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PubMed1983

Phototherapy-associated diarrhea. The role of bile salts.

The concentration of fecal bile salts was measured in 14 jaundiced neonates who received phototherapy (PT group) and their 14 nontreated matched controls (C). Before initiation of phototherapy, mean bile salt concentrations in stool specimens from the two groups were similar. At 12 hours of 'lights on', stool specimens from PT babies showed a significantly increased mean bile salt concentration, whereas in the C babies there was no change (3.65 +/- 0.39 vs 2.62 +/- 0.22 mmol/l; p less than 0.01). At 24 hours after 'lights off', stool specimens from the PT infants had a mean bile salt concentration like that before phototherapy, and not different from C. During phototherapy, nine PT babies had a bile salt concentration in their stools of 3.5 mmol/l and above; 6 of these babies had watery stools with a high sodium content. The high concentration of bile salts found in the colonic contents of neonates during phototherapy would appear to be a factor in the pathogenesis of phototherapy-associated diarrhea in the jaundiced neonate.

Bile Acids and Salts↗
PubMed1986

Efficacy of phototherapy in non-haemolytic hyperbilirubinaemia.

Clinical experience of phototherapy for non-haemolytic hyperbilirubinaemia in 3999 infants in Kandang Kerbau Hospital, Singapore, is documented. Phototherapy was most effective in extremely preterm infants with very low birth weight (gestation less than or equal to 32 weeks, birth weight less than or equal to 1500 g) and least effective in full term infants with very low birth weight (gestation greater than or equal to 37 weeks, birth weight less than or equal to 1500 g) and large preterm infants (gestation less than 37 weeks, birth weight greater than 2270 g). Overall, phototherapy was effective in almost all the infants, with a failure rate of only 2.00/1000 infants. No characteristic features common to all the failures could be detected. The bilirubin rebound was usually mild; repeat phototherapy was required in only 30 infants (7.50/1000), with the response to the second exposure comparable to that to the first. No infant required a third exposure. All the infants tolerated phototherapy well, none developing any illness that could be attributed to the treatment. This clinical experience shows that phototherapy for the treatment of nonhaemolytic hyperbilirubinaemia is effective and safe.

Bilirubin↗
PubMed1998

The effect of phototherapy on renal blood flow velocity in preterm infants.

Mean renal blood flow velocity (RBFV) was studied with two-dimensional/ pulsed Doppler ultrasound and relative renal vascular resistance (RVR) was calculated before, during, and after phototherapy treatment in 30 preterm infants (gestational age < or = 32 weeks) who were treated for a minimum of 12 h with phototherapy for nonhemolytic hyperbilirubinemia. RBFV decreased, whereas RVR increased significantly after the initiation of phototherapy. In 'healthy' (nonventilated) infants RBFV and RVR returned to baseline values after discontinuation of phototherapy. Whereas in 'unhealthy' (ventilated) infants, RBFV and RVR did not return to baseline values after discontinuation of phototherapy. In 16 infants (> 50% of the cases) the ductus arteriosus reopened during phototherapy.

Blood Flow Velocity↗
PubMed2006

Which phototherapy system is most effective in lowering serum bilirubin in very preterm infants?

OBJECTIVE: To compare the effectiveness of various phototherapy systems in lowering serum bilirubin levels in preterm infants. METHODS: This randomized clinical trial enrolled 140 preterm infants with gestational age < or =30 weeks and presenting nonhemolytic hyperbilirubinemia. When total serum bilirubin level reached 6.0 mg/dl (102.6 micromol/l), eligible infants were randomly assigned to four study groups: conventional, fiberoptic Wallaby, fiberoptic Biliblanket, and combined phototherapy. Efficacy was assessed by comparing highest serum bilirubin levels, duration of treatment, and number of infants requiring exchange transfusion. RESULTS: Our results confirm that fiberoptic phototherapy, both Wallaby and Biliblanket, had the same effectiveness of conventional phototherapy. The best results have been obtained using combined phototherapy, which allowed to reach lower serum bilirubin levels, a shorter duration of treatment and a significant reduction of exchange transfusions. CONCLUSION: Our data suggest that combined phototherapy should be the method of choice in treating hyperbilirubinemia in very preterm infants.

