Phototherapy for neonatal hyperbilirubinemia

Itoh, Shinji; Okada, Hitoshi; Kuboi, Toru; Kusaka, Takashi

doi:10.1111/ped.13332

Cited by 47 publications

(46 citation statements)

References 53 publications

(150 reference statements)

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“…With regard to bilirubin, besides investigations on molecule photoisomerization to cure hyperbilirubinemia toxicity, studies on its bichromophore properties have improved its diagnostic meaning in the bile. Besides the merely estimating of the bile flow, relatable to the energy status of the liver submitted to ischaemia and reperfusion, bile AF has been proposed as an optical biomarker of liver functionality …”

Section: Optical Biopsy In Hepatologymentioning

confidence: 99%

Autofluorescence‐based optical biopsy: An effective diagnostic tool in hepatology

Croce

Ferrigno

Bottiroli

et al. 2018

Liver International

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Autofluorescence emission of liver tissue depends on the presence of endogenous biomolecules able to fluoresce under suitable light excitation. Overall autofluorescence emission contains much information of diagnostic value because it is the sum of individual autofluorescence contributions from fluorophores involved in metabolism, for example, NAD(P)H, flavins, lipofuscins, retinoids, porphyrins, bilirubin and lipids, or in structural architecture, for example, fibrous proteins, in close relationship with normal, altered or diseased conditions of the liver. Since the 1950s, hepatocytes and liver have been historical models to study NAD(P)H and flavins as in situ, real-time autofluorescence biomarkers of energy metabolism and redox state. Later investigations designed to monitor organ responses to ischaemia/reperfusion were able to predict the risk of dysfunction in surgery and transplantation or support the development of procedures to ameliorate the liver outcome. Subsequently, fluorescent fatty acids, lipofuscin-like lipopigments and collagen were characterized as optical biomarkers of liver steatosis, oxidative stress damage, fibrosis and disease progression. Currently, serum AF is being investigated to improve non-invasive optical diagnosis of liver disease. Validation of endogenous fluorophores and in situ discrimination of cancerous from non-cancerous tissue belong to the few studies on liver in human subjects. These reports along with other optical techniques and the huge work performed on animal models suggest many optically based applications in hepatology. Optical diagnosis is currently offering beneficial outcomes in clinical fields ranging from the respiratory and gastrointestinal tracts, to dermatology and ophthalmology. Accordingly, this review aims to promote an effective bench to bedside transfer in hepatology.

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Section: Optical Biopsy In Hepatologymentioning

confidence: 99%

Autofluorescence‐based optical biopsy: An effective diagnostic tool in hepatology

Croce

Ferrigno

Bottiroli

et al. 2018

Liver International

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“…Treatment methods for hyperbilirubinemia using phototherapy (PT) and exchange blood transfusion (ET) were established . The mechanism of serum bilirubin decrease during PT involves the production of water‐soluble bilirubin photoisomer [( EZ )‐cyclobilirubin] for excretion from the kidney . Most perinatal institutions throughout Japan currently possess PT devices; thus, jaundiced newborns who need PT can receive it anywhere in the country.…”

Section: Hyperbilirubinemia Management In Term Newbornsmentioning

confidence: 99%

“…In in vitro studies, PT can cause oxidative injury to the cell membrane and DNA, and the injury could have a negative effect on extremely preterm infants . To investigate if aggressive PT is effective for the prevention of bilirubin neurotoxicity or harmful for extremely preterm infants, a multi‐center cohort study was conducted involving 1,974 extremely preterm infants in the USA .…”

Section: Is Aggressive Pt Effective or Harmful For Preterm Infants?mentioning

confidence: 99%

“…The Subcommittee of Hyperbilirubinemia in the American Academy of Pediatrics defined the standard PT spectral power as 8–10 μW/cm 2 per nm and intensive PT as >30 μW/cm 2 per nm . Because the increased mortality observed in extremely preterm infants who are receiving PT and the injury to cell membranes and DNA by PT in in vitro studies suggest that it is prudent to use less intensive irradiance, it has been recommended to initiate PT at lower irradiance (standard PT), and to increase the level (intensive PT) only when TSB continues to rise . In addition, bilirubin is not only cytotoxic, it also has antioxidant effects for preterm infants, who are susceptible to oxidative stress …”

