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PubMed2006

Efficacy of phototherapy for neonatal jaundice is increased by the use of low-cost white reflecting curtains.

OBJECTIVE: To determine whether the addition of low-cost reflecting curtains to a standard phototherapy unit could increase effectiveness of phototherapy for neonatal jaundice. DESIGN: Randomised controlled clinical trial. SETTING: Level-one nursery of the Hospital Universiti Sains Malaysia, Kelantan, Malayasia. PATIENTS: Term newborns with uncomplicated neonatal jaundice presenting in the first week of life. INTERVENTIONS: Phototherapy with white curtains hanging from the sides of the phototherapy unit (study group, n = 50) was compared with single phototherapy without curtains (control group, n = 47). MAIN OUTCOME MEASURES: The primary outcome was the mean difference in total serum bilirubin measured at baseline and after 4 h of phototherapy. The secondary outcome was the duration of phototherapy. RESULTS: The mean (standard deviation) decrease in total serum bilirubin levels after 4 h of phototherapy was significantly (p<0.001) higher in the study group (27.62 (25.24) micromol/l) than in the control group (4.04 (24.27) micromol/l). Cox proportional hazards regression analysis indicated that the median duration of phototherapy was significantly shorter in the study group (12 h) than in the control group (34 h; chi(2) change 45.2; p<0.001; hazards ratio 0.20; 95% confidence interval 0.12 to 0.32). No difference in adverse events was noted in terms of hyperthermia or hypothermia, weight loss, rash, loose stools or feeding intolerance. CONCLUSION: Hanging white curtains around phototherapy units significantly increases efficacy of phototherapy in the treatment of neonatal jaundice without evidence of increased adverse effects.

Bedding and Linens↗
PubMed1989

Transcutaneous bilirubinometry: bilirubin kinetics of the skin and serum during and after phototherapy.

Skin bilirubin (transcutaneous bilirubinometry, TcB, reading) and serum bilirubin kinetics were studied in 20 full-term hyperbilirubinemic infants during and after phototherapy. TcB readings at the chest site decreased after 2 h of phototherapy from 28.0 to 21.3 (25% of initial TcB reading, p less than 0.001) and thereafter continued to decrease in a nonlinear fashion through the first 24 h of phototherapy. However, TcB readings after 12 h of phototherapy were about 50% of the initial readings (p less than 0.001), declining minimally during the second 12 h of phototherapy, suggesting saturation kinetics. While serum bilirubin levels remained unchanged during the first 4 h of phototherapy, thereafter they showed a rapid decline to 12 h of phototherapy. The rate of decline decreased during the second 12 h of phototherapy, but serum bilirubin levels still decreased significantly from 16.9 to 14.9 mg/dl. Although TcB readings showed saturation kinetics during the second 12 h of phototherapy, the serum bilirubin levels were shown to decrease significantly. This suggests that the main site of action of phototherapy may be intravascular at this stage, rather than the skin and subcutaneous capillary bed as in the early stage of phototherapy.

Bilirubin↗
PubMed1993

[The effect of human albumin in association with intensive phototherapy in the management of neonatal jaundice].

BACKGROUND: The effectiveness of phototherapy in lowering serum bilirubin levels in neonates varies inversely with the rate and degree of hemolysis. Combining this therapy with albumin perfusion could enhance its effectiveness. This study examines total, unconjugated and unbound fractions of bilirubin in infants treated by phototherapy alone or by phototherapy plus albumin. PATIENTS AND METHODS: The files of 211 neonates treated from January 1990 to March 1991 for severe neonatal jaundice were analysed. Jaundice was due to ABO incompatibility in 113 cases and hereditary hemolytic anemia in 6 cases; its cause was unknown in 92 patients. Other causes of jaundice such as Rh incompatibility, premature delivery before 34 gestational weeks and neonatal infections were excluded from the study. All 211 neonates were given phototherapy from admission with similar light energy. 114 babies (group I) received only phototherapy, while the 97 others (group II) were also given human albumin, (1.5 g/kg), during the first 2 hours of phototherapy. RESULTS: The decrease in serum unconjugated and unbound bilirubin after 4 hours of phototherapy was 34% in group I and 45% in group II (p < 0.0005). There was no difference between both groups after 24 hours of phototherapy. Other factors such as the initial concentration of serum unconjugated and unbound bilirubin, age at the onset of therapy, and ethnic skin color also influenced the decrease in bilirubin after 4 and 24 hours of phototherapy, in addition to albumin perfusion. CONCLUSIONS: Albumin perfusion plus phototherapy appears to induce a rapid and early decrease in unconjugated, unbound bilirubin, the fraction that is potentially neurotoxic, while phototherapy alone acts over a longer period.

