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PubMed1977

The nature of the dose-response relationship of phototherapy for neonatal hyperbilirubinemia.

The nature of the dose response relationship of phototherapy for neonatal hyperbilirubinemia was studied in 110 infants divided into ten comparable groups; each group was subjected to phototherapy of different intensity. The response to phototherapy increases with increasing dose, but the rate of this response progressively decreases with increasing radiance till a "saturation point" is reached, beyond which no further increase in response occurs to further increase in radiance, i.e., an asymptotic regression was demonstrated. The minimal radiance at which phototherapy begins to be effective for neonatal hyperbilirubinemia was also determined. The rebound after cessation of phototherapy was similar in all groups of infants, despite the shorter duration of exposure required for the groups subjected to intense phototherapy.

Bilirubin↗
PubMed1985

Randomized trial of prophylactic phototherapy in the infant with very low birth weight.

Twenty-two preterm infants (birth weight 850 +/- 220 gm) were randomly assigned to receive phototherapy either soon after birth or after the serum bilirubin concentration reached 5 mg/dl. Infants receiving prophylactic phototherapy were placed under lights at a significantly earlier age and lower serum bilirubin concentration than infants in the routine group (P less than 0.001). There was no significant difference between groups in peak serum bilirubin concentration, age at which it peaked, rate of rise in serum bilirubin concentration, or serum bilirubin concentration at any time during the study. Infants assigned to the prophylactic phototherapy group were under lights for a significantly longer time than those in the routine group (P less than 0.05). There was a significant rise in both configurational and structural photo-isomers (P less than 0.005) independent of serum bilirubin concentration after phototherapy in all patients. These data suggest that the clinical course of hyperbilirubinemia is not altered in infants with very low birth weight receiving prophylactic phototherapy compared with infants with phototherapy begun at a bilirubin concentration of 5 mg/dl.

Age Factors↗
PubMed1982

Use or abuse of phototherapy for physiological jaundice of newborn infants.

To investigate the need for and effects of phototherapy in full-term otherwise healthy babies with physiological jaundice, 40 consecutive babies with serum bilirubin levels of 250 mumol/l or more were assigned at random to two treatment groups. Phototherapy was started in the early group (n = 20) when serum bilirubin was 250 mumol/l and in the late group (n = 20) when serum bilirubin reached 320 mumol/l; however, only 3 of the late group required treatment. Phototherapy prevented a further rise in bilirubin in almost all treated babies, but the difference in peak bilirubin level between early and late treatment groups was not significant. Early phototherapy produced a more rapid decline in bilirubin; levels fell to below 250 mumol/l in a median of 28 h with early treatment and 54 h with late treatment. In each group the ratio of boys to girls was 2/1 and boys remained jaundiced for significantly longer. Phototherapy therefore curtailed the rise and duration of hyperbilirubinaemia, but the effect was small. Jaundice subsided spontaneously in most of these mature infants, especially girls. Phototherapy can separate mother from baby, and it is physiologically stressful. Treatment may be safely withheld until serum bilirubin exceeds 320 mumol/l.

Bilirubin↗
PubMed1999

No additional effect of calcipotriol ointment on low-dose narrow-band UVB phototherapy in psoriasis.

BACKGROUND: Broad-band UVB phototherapy has appeared to be effective in clearing psoriatic lesions. After the advent of calcipotriol ointment, promising results have been obtained by combining these two therapeutic modalities. Also, an additional effect of narrow-band UVB phototherapy on treatment with calcipotriol ointment has been demonstrated. OBJECTIVE: Our purpose was to compare treatment with low-dose narrow-band UVB phototherapy both with and without calcipotriol ointment. METHODS: We included 53 patients suffering from plaque-type psoriasis. All patients underwent low-dose narrow-band UVB phototherapy. Nearly half of the patients were randomized to apply calcipotriol ointment (50 microg/g) twice daily on the affected skin. The Psoriasis Area and Severity Index (PASI) was used to evaluate psoriatic lesions. RESULTS: In this study we showed that low-dose narrow-band UVB phototherapy is effective in the treatment of psoriasis and that calcipotriol ointment does not improve treatment outcome. CONCLUSION: Calcipotriol ointment does not improve treatment with low-dose narrow-band UVB phototherapy.

Adolescent↗
PubMed2002

Quantitative assessment of narrow-band UVB induced tanning during phototherapy in Korea.

