Phototherapy Increases Hemoglobin Degradation and Bilirubin Production in Preterm Infants

Aouthmany, Moustafa M.

doi:10.1038/sj.jp.7200184

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…Phototherapy at the intensity we used (18 W/cm 2 / nm) was effective and resulted in signifi cant decreases in TPB during the fi rst 24 h of treatment. The light energy intensity used in our study was considerably higher than the 5-10 W/cm 2 /nm used by Aouthmany [15] . (Gathwala and Sharma [41] did not report the intensity of light used.)…”

Section: Discussionmentioning

confidence: 87%

“…In contrast, and of possible concern, are two studies which do indicate a potential risk of oxidative stress. In a study of 24 premature infants Aouthmany [15] found a signifi cant increase in end tidal CO concentrations corrected for ambient CO, refl ective of hemolysis, from baseline to approximately 14 h after commencing phototherapy. These results were interpreted as consistent with an increase in phototherapy-induced hemoglobin degradation and subsequent bilirubin production in these premature infants.…”

Section: Discussionmentioning

confidence: 99%

“…However, the fi ndings of Aouthmany [15] and Gathwala and Sharma [41] are of concern and should be borne in mind, especially when treating premature infants for long periods of time or with repeated doses of phototherapy. Our results cannot be appropriately compared with the fourfold longer period of therapy used by Gathwala and Sharma [41] , and our negative results can therefore not be extrapolated to more prolonged phototherapy administration.…”

Section: Discussionmentioning

confidence: 99%

“…As end-tidal CO (ETCO), closely related to COHbc, is the only parameter documented to date to increase in response to phototherapy administered in the clinical setting, projected changes in COHbc were used to calculate the patient sample size [15] . Based on a 10% expected increase in COHbc values, with a power of 0.8 and an alpha value of 0.05, it was estimated that a sample size of 35 patients would be necessary.…”

Section: Sample Sizementioning

confidence: 99%

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Phototherapy and Photo-Oxidation in Premature Neonates

et al. 2005

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Objective: The potential for photo-oxidation during phototherapy in premature neonates was assessed by measuring parameters reflective of photo-oxidation. Methods: Blood was sampled from premature neonates prior to, and after 4 and 24 h of phototherapy, respectively. Total plasma bilirubin (TPB), blood carboxyhemoglobin corrected for inspired carbon monoxide (COHbc) (a sensitive index of heme catabolism), blood thiobarbituric acid reacting substances (TBARS) (a measure of lipid peroxidation), and plasma protein carbonyls (representative of protein oxidation) were determined. Study measurements were compared with baseline values both for the entire study group, and also individually for subgroups < and ≧1.5 kg birthweight, respectively. The percentage difference (%δ) between baseline and the 24-hour measurement was calculated for each parameter. Results: Forty-one premature neonates (mean [± SD] gestational age 30.5 ± 2.7 weeks and birthweight 1,499 ± 448 g) were studied. Mean TPB values decreased from a baseline of 9.1 ± 2.3 to one of 7.2 ± 2.8 mg/dl, p < 0.01, during the first 24 h of phototherapy. For the entire patient sample, neither COHbc, TBARS or protein carbonyl values increased significantly over baseline measurements: COHbc: 0.90 ± 0.26% vs. 0.92 ± 0.32%; TBARS: 19.0 ± 5.6 vs. 18.0 ± 4.5 nmol/ml, and protein carbonyls 7.73 ± 3.78 vs. 7.63 ± 3.56 U/ml (baseline and 24-hour samples only are shown in the abstract). Similarly, for the entire group, %δ (mean, interquartile range) were not significantly different between COHbc [–3.77 (–15.89–17.65)%], TBARS [–7.47 (–17.37–7.38)%], and protein carbonyls [–1.47 (–28.51–43.48)%], respectively. For subgroup analysis of neonates < or ≧ 1.5 kg birthweight, respectively, no significant increases in COHbc, TBARS or protein carbonyls were documented. A significant increase in %δ for COHbc in the <1.5 kg birthweight subgroup compared with those ≧1.5 kg, possibly indicative of hemolysis, was not matched by similar changes in %δ for TBARS or protein carbonyls, and may therefore not be a result of photo-oxidation. Conclusions: Except for changes in %δ in COHbc alone and in the smallest babies only, overall, short term phototherapy in premature infants was effective in reducing TPB concentrations without associated evidence reflective of photo-oxidation.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