Analysis of Variance↗
PubMed2002

Taking treatment to the patient: development of a home TL-01 ultraviolet B phototherapy service.

BACKGROUND: While most patients requiring phototherapy can attend for hospital-based out-patient ultraviolet (UV) B therapy, a significant number cannot attend because of geographical, work, economic and other reasons. OBJECTIVES: To determine whether there was a need for home phototherapy in the Tayside area and, if so, to establish protocols and then to assess if such a service would be workable. METHODS: Patients referred from dermatology out-patient clinics in Tayside for narrow-band UVB (TL-01) phototherapy completed a pilot questionnaire that was followed by a two-phase project. In phase 1, patients with psoriasis were trained to use the home phototherapy equipment (HoPE) within the hospital department under nursing supervision while a teaching package and protocols were developed. In phase 2, home phototherapy was made available for patient use in the community, supported by a specialist home phototherapy nurse. Waldmann UV100 home therapy units were used, with accurate dosimetry. Detailed treatment records were kept and questionnaires were used to assess acceptability and costs of therapy. RESULTS: Fifty-two pilot questionnaires were completed. Forty-two per cent of respondents found hospital phototherapy inconvenient and 75% felt phototherapy at home would be helpful. In phase 1, seven of 10 patients trained to use the HoPE completed therapy with the HoPE unit alone, reaching minimal residual activity (MRA) or clearance in a median of 18 exposures (median dose 10.38 J cm-2). In phase 2, 32 courses of home phototherapy were given to 30 patients. Of 23 with psoriasis, 18 reached clearance or MRA in a median of 22.5 exposures (median dose 9.84 J cm-2). Although self-reported erythema rates appeared higher than expected, all post-treatment questionnaire respondents would choose home phototherapy over hospital therapy if required in the future. CONCLUSIONS: UVB (TL-01) home phototherapy is a useful practical development that has fulfilled a need in our catchment area. Where appropriate training and support teams are available it appears to be similar in effectiveness to hospital therapy, to be safe and to be cost-effective for patients.

Adult↗
PubMed2004

Laser Doppler perfusion imaging (LDPI) and transepidermal water loss (TEWL) values in psoriatic lesions treated with narrow band UVB phototherapy. Dermal vascularity may be useful indicator of psoriatic activity.

