Phototherapy for neonatal jaundice in Chinese, Malay and Indian infants.
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Biomedical subjects
Publications and source records attributed to K L Tan.
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The relative effectiveness of phototherapy and exchange transfusion for nonhemolytic neonatal hyperbilirubinemia was compared in two closely matched groups of infants. Although the exchange transfusion achieved an immediate reduction of bilirubin level, the "rebound" was rapid and tended to offset this reduction. The more gradual and steady effect of phototherapy resulted in a significantly lower serum bilirubin level at 1, 2, and 3 days after commencement of therapy; the rebound after phototherapy was small. Phototherapy was demonstrated to be more effective than exchange transfusion in achieving prolonged reduction of bilirubin levels for nonhemolytic hyperbilirubinemia. With more efficient lamps delivering more energy in the desired spectrum, it would seem feasible to treat hyperbilirubinemia of whatever etiology with this safer and more convenient form of therapy, though sometimes only as in adjunct therapy.
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Two matched groups of Chinese infants with "idiopathic" jaundice were subjected to phototherapy, one group to "single-direction" phototherapy and the other to "double-direction" phototherapy. The total energy output on the skin of the infants was similar in both groups. The 24-hour fall in bilirubin levels was almost identical in the two groups; the number of infants in each group achieving bilirubin levels less than 11 mg/100 ml at 24, 48, and 72 hours was statistically very similar too. Where the energy output can be adjusted to supply a constant dose on the infant (by varying the energy output in inverse proportion to the skin area exposed), the effect of varying the skin area under phototherapy is minimal. However, the total area of skin exposed to phototherapy under uniform lighting conditions is important because it determines the dose of energy output acting on it, and hence the effectiveness of the procedure.
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Serum IgM and IgA levels were measured in 97 newborn infants with and 141 without hepatosplenomegaly. All were considered normal at birth and had no apparent disease on clinical examination. Thirty per cent. of the infants with hepatosplenomegaly were found to have IgM levels of 20 mg/100 ml or greater, a level established as abnormal when compared with the control group. The number of infants with raised IgM level and the geometric mean level were significantly different (P < 0.001) from those in the control group. No difference, however, was found in serum IgA levels between the two groups of infants. The results suggest that intrauterine infections may sometimes be the cause of hepatosplenomegaly in newborn infants without apparent disease.
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