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Phototherapy and Photo-Oxidation in Premature Neonates

et al. 2005

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“…Again, whether the effects observed in these in vitro studies can be translated to the bedside is unclear given that skin‐filtering effects and varying binding of bilirubin to albumin can affect the formation of photoisomers 10, 11. In a study in preterm infants with hyperbilirubinemia, phototherapy was shown to increase hemoglobin degradation and bilirubin production 12. However, there remains a dearth of information in the published literature on whether photo‐oxidation products from phototherapy have any adverse effects on infants.…”

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confidence: 99%

Phototherapy: Old questions, new answers

Madan

2005

Acta Paediatrica

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Despite its popularity and widespread use, there remains much more to be learned about phototherapy. Conclusion: There is continued debate on whether intermittent phototherapy is more effective than continuous phototherapy; if light of a longer wavelength is more effective than blue light phototherapy; and if phototherapy in the presence of bilirubin is toxic to normal or abnormal red blood cells. Three in vitro studies in this issue of the journal provide answers to some of these questions.

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Cycled Phototherapy Dose-Finding Study for Extremely Low-Birth-Weight Infants

et al. 2020

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IMPORTANCE Cycled (intermittent) phototherapy (PT) might adequately control peak total serum bilirubin (TSB) level and avoid mortality associated with usual care (continuous PT) among extremely low-birth-weight (ELBW) infants (401-1000 g). OBJECTIVETo identify a cycled PT regimen that substantially reduces PT exposure, with an increase in mean peak TSB level lower than 1.5 mg/dL in ELBW infants. DESIGN, SETTING, AND PARTICIPANTS This dose-finding randomized clinical trial of cycled PT vs continuous PT among 305 ELBW infants in 6 US newborn intensive care units was conducted from March 12, 2014, to November 14, 2018. INTERVENTIONS Two cycled PT regimens (Ն15 min/h and Ն30 min/h) were provided using a simple, commercially available timer to titrate PT minutes per hour against TSB level. The comparator arm was usual care (continuous PT). MAIN OUTCOMES AND MEASURESMean peak TSB level and total PT hours through day 14 in all 6 centers and predischarge brainstem auditory-evoked response wave V latency in 1 center. Mortality and major morbidities were secondary outcomes despite limited power. RESULTSConsent was requested for 452 eligible infants and obtained for 305 (all enrolled) (mean [SD] birth weight, 749 [152] g; gestational age, 25.7 [1.9] weeks; 81 infants [27%] were multiple births; 137 infants [45%] were male; 112 [37%] were black infants; and 107 [35%] were Hispanic infants). Clinical and demographic characteristics of the groups were similar at baseline. After a preplanned interim analysis of 100 infants, the regimen of 30 min/h or more was discontinued, and the study proceeded with 2 arms. Comparing 128 infants receiving PT of 15 min/h or more with 128 infants receiving continuous PT among those surviving to 14 days, mean peak TSB levels were 7.1 vs 6.4 mg/dL (adjusted difference, 0.7; 95% CI, 0.4-1.1 mg/dL) and mean total PT hours were 34 vs 72 (adjusted difference, −39; 95% CI, −45 to −32). Wave V latency adjusted for postmenstrual age was similar in 37 infants receiving 15 min/h or more of PT and 33 infants receiving continuous PT: 7.42 vs 7.32 milliseconds (difference, 0.10; 95% CI, −0.11 to 0.30 millisecond). The relative risk for death was 0.79 (95% CI, 0.40-1.54), with a risk difference of −4.5% (95% CI, −10.9 to 2.0). Morbidities did not differ between groups.CONCLUSIONS AND RELEVANCE Cycled PT can substantially reduce total PT with little increase in peak TSB level. A large, randomized trial is needed to assess whether cycled PT would increase survival and survival without impairment in small, preterm infants.

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Phototherapy Increases Hemoglobin Degradation and Bilirubin Production in Preterm Infants

Cited by 14 publications

References 21 publications

Phototherapy and Photo-Oxidation in Premature Neonates

Phototherapy and Photo-Oxidation in Premature Neonates

Phototherapy: Old questions, new answers

Cycled Phototherapy Dose-Finding Study for Extremely Low-Birth-Weight Infants

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