OBJECTIVE: This study attempts to objectively measure physiological changes in transepidermal water loss (TEWL), an indicator of skin barrier function and laser Doppler perfusion index (LDPI) an indicator of skin vascularity, of psoriatic skin lesions following treatment to narrow-band ultraviolet B (UVB) phototherapy using the psoriasis severity (PS) score as a measurement of clinical phototherapy response. MATERIALS AND METHODS: Fourteen patients with established diagnosis of plaque type psoriasis were studied. The patients received narrow band UVB phototherapy 3 times a week until clearance of their psoriasis and the frequencies are reduced as clearance is observed. Two psoriasis plaques ("lesional skin") were used to measure treatment response and another 2 areas of uninvolved ("non-lesional skin") on the corresponding opposite limbs were identified for comparison. PS score, TEWL and LDPI were carried out at baseline (0 week), 2 weeks and 8 weeks during treatment. Measurements were carried out just before each phototherapy session and repeated 1 hour after phototherapy treatment. RESULTS: The mean PS score decreased by almost 40% after 2 months phototherapy (t = 2.44, P = 0.028). There was no significant difference in PS score between week 0 and week 2, or between week 2 and week 8. After phototherapy, there was no significant difference in LDPI values on the psoriatic lesional skin between week 0 and week 8 or between week 2 and week 8. It appears that phototherapy does not induce inflammation on non-lesional skin to provoke measurable LDPI changes. The mean TEWL values of psoriatic lesional skin were significantly higher than normal skin throughout the study period before and during phototherapy (week 0, t = 5.71, P = 0.000, week 2, t = 9.29, P = 0.00, week 8, t = 6.93, P = 0.000). It appears that the skin barrier function of psoriatic skin improves only minimally as psoriatic lesions improve clinically (as evidenced by the reduction in PS scores) with narrow-band UVB phototherapy, but the dermal vascularity and blood flow and barrier function of the psoriatic skin remained abnormal. CONCLUSION: It appears that LDPI and TEWL measurement may not be a good surrogate marker of clinical response to narrow-band UVB phototherapy.

Adult↗
PubMed1998

Decreased response to phototherapy for neonatal jaundice in breast-fed infants.

OBJECTIVE: To evaluate the efficacy of phototherapy for nonhemolytic hyperbilirubinemia in breast-fed and formula-fed infants and infants receiving formula and breast milk. DESIGN: Prospective study. SETTING: Nursery for healthy infants. METHOD: Full-term healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 micromol/L [14.9 mg/dL] or 222 micromol/L [13.0 mg/dL] at ages younger than 48 hours) were treated with conventional phototherapy by using daylight fluorescent lamps. Three groups of infants were studied: group 1, formula-fed infants; group 2, breast-fed infants; and group 3, infants receiving formula and breast milk. All patterns of feeding started at birth. Phototherapy was terminated only when bilirubin concentrations had decreased to less than 185 micromol/L (10.8 mg/dL); the minimum exposure period was 24 hours. RESULTS: A total of 163 infants were studied: group 1, 79; group 2, 34; and group 3, 50. The age at the start of exposure was comparable in all groups. The mean+/-SD weight loss as a percentage of birth weight was as follows: group 1, 2.8%+/-5.0%; group 2, 6.1%+/-3.4%; and group 3, 3.2%+/-2.6%. The duration of exposure to phototherapy was as follows: group 1, 54.1+/-20.8 hours; group 2, 64.6+/-25.1 hours; and group 3, 54.9+/-21.5 hours; the 24-hour rate of decrease in the bilirubin concentration was as follows: group 1, 18.6%+/-11.7%; group 2, 17.1%+/-9.6%; and group 3, 22.9%+/-9.4%. The overall rate of decrease in the bilirubin concentration for the duration of exposure to phototherapy was as follows: group 1, 0.8%+/-0.3% per hour; group 2, 0.6%+/-0.3% per hour; and group 3, 0.8%+/-0.3% per hour. Weight loss at the start of phototherapy was significantly greater in group 2 compared with group 1 (P<.001) and group 3 (P<.001), although the hemoglobin and hematocrit values were comparable. The duration of exposure to phototherapy was not significantly different in the 3 groups (P=.06); however, the duration of exposure of group 2 infants was 10 hours more than that of the other 2 groups. The 24-hour rate of decrease in the bilirubin concentration in group 3 was significantly better than that of group 2 (P = .007) and group 3 (P = .02); the rates of decrease for groups 2 and 3 were similar (P = .52). The overall rate of decrease in the bilirubin concentration during the duration of exposure to phototherapy in group 2 was significantly less than that of group 1 (P = .002) and group 3 (P<.001); the rates for groups 1 and 3 were similar (P = .35). The postexposure rebound bilirubin concentrations were comparable in all groups during the first 2 days; however, the duration of moderate jaundice in group 2 was more prolonged. CONCLUSIONS: The response to phototherapy of group 2 infants was significantly slower than that of group 3 and group 1 infants; this response was still of adequate efficacy. The addition of formula to the feedings for totally breast-fed infants, without suspension of breast-feeding, would enhance the efficacy of phototherapy and reduce exposure time.