Section: What Are Standard and Intensive Pt?mentioning

confidence: 99%

“…by avoiding the wavelength 400–500 nm, which belongs to the blue region), can be used in preterm infants. Green light, however, has side‐effects for the observer's vision, and generates bilirubin phototoxicity in human cells in vitro . Further studies are needed to identify light sources that are effective and safe for preterm infants. A jaundice management protocol for preterm infants is proposed (Table ) .…”

Section: Treatment Protocols Using the New Treatment Criteriamentioning

confidence: 99%

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Hyperbilirubinemia in preterm infants in Japan: New treatment criteria

Morioka

2018

Pediatrics International

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In 1992, Kobe University proposed treatment criteria for hyperbilirubinemia in newborns using total serum bilirubin and serum unbound bilirubin reference values. In the last decade, chronic bilirubin encephalopathy has been found to develop in preterm infants in Japan because it can now be clinically diagnosed based on an abnormal signal of the globus pallidus on T2-weighted magnetic resonance imaging and abnormal auditory brainstem response with or without apparent hearing loss, along with physical findings of kinetic disorders with athetosis. We therefore revised the Kobe University treatment criteria for preterm hyperbilirubinemic infants in 2017. The three revised points are as follows: (i) newborns are classified under gestational age at birth or corrected gestational age, not birthweight; (ii) three treatment options were created: standard phototherapy, intensive phototherapy, and albumin therapy and/or exchange blood transfusion; and (iii) initiation of standard phototherapy, intensive phototherapy, and albumin therapy and/or exchange blood transfusion is decided based on the total serum bilirubin and serum unbound bilirubin reference values for gestational weeks at birth at <7 days of age, and on the reference values for corrected gestational age at ≥7 days of age. Studies are needed to establish whether chronic bilirubin encephalopathy can be prevented using the 2017 revised Kobe University treatment criteria for preterm infants in Japan.

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Utilization of therapeutic plasma exchange for hyperbilirubinemia in a premature newborn on extracorporeal membrane oxygenation

Belousova

Tong

Bai

et al. 2019

J of Clinical Apheresis

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BACKGROUND:We report a case of a premature newborn girl with a hospital course complicated by suspected respiratory syncytial virus pneumonitis for which she was placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Despite phototherapy, her total bilirubin steadily increased to a peak of 50.4 mg/dL with concern for bilirubin-induced neurologic dysfunction, kernicterus. STUDY DESIGN AND METHODS: Therapeutic plasma exchange (TPE) was achieved via connection with the VA-ECMO circuit. Our institution's standard apheresis procedural parameters were adjusted to account for the small body weight and thus the low blood volume of the neonate while on ECMO. These included calculating the total blood volume to include the patient as well as the ECMO circuit, priming of the apheresis instrument with packed red blood cells to limit the extracorporeal volume, using a lower inlet flow rate, the connection setup of the inlet and return line, and monitoring of ionized calcium and anticoagulation throughout the procedure. RESULTS: A total of three TPE procedures were performed over three consecutive days. This resulted in improvement and stabilization of the patient's bilirubin. CONCLUSION: This case emphasizes that TPE is feasible on a neonate with a suboptimal body weight and thus a low blood volume due to the increased blood volume provided while on ECMO. In the absence of ECMO, whole blood manual exchange transfusion is recommended as TPE would be unsafe due to significant extracorporeal volume that would occur during TPE in a pediatric patient with low body weight.

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Phototherapy for neonatal hyperbilirubinemia

Cited by 47 publications

References 53 publications

Autofluorescence‐based optical biopsy: An effective diagnostic tool in hepatology

Autofluorescence‐based optical biopsy: An effective diagnostic tool in hepatology

Hyperbilirubinemia in preterm infants in Japan: New treatment criteria

Utilization of therapeutic plasma exchange for hyperbilirubinemia in a premature newborn on extracorporeal membrane oxygenation

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