BACKGROUND/PURPOSE: Narrow-band (TL-01) UVB lamps are being increasingly used for phototherapy of psoriasis and other dermatoses, for their excellent effect compared with broad-band UVB sources. Many patients receiving phototherapy have complained about the tanning effect of ultraviolet radiation especially in dark-skinned ones. So we wished to know the degree of pigmentation induced by phototherapy during narrow-band UVB treatment. METHODS: A total of 20 psoriasis patients receiving narrow-band UVB phototherapy were included in this study. A Minolta spectrophotometer CM-2002 was used to measure pigmentation. All patients were evaluated for skin color every seventh day for 7 weeks. The L* value (luminance) gives information about the relative lightness ranging from total black to pure white. The a* value represents the balance between red and green, and the b* value between yellow and blue. RESULTS: The L* values which indicate luminance decreased continuously until the 5th week, when maximum tanning was obtained. Afterwards minimal change was observed until the 7th week. The change of a* and b* values also showed the pattern that was compatible with the above results. The mean individual typology angle of our subjects was 41.9 degrees, which indicated they fell into "light" group of constitutional skin color category. CONCLUSION: From this study, we found that pigmentation induced by narrow-band UVB phototherapy increased continuously until the 5th week and then did not progress. Our results provide standard data of skin pigmentation during narrow-band UVB phototherapy in Korean brown skin.

Adult↗
PubMed2003

Ninety-six points of light: phototherapy practices of members of The Photomedicine Society.

BACKGROUND: Phototherapy is an effective and relatively safe treatment for many skin diseases. Recent concern has focused on an apparent decline in phototherapy usage in the US. OBJECTIVE: To determine the current state of phototherapy as practiced globally. METHODS: Cross-sectional survey of members of the Photomedicine Society. RESULTS: Data derived from responses of 96 members showed all to have been in practice for more than five years, providing phototherapy within two years of completing residency. Usage of narrow-band ultraviolet B, ultraviolet A-1 (UVA-1), bath-psoralens plus UVA, and photodynamic therapy was markedly greater among phototherapists in Europe compared to their counterparts in North America and Asia. CONCLUSIONS: Worldwide, there are fewer younger dermatologists who incorporate phototherapy in their practices. European phototherapists have led the world in usage of the newer phototherapy modalities.

Asia↗
PubMed1999

Phototherapy increases hemoglobin degradation and bilirubin production in preterm infants.

OBJECTIVE: To compare hemoglobin degradation and bilirubin production before and during phototherapy in preterm infants. BACKGROUND: Hemoglobin is catabolized into globin and heme, which is degraded by microsomal heme oxygenase into equimolar carbon monoxide and biliverdin. Biliverdin is then reduced into bilirubin. CO is excreted exclusively by the lungs; therefore, end-tidal carbon monoxide, corrected for inhaled CO (ETCOc), reflects hemoglobin degradation and total bilirubin production. METHOD: A prospective study design was used, including a study group of 24 preterm infants requiring phototherapy. Infants with hemolytic diseases, sepsis, recent blood transfusion, and infants on mechanical ventilation were excluded. ETCOc was measured in preterm infants before and during phototherapy. Hemoglobin degradation and bilirubin production were calculated by measuring ETCOc. RESULTS: The (mean +/- SD) birth weight of 24 preterm neonates was 1975 +/- 613 gm, gestational age was 32.7 +/- 2.3 weeks, hematocrit was 47.5 +/- 6.2 volume%, and peak bilirubin was 13.1 +/- 3.2 mg/dl. First ETCOc measurements were done at 59.6 +/- 22.2 hours of age immediately before starting phototherapy. The second ETCOc measurements were taken at 13.7 +/- 7.9 hours after starting phototherapy. The second measurement of 2.6 +/- 0.6 ppm (mean +/- SD) was significantly higher than the first ETCOc of 2.1 +/- 0.6 ppm (p < 0.05). CONCLUSION: Phototherapy increases hemoglobin degradation and bilirubin production in preterm infants.

Bilirubin↗
PubMed2005

A randomized, triple-blind, placebo-controlled trial of prophylactic oral phenobarbital to reduce the need for phototherapy in G6PD-deficient neonates.