Bilirubin↗
PubMedDate not supplied

Effect of combined treatment with 2,3,7,8-tetrachlorodibenzo-p-dioxin and phototherapy on bilirubin metabolism in the jaundiced Gunn rat.

2,3,7,8-Tetrachlorodibenzo-p-dioxin, a potent inducer of microsomal cytochrome P448-dependent monoxygenases, and phototherapy both accelerate bilirubin metabolism and decrease jaundice in Gunn rats. The effects of combined treatment with 2,3,7,8-tetrachlorodibenzo-p-dioxin and light were studied in these rats by applying phototherapy for 65 hr, beginning 5 days after induction with 2,3,7,8-tetrachlorodibenzo-p-dioxin. 2,3,7,8-Tetrachlorodibenzo-p-dioxin pretreatment caused a 75% decline in plasma bilirubin in 5 days, with no change thereafter, whether or not the rats were exposed subsequently to phototherapy. In the uninduced rats, plasma bilirubin levels declined by 55% after 40 hr of phototherapy. As determined by [14C]bilirubin kinetics, both 2,3,7,8-tetrachlorodibenzo-p-dioxin and phototherapy increased fractional bilirubin turnover and decreased the total bilirubin pool. In the 2,3,7,8-tetrachlorodibenzo-p-dioxin-induced rats, the contracted bilirubin pool shifted from skin to liver, but these tissue pools did not change further during phototherapy. By contrast, in uninduced rats, phototherapy decreased the cutaneous bilirubin pool, which is the main target of phototherapy. 2,3,7,8-Tetrachlorodibenzo-p-dioxin was more effective than phototherapy in diminishing plasma bilirubin levels and the total bilirubin pool, but the combined treatment (2,3,7,8-tetrachlorodibenzo-p-dioxin followed by phototherapy) was no more effective than 2,3,7,8-tetrachlorodibenzo-p-dioxin alone.

Animals↗
PubMed2006

[Incidence of drug-induced photosensitization during phototherapy].

BACKGROUND: Exogenous photosensitization represents one of the adverse effects of phototherapy. However, the impact of potentially photosensitizing drugs on the incidence of photo-induced eruptions during phototherapy is unknown. AIM OF THE STUDY: To determine the incidence of drug photosensitization during phototherapy. PATIENTS AND METHODS: This was a retrospective study of all patients undergoing phototherapy between November 1999 and April 2004 in the Dermatology Department of Caen University Teaching Hospital. Details of all topical or systemic medications taken before or during phototherapy were recorded. Since methoxsalen induces photosensitization, sessions of phototherapy were stratified according to whether methoxsalen was given. Screening was performed for the following clinical signs of drug photosensitization: acute photo-induced, erythematous and/or vesicular eruption, associated with pruritus or burning. RESULTS: In the non-methoxsalen group, use of a potentially photosensitizing drug was found for 29/155 TL01 phototherapy sessions. Drug-induced photosensitization was suspected in 3/29 sessions (10.3%). In the methoxsalen group, a potentially photosensitizing drug was found in 21/118 sessions of PUVA-therapy. Drug-induced photosensitization was suspected in 4/21 sessions (19%). Risk of photo-induced eruption was not associated with photosensitizing drug therapy, TL01 phototherapy or PUVA-therapy. DISCUSSION: Drug photosensitization appears to be rare during phototherapy, regardless of photosensitizing drug intake. It is twice as frequent during PUVA-therapy as during TL01 phototherapy but this difference is not significant.

Adolescent↗
PubMed1986

Home phototherapy. An alternative to prolonged hospitalization of the full-term, well newborn.