Bilirubin↗
PubMed1992

Phototherapy for ABO haemolytic hyperbilirubinaemia.

The efficacy of 'standard' daylight phototherapy and 'high intensity' blue light phototherapy for neonatal jaundice from ABO-HD, or of a non-haemolytic nature was evaluated. Altogether 77 full-term infants with ABO-HD and 3,020 with non-haemolytic jaundice were studied. Both groups of infants responded well to standard daylight phototherapy; the response in non-haemolytic hyperbilirubinaemia was significantly greater. High intensity blue light phototherapy was significantly more effective in reducing bilirubin levels than standard daylight phototherapy in both group of infants with no failure being encountered. Four infants with non-haemolytic jaundice did not respond adequately to white light (1.4/1,000); they needed high intensity blue light for adequate response. Bilirubin rebound was mild. Four infants in the blue light group needed a second exposure (28.3/1,000) compared with 20 in the white light group (6.9/1,000), a difference that was significant. Standard white light phototherapy is usually adequate for ABO-HD as well as non-haemolytic hyperbilirubinaemia. High intensity blue light would be preferable where a more rapid and greater response is desirable.

ABO Blood-Group System↗
PubMed1987

Activated charcoal as an adjunct to phototherapy for neonatal jaundice.

The effectiveness of activated charcoal as an adjunct to phototherapy in reducing plasma bilirubin levels was studied in the jaundiced rat. The administration of charcoal either by feeding or gavage was effective in reducing plasma bilirubin levels in both the adult and suckling jaundiced rat. The combination of charcoal feeding and phototherapy in the adult rat was additive in that the bilirubin levels were significantly lower when compared to levels of the rats given charcoal alone. Plasma bilirubin levels were significantly reduced in the suckling jaundiced rat given either charcoal or charcoal together with phototherapy, however, the combination of treatments did not appear to be additive. These data suggest that charcoal could be a useful adjunct to phototherapy by binding bilirubin in the intestinal lumen and reducing the potential for the enterohepatic circulation of unconjugated bilirubin. Charcoal combined with phototherapy may also reduce the intensity of phototherapy needed to effectively lower plasma bilirubin levels.

Animals↗
PubMed1992

Fiberoptic vs conventional home phototherapy for neonatal hyperbilirubinemia.

Two methods of administering home phototherapy were compared. Twenty-two infants received home phototherapy with a fiberoptic cummerbund, and 26 infants received home phototherapy with a conventional four-bul "bililight." The two treatment modalities proved equally effective in lowering bilirubin levels. The duration of treatment was a mean of 3.09 days in the fiberoptic group and 2.77 days in the bililight group, and the daily decline in bilirubin levels was a mean of 1.84 mg/dL/day in the fiberoptic group and 2.18 mg/dL/day in the bililight group. Differences were not statistically significant (Student's t-test, two-tailed). Upon completion of therapy, mothers responded to 15 statements intended to measure attitudes and perceptions regarding home phototherapy. In four of the 15 statements there was a statistically significant preference for fiberoptic therapy, as measured with the chi-square statistic (p less than .05), while in the remaining statements there were no preferences expressed toward either treatment modality. Fiberoptic home phototherapy appears to be as effective as home phototherapy administered with conventional bililights and may be better accepted by parents.

Bilirubin↗
PubMed1997

Purpuric phototherapy-induced eruption in transfused neonates: relation to transient porphyrinemia.

OBJECTIVE: Blue light phototherapy is commonly administered to neonates as treatment of indirect hyperbilirubinemia, often in conjunction with blood transfusions to treat hemolytic anemia. We observed a distinctive cutaneous complication of phototherapy in six neonates with hyperbilirubinemia. METHODOLOGY: We studied the clinical and histologic characteristics of the eruption, as well as the porphyrin levels in affected neonates. Five of the patients had erythroblastosis fetalis; the other had profound anemia from twin-twin transfusion. All of the neonates developed purpuric patches at sites of maximal exposure to the phototherapy lights, with dramatic sparing at shielded sites within 24 hours after initiation of the phototherapy. On discontinuation of phototherapy, all eruptions cleared within 1 week. Examination of skin biopsy sections showed purpura without significant inflammation or keratinocyte necrosis. Plasma porphyrins (copro- and proto-) were elevated in the two patients in which they were assessed. CONCLUSIONS: The distribution of the eruption in areas exposed to light and presence of circulating porphyrins suggest that porphyrinemia may underlie the light-induced purpuric eruption. Additional studies will be required to determine definitively the mechanisms of both the purpuric phototherapy-induced eruption and the development of increased blood porphyrin levels in these transfused neonates.