OBJECTIVE: Decreased conjugation is probably more important than hemolysis for causing jaundice in G6PD-deficient neonates. The role of enzyme inducers, like phenobarbital, in G6PD deficiency is unclear. This randomized controlled trial was performed to evaluate Phenobarbital's role in reducing the need for phototherapy among G6PD-deficient neonates. STUDY DESIGN: This stratified, randomized, triple-blinded, placebo-controlled trial was conducted in a level III NICU. Consecutive babies with gestation >/=34 weeks and birth weight >/=1800 g were screened from cord blood. G6PD-deficient neonates, who were otherwise healthy, were enrolled. Rh isoimmunization, maternal Phenobarbital use and lack of parental consent were exclusion criteria. Subjects were randomly allocated to receive 5 mg/kg day of oral phenobarbital/ placebo for first 3 days. They were monitored daily for total serum bilirubin (TSB) until declining TSB was documented twice. The primary outcome was requirement for phototherapy and secondary outcomes were duration of phototherapy, need for exchange transfusion, peak TSB and adverse effects. Sample size of 56 could detect a decline in phototherapy requirement from 40 to 5% with 80% power and 5% error. RESULTS: Of 2370 babies screened, 63 were G6PD-deficient. Of them, 56 eligible babies were allocated to phenobarbital (n=27) or placebo (n=29). The mean age of administration of the first dose was 18.55+/-7.3 h. In total, 44% in phenobarbital group and 41% in placebo group required phototherapy (p=1.0). There was no significant difference in exchange transfusion rates (18.5 vs 10%, p=0.46). No baby had adverse reactions. CONCLUSION: Prophylactic oral phenobarbital does not decrease the need for phototherapy or exchange transfusions in G6PD-deficient neonates.

Administration, Oral↗
PubMed1995

Effect of different phototherapy lights on incubator characteristics and dynamics under three modes of servocontrol.

Phototherapy is one of the most common therapeutic interventions in modern neonatal medicine. Analysis of physiological responses to phototherapy requires understanding the physical effects of incident light under different modes of environmental control. In this study, we tested the effect of initiation of phototherapy under laboratory conditions in a convective incubator maintained in three clinically used servocontrol modes. Under conditions of air servocontrol, the initiation of phototherapy resulted in an abrupt sustained increase in the surface temperature of an infant simulator (a blackened aluminum disc). In contrast, when the surface (skin) temperature was the controlled variable, there was a profound drop in the incubator air temperature. An algorithm that simultaneously controlled both the skin and the air temperatures showed intermediate effects. Under conditions of skin servocontrol, fluctuations in air and environmental temperatures were observed for a period of 3 hours before steady state was reached. These findings are most clearly demonstrated using phase plane plotting techniques. We conclude that wide, abrupt, and sustained changes in the thermal environment of an incubator occur after phototherapy is initiated. Such changes must be anticipated in physiological studies using phototherapy.

Algorithms↗
PubMedDate not supplied

Effects of phototherapy on newborn rat testicles.

Phototherapy is the most widespread treatment for lowering bilirubin concentration in neonates. In the routine, phototherapy has some side effects including skin eruption, fluid loss, abdominal distention, mild hemolysis and mild thrombocytopenia. The aim of the study was to investigate the possible mutagenic and gametocidal side effects of 72 h continuous phototherapy on the rat testicle. We observed decreases in spermatogonia numbers per tubule (S/T values), tubular fertilization index (TFI) and sperm sertoli cell index (SSCI), which are the most reliable methods in estimating future fertility potential, due to sensitivity to phototherapy. The differences between study and control groups for S/T, TFI and SSCI values were statistically significant (p = 0.008, p = 0.02 and p = 0.004, respectively). There were significant differences in seminiferous tubule diameters between the control and study groups (p < 0.005), but no significant difference in DNA index values between the control (0.66 +/- 0.12) and study (0.59 +/- 0.05) groups (p > 0.05). As a conclusion, phototherapy seems to have some side effects on the newborn rat testicle. Further studies with larger groups, designed for investigation of the effects of phototherapy on seminiferous tubules, may give more beneficial results.

Animals↗
PubMed2006

Patent ductus arteriosus in extremely preterm infants receiving phototherapy: does shielding the chest make a difference? A randomized, controlled trial.