Hyperbilirubinemia in the healthy, term neonate is the most common reason for prolonged hospitalization. Expense, separation from a nursing mother, imparting a sense of illness to the infant, and disrupting such processes as "bonding" are all drawbacks to in-hospital phototherapy. Home Phototherapy Associates in Colorado Springs, Colorado has treated 260 newborns from April 1982 to February 1985. The infants treated by home phototherapy averaged 0.81 days of hospital phototherapy before being discharged to home phototherapy for an average of 2.44 days. Average bilirubin on entry into home phototherapy was 14.19 mg/dl and 10.97 mg/dl when discontinued. The average age upon entering home phototherapy was 3.97 days. Home phototherapy was ordered at the discretion of the private physician. Parents were given verbal and written instructions on care of the jaundiced newborn, kept a record of their baby's progress and signed a consent form. There have been no complications in 260 newborns treated at home. There were 17 rehospitalizations. Home phototherapy is an effective and safe alternative to prolonged hospitalization for the healthy, full-term newborn with jaundice. Parental satisfaction has been nearly 100 percent. The average daily decrement in bilirubin is comparable with that reported by others for in-hospital phototherapy. The cost savings, uninterrupted "bonding" process, and the ability to keep mother and child united are some of the observable benefits.

Bilirubin↗
PubMed2000

A new blue light-emitting phototherapy device: a prospective randomized controlled study.

OBJECTIVE: To evaluate the efficacy of a new phototherapy light source with a narrow luminous blue spectrum. The device, made with high-intensity gallium nitride light-emitting diodes (LEDs), was compared with conventional phototherapy at similar light intensities. SETTING: Two university-affiliated community hospitals in Jerusalem. DESIGN: Prospective open randomized study. PARTICIPANTS: Sixty-nine jaundiced, but otherwise healthy, term infants who met the entry criteria for phototherapy set by the American Academy of Pediatrics' Practice Parameter. MAIN OUTCOME MEASURES: The duration of phototherapy and the rate of decrease in total serum bilirubin (TSB) concentration. RESULTS: The mean TSB concentrations at initiation and termination of treatment did not differ between newborns receiving LED and those receiving conventional phototherapy. The duration of phototherapy and the rate of decrease in TSB concentration were not statistically different in the 2 groups. The average rate of decrease in TSB after adjustment by a linear regression analysis for confounding factors was -3.16 micromol/L/h (95% confidence limits -4.81, -1.51) in newborns receiving LED phototherapy compared with -2.19 micromol/L/h (-3.99, -0.40) in those treated with conventional phototherapy (P <.14). No side effects were noted in any of the newborns. CONCLUSIONS: The blue gallium nitride LED device is as effective as conventional phototherapy and is readily accepted by nursing staff. Future LED phototherapy devices can provide much higher irradiance, and thus greater efficacy, and offer a new highly versatile approach to the treatment of jaundice.

Bilirubin↗
PubMed2002

Clear topical ointment decreases transepidermal water loss in jaundiced preterm infants receiving phototherapy.

The evaporation rate (ER) from the skin was measured in 40 jaundiced preterm infants born at less than or equal to 34 weeks of gestation. The baseline measurements were executed in both the right and left side in 3 positions: upper arm, back and lower leg. The patients were randomly recruited to a treatment or a control group. The treatment group received 3.0 ml of clear topical ointment just before phototherapy. Conventional phototherapy was placed above the incubators in both groups. ER and ambient skin temperature were measured at the same point at 30 minutes and 5 hours during phototherapy. In the control group, ER was increased by 8.0 per cent (P value = 0.01) and 14.5 per cent (P value < 0.001) at 30 minutes and 5 hours during phototherapy, respectively. In the treatment group, clear topical ointment decreased ER by 19.2 per cent (P value < 0.001) and 13.2 per cent (P value = 0.003) at 30 minutes and 5 hours during phototherapy, respectively. Ambient skin temperature during phototherapy was increased significantly (P < 0.01) in both groups. Serum microbilirubin difference of pre and post phototherapy at 24 hours of phototherapy between the 2 groups was not significantly different (P = 0.38). The authors concluded that conventional phototherapy, in premature infants nursed in an incubator, increased transepidermal water loss (TEWL) significantly and the application of clear topical ointment on the skin of jaundiced preterm infants receiving conventional phototherapy in incubators reduce TEWL significantly, without effect on serum microbilirubin.

