Phototherapy is associated with the decrease in serum globulin levels in neonatal hyperbilirubinemia

Abstract

Previous studies have indicated that phototherapy may be associated with childhood immune disorders in later life. The present study aimed to assess the effects of phototherapy as a risk factor in the decrease in serum globulin (GLB) levels during neonatal hyperbilirubinemia. A total of 430 full-term infants aged between 1 and 28 days, diagnosed with neonatal hyperbilirubinemia, were enrolled in the present study. Neonates with intrauterine infection, genetic abnormalities and congenital diseases were excluded from the cohort. All neonates received single-side phototherapy (halogen lamps for 12 h per day, for 3 days) and/or intravenous albumin (IVALB; 1 g/kg/day, for 2 days) and/or intravenous immunoglobulin (1 g/kg/day, for 2 days). Total serum bilirubin (TSB), albumin (ALB) and GLB levels were examined twice, on the first and fourth days of hospitalization. Neonatal TSB concentrations decreased from 299.6±83.9 to 163.6±57.6 µmol/l following 3 days of intensive treatment (P<0.001). Pearson correlative analysis indicated that TSB was significantly correlated to the GLB level (r=0.249; P<0.01), but not with ALB level. There was a significant decrease in GLB levels following phototherapy+IVALB (P<0.001). The GLB levels decreased to 2-4 g/l (10-20% compared with their baseline levels) and were markedly decreased in infants >16 days old compared with those in patients aged <16 days (P<0.001). The decreases in GLB levels observed were 21.3±4.1 to 18.5±4.2 g/l in the phototherapy group, and 23.0±3.9 to 16.6±4.5 g/l in the phototherapy+IVALB (P<0.001). The decrease in GLB levels was associated with age (95% confidence interval;-0.152,-0.016). The results demonstrated that phototherapy decreased serum GLB levels, particularly in infants aged >16 days, while additional IVALB treatment promoted the decrease, along with increased age.

Challenges of phototherapy for neonatal hyperbilirubinemia (Review)

“…To prevent the serious damage to the nervous system caused by free serum bilirubin, early detection and timely intervention are crucial. In clinical practice, liver enzyme inducers, albumin, intravenous immunoglobulin ( 37 ), phototherapy ( 38 ) and blood exchange therapy ( 39 ) are the treatments mainly used for neonatal hyperbilirubinemia. Phototherapy is widely used, and blue light therapy is currently employed to treat neonatal jaundice in the majority of countries, including China.…”

Características e efeitos da fototerapia em recém-nascidos: revisão integrativa

“…Foi constatado que o nível sérico de albumina aumentou conforme a idade dos recém-nascidos e não se obteve variação durante a aplicação da fototerapia ou da fototerapia combinada com IVIG, contudo foi percebido um aumento da albumina na fototerapia combinada com IVALB. A globina diminuiu conforme a idade, entretanto foi identificado que a hiperbilirrubinemia, a fototerapia convencional e a administração de IVALB são fatores de risco que corroboram para o decrescimento dos níveis de globina em recém-nascidos com hiperbilirrubinemia, aumentando assim o risco de imunossupressão, principalmente em recém-nascidos com mais de 16 dias de vida (Zheng, et al;.…”

“…Após 48 horas de exposição à fototerapia, 26,1% dos recém-nascidos envolvidos na pesquisa desenvolveram hipocalcemia, sendo apenas 1,2% deles hipocalcemia sintomática (Padippura, et al;2018). Uma das limitações do estudo em questão é o fato de apenas o cálcio sérico ter sido verificado, pois na realidade o cálcio ionizado é o responsável por verificar a hipocalcemia verdadeira, uma vez que é constatado que os níveis de cálcio sérico podem ser afetados pelos níveis séricos de albumina que não é influenciada pela fototerapia (Zheng, et al;. Um dos sintomas da hipocalcemia são as convulsões, podendo esse estudo (Padippura, et al;2018) estar corroborando com os resultados do estudo abaixo em que são encontradas evidências da relação entre a fototerapia e as crises convulsivas (Newman, et al, 2016).…”

“…Esses estudos também reforçam a ideia de que a fototerapia influencia no sistema imunológico do recém-nascido (Zarkesh, et. ;Sajid, et al;Zheng, et al;.…”

Diagnostic value of combination of cranial MRI, serum homocysteine and procalcitonin for hyperbilirubinemia complicated with brain injury in neonates

“…Neonatal hyperbilirubinemia is common, and children with the disease account for approximately 60% of full-term neonates ( 1 ). With complex pathogenesis, it causes an imbalance between the production and elimination of bilirubin ( 2 , 3 ), brain injury, and permanent neurological damage to the subcortical brain structure, even neurological sequelae, such as abnormalities of the vertebral body, hearing impairment and mental retardation ( 3-5 ).…”