BACKGROUND: Patent ductus arteriosus (PDA), a common complication in extremely preterm infants, is associated with increased mortality and morbidity. Phototherapy has been associated with PDA, and one randomized, control trial has shown that shielding of the chest may decrease the risk of PDA. AIM: To examine if chest shielding reduces the incidence and severity of PDA in extremely preterm infants. STUDY DESIGN: Randomized clinical trial of infants < 29 wk gestation (stratified into two groups: < 27 wk gestation and 27-28 wk gestation). METHODS: Following written parental consent, eligible infants were randomized to receive phototherapy, with or without a chest shield. Ductal parameters were assessed by Doppler echocardiogram in all infants prior to starting phototherapy and at 48 h after initiation, or earlier if phototherapy was discontinued. RESULTS: 54 infants were enrolled in the study. The incidence of PDA (shield 19/27 vs no shield 21/27), ductal size (1.4 vs 1.0 mm) and left atrial/aortic root (LA/Ao) ratio (1.2 vs 1.3) were similar in the two groups pre-phototherapy. There was no difference between the groups post-phototherapy in incidence (shield 12/27 vs no shield 13/27), ductal size (1.4 vs 1.5 mm) or LA/Ao ratio (1.1 vs 1.3). CONCLUSION: Chest shielding did not alter the incidence or severity of PDA in our population of extremely preterm infants.

Ductus Arteriosus, Patent↗
PubMed1999

Intensified phototherapy using daylight fluorescent lamps.

Jaundice is a common reason for therapeutic intervention in newborn infants and phototherapy is effective treatment if enough light energy is delivered to a skin surface area of sufficient size. Narrow spectrum blue light is superior to white light, but in developing countries fluorescent blue lamps often have to be imported and are much more expensive than white lamps. We developed a phototherapy unit in which seven daylight fluorescent tubes are placed immediately under the floor of a transparent plexiglass crib. The efficacy of this unit, delivering approximately 19 microW/cm2/nm, was compared with that of two conventional phototherapy units using overhead lamps placed 35 cm above the infants. One unit used daylight fluorescent tubes and delivered approximately 4 microW/cm2/nm, the other unit used special blue fluorescent tubes and delivered approximately 22 microW/cm2/nm. Fifty-one infants were included in the analyses, all of them breastfed on demand. Serum bilirubin levels were determined spectrophotometrically at 0, 12 and 24 h. The decrement in serum bilirubin concentrations was significantly greater in infants undergoing phototherapy with the new device or with special blue lamps compared to conventional overhead daylight lamps (p < 0.001 both at 12 and at 24 h). We conclude that highly efficient phototherapy may be delivered with daylight fluorescent lamps placed in very close proximity to the patient. Thus, lack of access to expensive imported special blue lamps does not preclude delivery of effective phototherapy in developing countries.

Circadian Rhythm↗
PubMed1985

Lactose malabsorption is not a cause of diarrhea during phototherapy.

Lactose malabsorption is not a cause of diarrhea during phototherapy. Jaundiced neonates under phototherapy develop diarrhea or loose stools during the treatment. These phenomena were attributed to an induced lactase deficiency caused by bilirubin breakdown products. We investigated lactose malabsorption in 59 neonates--29 normals and 30 jaundiced under phototherapy. Five-hour hydrogen breath tests were performed. Preprandial and postprandial (at 30, 60, 120, 180, 240, and 300 min) expired air samples were analyzed for hydrogen. Ten controls and five jaundiced neonates had positive hydrogen breath tests. Eighteen controls and 16 neonates under phototherapy had preprandial hydrogen (concentrations above 5 ppm). In our hands, lactase deficiency and lactose malabsorption were not induced by phototherapy. Lactase deficiency is therefore not the cause of diarrhea associated with phototherapy.

Breath Tests↗
PubMed1999

Home phototherapy: report on a workshop of the British Photodermatology Group, December 1996.

Phototherapy is a popular and effective treatment for many patients with skin diseases. However, repeated journeys to hospital for phototherapy can be inconvenient and expensive. If it were available, many patients might prefer home-based phototherapy as long as it was safe and effective. Indeed, many psoriasis patients already self-treat with ultraviolet A sunbeds at home. This report represents a consensus view from a British Photodermatology Group workshop held in December 1996, the purpose of which was to examine the potential role of home-based phototherapy in dermatological practice. We conclude that home-based therapy represents a suboptimal treatment with greater attendant risks than phototherapy in a hospital environment. The level of medical supervision of the home treatment is crucial to its safety and effectiveness. Until further studies are forthcoming, home phototherapy should be largely restricted to those with overwhelming difficulties in attending hospital.

Home Care Services↗
PubMed2006

Quality of life in psoriasis improves after standardized administration of narrowband UVB phototherapy.