Administration, Topical↗
PubMed2002

Rebound hyperbilirubinemia in term infants after phototherapy.

OBJECTIVE: To determine whether a rebound in serum bilirubin level occurs within 24 hours after discontinuation of phototherapy in term infants with hyperbilirubinemia. METHODS: A retrospective medical record review of term infants with hyperbilirubinemia requiring phototherapy who were admitted over 24 months, June 1999 to December 2001, at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia was completed. Total serum bilirubin levels (TSB) at and up to 24 hours after termination of phototherapy (follow-up levels) were recorded. The difference between mean TSB level at termination of phototherapy and at follow-up was calculated using the paired t test. RESULTS: Three hundred and one infants, 53% (n=161) were boys, mean standard deviation (SD) for gestational age was 39.4 +/- 1.4 weeks, mean birth weight was 3200 +/- 600 g, mean TSB SD at termination of phototherapy was 193 +/- 46 micromole/liter (micromol/l) and at follow-up was 188 +/- 45 micromol/l for all infants with either positive or negative direct coombs' test results. The difference in mean TSB level at discontinuation of phototherapy and at follow-up was statistically significant, (t=3.12, P=0.002). The mean TSB level at termination of phototherapy was 179 +/- 47 micromol/l and at follow-up was 177 +/- 47 micromol/l for 65 infants with positive direct coombs' test results. This difference was statistically insignificant (t=0.725, P=0.47). The mean time interval between the termination of phototherapy and the measurement of follow-up TSB level was 8.3 +/- 5.3 hour. CONCLUSION: The rebound of bilirubin level after termination of phototherapy in otherwise healthy term infants is minimal; thus measurement of serum bilirubin is not required after termination of phototherapy and adds unnecessary expense, prolongs hospitalization, or both.

Female↗
PubMed2006

Randomized controlled trial of compact fluorescent lamp versus standard phototherapy for the treatment of neonatal hyperbilirubinemia.

BACKGROUND: Special blue tube lights of standard length are used in most neonatal units to deliver phototherapy. Of late, special blue compact fluorescent lamp phototherapy equipments have been introduced in India, which are claimed to be better than standard tube lights. AIM: To compare special blue compact fluorescent lamp (CFL) phototherapy with special blue standard-length tube lights (STL). METHODS: This randomized, controlled trial was conducted in a level III NICU. Neonates, otherwise healthy, of gestation greater than 34 weeks with hyperbilirubinemia requiring phototherapy, were included. Rh iso-immunized babies, those who underwent prior exchange transfusion and whose parents declined to consent were excluded. By stratified block randomization, babies were allocated to receive phototherapy by CFL or STL. CFL and STL were both special blue lights with irradiance maintained above 15 microWatts/nm/cm2. Total serum bilirubin (TSB) was measured 12 hourly till phototherapy was stopped or an exchange transfusion was done. Temperature and clinical and laboratory parameters of dehydration were recorded 12 hourly till 72 hrs. Nursing staff answered an objectivized proforma about the disadvantageous effects on nurses. RESULTS: Fifty babies were enrolled in each group. Baseline characteristics, causes of jaundice, hemolysis, baseline TSB and irradiance were similar in both groups. Mean duration of phototherapy (P = 0.98) was similar in both groups. Kaplan-Meier analysis of phototherapy duration showed no difference in the survival curves of the 2 groups (P = 0.6). Axillary temperature was similar in both groups and no baby was dehydrated. Nursing staff reported no significant differences between CFL and STL visavis glare hurting the eyes, giddiness and headache. CONCLUSIONS: CFL phototherapy has no superiority over STL phototherapy in terms of efficacy and adverse effects on the neonate and effects on nursing staff.