Anemia↗
PubMedDate not supplied

[Daily sensation of hunger, before and after phototherapy, in subjects with depression-type seasonal affective disorder].

OBJECTIVE: The present study investigates the daily pattern of hunger sensation (HS) in women affected by "seasonal affective disorder--depression type" (SAD-DT), before and after therapeutic exposure to bright light (phototherapy). The aim is to detect whether there are disorders in daily HS during the active phase of the disease which can be normalized by an effective treatment of the depressive status, via phototherapy. MATERIALS AND METHODS: Volunteered for the study 4 women affected by SAD-DT, 32-58 years old (BMI: 17.8-29.6 Kg/m2); 10 clinically healthy women (CHW), 21-52 years old (BMI: 23 e 25 Kg/m2) were recruited as controls. Both of the SAD-DT patients and CHW were asked to compile the "orexigram", which was chronobiometrically analyzed by means of the 1. conventional statistical methods; 2. rhythmometric analysis; 3. spectral analysis. RESULTS: Before phototherapy, the SAD-DT patients were found to be characterized by an increased HS (hyperorexia), with the circadian rhythm of the orectic stimulus (OS) which is shifted in its acrophase, being prone to become "free running". After phototherapy, the SAD-DT patients were found to show a little insignificant decrease in their OS, which still maintains a delayed phase in its circadian rhythm as well as the tendency to be "free running". CONCLUSIONS: The pre-treatment findings suggest that the SAD-DT patients are affected by hyperorexia associated with a "phase-shift" for the circadian periodicity of their HS, which is prone to the desynchronization. Such a dyschronism reinforces the hypothesis that the SAD-DT may be pathogenetically sustained by a mechanism of "phase-shift". The post-treatment findings suggest that both the hyperorexia and dyschronism of the orectic circadian rhythm are uncorrected by the phototherapy, even though the SAD-DT patients seem to have had beneficial antidepressive effects from the therapeutic intervention. The persisting dyschronism indicates that the photic stimulus is not able to completely reset the biological clock of the suprachiasmatic nuclei, at least for the phasic modulation of the HS circadian rhythm. The orexigram, thus, could be enclosed among the clinical tools in order to assess the complete efficacy of the phototherapy in SAD-DP patients.

Adult↗
PubMed2006

Would elimination of copayments for phototherapy decrease the cost of treating psoriasis with systemic biologics? A cost analysis.

Phototherapy is a proven treatment method for the treatment of psoriasis, yet is typically underutilized because of the frequency of physician visits and copayments required for each session (typically 2-5 treatments/wk). Injectable biologic therapies are effective but costly. The objective of this study was to explore how changes in copayment strategies for phototherapy may affect biologic usage. Published estimates of the cost of phototherapy and biologic treatment were used to determine the costs of these treatments to patients and insurers. With an estimated patient copayment of $30 per office visit and a pharmacy copayment of $50 per month, the $1,800 annual patient expense for phototherapy far exceeds the estimated out-of-pocket expenses for etanercept, alefacept, and efalizumab ($840, $405, and $780, respectively). The estimated annual costs to MCOs ranged from $3,008 for phototherapy, to $20,300 for etanercept. Copayments for phototherapy may be shifting patients toward biologic treatment, which is more convenient but more costly to managed care plans.

Cost Sharing↗
PubMed1989

Phototoxicity of tin protoporphyrin, tin mesoporphyrin, and tin diiododeuteroporphyrin under neonatal phototherapy conditions.

