pediatr Res 51: 402-405, 2002) Abbreviations H conv , heat exchange through convection H evap , heat exchange through evaporation H rad , heat exchange through radiation H tot , total heat loss RH, relative humidity TEWL, transepidermal water loss T amb , ambient temperature in the incubator T roof , temperature of the incubator roof T skin , skin temperature Phototherapy is a standard therapy for hyperbilirubinemia in the newborn. Although it has proven to be an effective and relatively safe treatment (1), uncertainty still exists about whether phototherapy influences the fluid balance of the infant. Previously, studies on the effect of phototherapy upon insensible water loss reported a range of extra water loss between 0 and well over 100% (2-4). All of these studies were using bank lights.The present study is designed to assess the amount of extra water loss through evaporation during phototherapy, given by the currently used halogen spotlights instead of the older bank lights. Various studies have demonstrated that the radiative energy of the phototherapy lamp increases skin blood flow (5-8). We therefore expect that the heat balance of a newborn infant during phototherapy is affected by heat loss through evaporation. Extra fluid intake will then be necessary. We measured TEWL in 18 preterm infants receiving halogen spotlight phototherapy to examine this hypothesis. METHODS Subjects.All subjects were admitted to the neonatal intensive care unit of the Leiden University Medical Center/the Juliana Children's Hospital for treatment of prematurity and developed nonhemolytic hyperbilirubinemia during their nursery course for which they received phototherapy. Infants selected for this study were born after a gestational age of Ͻ34 wk, appropriate for gestational age, and nursed in a doublewalled incubator (type 8000, Dräger, Lübeck, Germany) in which the RH was at least 40% at the time of the measurements. The infa...

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Prophylactic phototherapy for preventing jaundice in preterm very low birth weight infants

Okwundu

Okoromah

Shah

2009

Cochrane Database of Systematic Reviews

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Insensible water loss from the skin during phototherapy in term and preterm infants

Cited by 40 publications

References 15 publications

Responsiveness of cutaneous vasculature to thermal stimulation during phototherapy in neonatal jaundice

Responsiveness of cutaneous vasculature to thermal stimulation during phototherapy in neonatal jaundice

Transepidermal Water Loss During Halogen Spotlight Phototherapy in Preterm Infants

Prophylactic phototherapy for preventing jaundice in preterm very low birth weight infants

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