Female↗
PubMed2006

Modulation of ultraviolet (UV) transmission by emollients: relevance to narrowband UVB phototherapy and psoralen plus UVA photochemotherapy.

BACKGROUND: Patients with psoriasis undergoing or about to undergo ultraviolet (UV) phototherapy and photochemotherapy often have thick scale on their plaques which can prevent the penetration of UV radiation. Emollients are used to moisturize the skin and to prevent or reduce some of the milder side-effects ('dryness', itching) sometimes experienced during UV therapy. However, emollients can alter the UV transmission of skin and thus may alter the clinical effects of phototherapy and photochemotherapy. OBJECTIVES: We tested 30 of the topical emollients in the British National Formulary (BNF) using a standard in vitro technique used to test sunscreens. We also surveyed U.K. phototherapy units to establish routine practice for emollient use in phototherapy and photochemotherapy. METHODS: We used a standard in vitro technique to measure the monochromatic protection factors (MPFs) of 30 non-bath emollients from the BNF. An application rate of 2 mg cm-2 was used. For the assessment of effects during narrowband UVB (TL-01) phototherapy, the mean of the protection factors at 310 and 315 nm was calculated; for psoralen plus UVA photochemotherapy the mean UVA protection factor was used. A questionnaire survey was used to assess routine practice concerning emollient use prior to phototherapies in phototherapy units throughout the U.K. RESULTS: In the UVA range, 17 of the 30 emollients gave protection factors of 1.2 or above. In the UVB range, 23 of 30 had an MPF of 1.2 or above. Yellow soft paraffin had the highest protection factor in the UVB range. Of 78 centres surveyed, 57 returned completed questionnaires (73%). Seventeen of 57 (30%) centres routinely used emollients immediately prior to administering phototherapy treatments. The remaining 40 of 57 (70%) did not. Forty-five (79%) responding centres recommended the use of emollients after phototherapy. CONCLUSIONS: This study has revealed considerable variability in the practice of emollient use before phototherapy treatments. Although the majority of centres included in this study did not routinely use emollients, almost one third did. Our in vitro measurement of 30 emollients revealed marked variation in UV transmission, with many emollients blocking sufficient UV to affect the response to therapy.

Drug Utilization↗
PubMed1996

Ten-year experience of phototherapy in Yonsei Medical Center.

Phototherapy with PUVA or UVB has been used to treat a wide variety of diseases such as psoriasis, vitiligo, atopic dermatitis and mycosis fungoides, etc. The present study was performed to investigate the pattern of phototherapy in the phototherapy clinic of Yonsei Medical Center. One thousand six hundred ninety two patients who received PUVA or UVB phototherapy were included in this study. We analyzed the protocols for phototherapy between 1985 and 1994. The number of phototherapy per year increased sharply until 1991 and thereafter it has remained relatively constant. The most common age group at the start of phototherapy was the third decade. The most common indications for PUVA and UVB phototherapy were vitiligo and psoriasis, respectively. Most patients had received less than 50 treatments of PUVA and less than 200 J/cm2 of cumulative UVA. Most patients had received less than 50 treatments with UVB and cumulative UVB doses were variable. We had not found any malignancy in the skin. Since the maximum safe cumulative doses of UVA or UVB have not yet been established, it is difficult to decide when phototherapy should be discontinued. The data presented in this study needs to be further analyzed in correlation with photoaging and cancer development for the safe usage of phototherapy.

Academic Medical Centers↗
PubMed1998

Fibre optic versus conventional phototherapy for hyperbilirubinaemia in preterm infants.