SUMMARY Psoriasis is a chronic fluctuating dermatosis with demonstrable impact on patients' quality of life. Our aim was to investigate if narrowband UVB phototherapy administered to psoriatic patients in a standardized manner leads to an improvement in patients' perceived quality of life. A total of 138 patients with psoriasis were recruited from referrals to the Skin and Cancer Foundation, Australia between January 1998 and September 2002. Patients had psoriasis inadequately controlled by topical therapies alone and no contraindications to the use of phototherapy. Patients completed a pre- and post-therapy questionnaire on quality of life parameters. The differences in mean and standard deviation of quality of life parameters were measured using a paired sample t-test based on pre- and post-phototherapy questionnaires. Ninety patients were included in the study. Forty-eight patients were excluded as they had not completed post-phototherapy questionnaires. The course of narrowband UVB phototherapy was found to significantly improve quality of life in psoriasis patients (P <or= 0.005). We conclude that narrowband UVB phototherapy improves quality of life in patients with psoriasis.

Adult↗
PubMed1980

The behavior of jaundiced infants undergoing phototherapy.

Ten full-term jaundiced infants were examined with the Brazelton Scale before, during and following phototherapy. They were compared with 10 non-jaundiced control infants examined at the same post-partum ages. All infants were appropriate for gestational age and free of perinatal complications other than hyperbilirubinemia. Differences on the orienting items of the Brazelton examinations (primarily visual orienting) were found prior to the onset of phototherapy or separation, and persisted for the length of the study. The greatest over-all differences were noted during phototherapy and separation from the mother, at which times the treatment group had lower scores on four of the six orienting items. They also had lower scores on muscle tonus, pull-to-sit and cuddliness while undergoing phototherapy, and poorer scores on orienting items, self-quieting and tremulousness were also evident three days following treatment. It is suggested that the differences found in mother-infant interaction following separation for the management of minor medical problems may be related to changes in infant behaviour which are already evident prior to separation. In the cases of jaundiced infants requiring phototherapy, these changes appear to be related primarily to hyperbilirubinemia. The possibility of these effects being prolonged or confounded by phototherapy or separation cannot be discounted.

Bilirubin↗
PubMed1980

Gut transit time and lactose malabsorption during phototherapy. II. A study using raw milk from the mothers of the infants.

Thirty newborn infants with normal birth weight suffering from uncomplicated hyperbilirubinemia were studied. 15 infants received ordinary phototherapy and 15 intensive phototherapy (blue double light). All infants received their mothers' milk or fresh milk from mothers of other newborn infants of the same age. All infants had normal lactose tolerance test during the phototherapy, except one infant receiving ordinary transit time was relatively long. The gut transit time was significantly shorter in the infants treated with intensive phototherapy than in those treated with ordinary phototherapy without there being any significant difference in the increase in blood glucose by lactose tolerance tests. It is concluded that lactose malabsorption is not the usual cause of the reduced gut transit time during phototherapy even if the infants receive their mothers' milk.

Bilirubin↗
PubMed1981

Bilirubin, reserve albumin for binding of bilirubin and pH in plasma during phototherapy (ordinary and double light) of term newborn infants.

Forty-five term newborn infants with uncomplicated hyperbilirubinaemia were treated continuously with phototherapy for 24 hours. Twenty-eight infants received double light treatment and 17 infants ordinary phototherapy. During both treatments a significant decrease in the serum unconjugated bilirubin concentration, a significant increase in the serum reserve albumin concentration for binding of bilirubin determined by the [14C] MADDS method, and a significant decrease in the index of serum bilirubin toxicity occurred. The changes in these parameters were significantly greater during the double light treatment than during the ordinary phototherapy. During the treatment the fall in index was constant. No significant change in plasma pH was seen. Thus, the study gives further evidence that the risk of bilirubin encephalopathy is reduced by phototherapy and that double light treatment is in the respect superior to ordinary phototherapy. Prior to phototherapy the molar ratio in serum of unconjugated bilirubin plus reserved albumin for binding of bilirubin to albumin was only 0.60, on average, and during the treatment the increase in the serum reserve albumin concentration was less than the decrease in the serum bilirubin concentration. This can be explained either by the presence in infant serum of an unknown ligand interfering competitively or allosterically in the binding of MADDS and bilirubin to albumin, or by the existence of a foetal albumin with a lower affinity for MADDS than adult albumin.

Bilirubin↗