UNLABELLED: Studies comparing efficacy of fibre optic phototherapy to conventional phototherapy are performed mostly in term infants and give conflicting results. This randomized prospective study compares efficacy of fibre optic phototherapy using the Ohmeda Biliblanket device to conventional fluorescent phototherapy in preterm infants. A total of 124 preterm infants with a nonhaemolytic hyperbilirubinaemia were evaluated. Stratification at randomisation was performed according to birth weight ( < 1000 g, 1000-1500 g or 1500-2000 g). Fifty-six infants received fibre optic and 68 conventional phototherapy. Efficacy was assessed by comparing the required duration of phototherapy. Median duration of phototherapy was 118 h and 114 h in the fibre optic and conventional groups respectively, the difference in which was not statistically significant. The median durations were also not significantly different within the separate weight groups. The number of infants requiring exchange transfusions was similar in both treatment groups. CONCLUSION: The efficacy of fibre optic phototherapy in preterm infants is comparable to conventional phototherapy.

Bilirubin↗
PubMed2001

Can sunlight replace phototherapy units in the treatment of neonatal jaundice? An in vitro study.

BACKGROUND/AIM: Light can be efficiently used for the treatment of neonatal jaundice. Sunlight, which covers a large portion of the light spectrum including the bilirubin-absorbing range, is abundant in the Middle East. Such advantages prompted the present study to investigate the efficiency of sunlight in isomerizing bilirubin. This may introduce a practical source of light for the treatment of hyperbilirubinic infants in areas where phototherapy units are not available. METHODS: The efficiency of sunlight was quantified by a comparison with a phototherapy unit. Aqueous bilirubin solutions were exposed to periodic sunlight over the entire year and the reduction of bilirubin concentration was monitored spectrophotometrically. Bilirubin solutions were also exposed to a phototherapy unit intensity comparable to that of sunlight (17 cm away from the source). RESULTS: The data indicated that at this comparable light intensity, the phototherapy unit was as effective as sunlight. However, for the treatment of neonatal jaundice, phototherapy units are usually operated at a distance of 50 cm (where the light intensity is six times less than that of sunlight). When this distance was tested, only 16% of bilirubin was isomerized in the first 5 min of exposure. In contrast, about 65% of bilirubin was isomerized when the phototherapy unit was placed at a distance of 17 cm and when the bilirubin solutions were exposed to sunlight for the same time period. The hourly and seasonal changes in sunlight intensity affected the reduction in bilirubin concentration significantly. CONCLUSION: Data revealed that sunlight is almost 6.5 times more effective than a phototherapy unit when operating at the ward geometry after taking isomerization efficiency and area of exposure into consideration. Moreover, sunlight is still more effective during the winter season, when its intensity is lower. Thus, sunlight may be considered an alternative phototherapy source for the treatment of neonatal jaundice, particularly in areas where conventional phototherapy units are unavailable.

Bilirubin↗
PubMed2003

Dermal bilirubin kinetics during phototherapy in term neonates.

AIM: To investigate dermal bilirubin kinetics during phototherapy in the presence of neonatal indirect hyperbilirubinaemia. METHODS: 33 neonates with non-haemolytic indirect hyperbilirubinaemia, who required phototherapy, were included in the study. Phototherapy modules containing four normal and four blue fluorescent lamps were used during the study. The transcutaneous bilirubin index (TcBI) was measured in an area of the forehead covered by a 2.5 cm diameter opaque patch and a nearby exposed site. The TcBI obtained from patched and unpatched areas and simultaneous serum bilirubin (SB) concentrations were measured before the start of phototherapy and after 6, 12, 18, 30, 42 and 66 h of phototherapy. RESULTS: SB concentration and the TcBI from the unpatched area decreased significantly during the first 6 h of exposure, while the TcBI obtained from the patched area decreased significantly after 12 h. The TcBI from the unpatched area was consistently lower than that from the patched area during phototherapy. After the onset of phototherapy, there was a weak, non-significant correlation between SB concentrations and the TcBI from patched and unpatched areas. CONCLUSION: Phototherapy was effective for both patched and unpatched areas, but the rate of decline was slower in patched areas, only becoming significant in the second 6 h of treatment. There was no significant correlation between the levels of SB and TcBI after the onset of phototherapy, and therefore the use of TcBI cannot be recommended as a surrogate measure of SB.

Bilirubin↗