Tin metalloporphyrins are being considered as therapeutic agents for neonatal hyperbilirubinemia, and it is possible that concurrent exposure to phototherapy will occur during their use. Euthymic hairless guinea pigs, Crl:IAF(HA)BR, were given daily intraperitoneal injections of tin protoporphyrin (SnPP), tin mesoporphyrin (SnMP), or tin diiododeuteroporphyrin (SnI2DP) for 3 successive days. They were concurrently exposed to ambient light or two different kinds of phototherapy light under conditions similar to that found in neonatal intensive care units. Phototherapy light exposure was for a continuous period of approximately 72 hours following the first injection of metalloporphyrin. The presence or absence of phototoxicity under these conditions was determined by observations for an erythematous response on the back and ears of the guinea pigs. The dosages used were 0.75, 3.75, and 7.5 mg/kg per day of SnPP, 0.075, 0.375, and 0.75 mg/kg per day of SnMP, and 0.9, 4.5, and 9.0 mg/kg per day of SnI2DP. These dosages for each drug were approximately 1 times, 5 times, and 10 times, respectively, the maximum anticipated clinical dosage. At equal multiples of the clinical dosages, SnI2DP was less phototoxic than SnPP, and SnMP was the least phototoxic of the three compounds. SnPP was marginally phototoxic at the lowest dosage. SnMP was phototoxic only at the highest dosage under phototherapy light emitting ultraviolet A irradiation, but when phototherapy light not emitting ultraviolet A irradiation was used, SnMP was not phototoxic. In all cases, the phototoxic response was reversible when the drug and phototherapy treatment were discontinued.

Animals↗
PubMed1987

[Phototherapy in full-term neonates].

In view of the indistinctiveness of the use of phototherapy in jaundiced term newborn infants a study is reported. The study is a longitudinal one (1966-1984). The number of infants is given in the time period before the use of phototherapy, during phototherapy as well as during the period of less frequent use of phototherapy. It appears that the use of phototherapy did not influence the number of exchanged infants. It is concluded that in the term newborn infants phototherapy is frequently used unnecessary.

Exchange Transfusion, Whole Blood↗
PubMed1985

Bilirubin photoisomerization in premature neonates under low- and high-dose phototherapy.

Photoisomerization of native bilirubin to more polar configurational isomers (Z,E-bilirubin) and structural isomers (lumirubin) was studied in 20 premature infants with physiologic jaundice to determine the effect of low-dose (6 microW/cm2/nm) v high-dose (12 microW/cm2/nm) phototherapy. Patients were assigned prospectively to receive either low- or high-dose treatment. Study groups were comparable with regard to birth weight, gestational age, and total bilirubin prior to the initiation of phototherapy. Treatment was administered with white light produced by a commercially available halogen-tungsten lamp. Dose was measured periodically during the study to ensure a uniform distribution of irradiance and constant exposure. Sera for photoisomers were obtained before initiation of treatment and at two, four, and eight hours. Photoisomers expressed as a percent of total bilirubin were determined using high-pressure liquid chromatography. Serum proportion of both configurational and structural isomers increased with the duration of phototherapy in both treatment groups. There was no significant difference between the percent of configurational isomers in low- and high-dose phototherapy groups. However, high-dose treatment produced a significantly higher proportion of the structural isomer lumirubin after four hours (0.7% low dose v 1.3% high dose, P less than .05). These data confirm that phototherapy results in both configurational and structural isomerization of bilirubin in vivo. Furthermore, the previously described "dose" effect of phototherapy may be attributed to the production of the structural isomer, lumirubin.

Bilirubin↗
PubMed1985

Threshold for initiation of phototherapy in infants with non-haemolytic hyperbilirubinaemia.

The effect of initiating phototherapy at three different bilirubin concentrations in infants with physiological jaundice was studied in 98 clinically jaundiced term infants. Phototherapy was initiated at levels of 170, 257 and 300 mumol/l in groups A, B and C respectively. There was no difference between the groups in terms of days in hospital and bilirubin levels at entry or at exit from the study. Of group A, 97% received phototherapy v. 47% and 18% in groups B and C respectively. Peak bilirubin in those infants in group C receiving phototherapy was 318 mumol/l v. 282 mumol/l and 229 mumol/l in groups A and B. Two group C infants suffered complications of hyperbilirubinaemia. Rebound hyperbilirubinaemia was noted in infants with more severe jaundice after cessation of phototherapy. The threshold for toxicity in non-haemolytic hyperbilirubinaemia may be higher than the still widely accepted 340 mumol/l value, but pending definitive studies phototherapy will continue to be initiated at levels of greater than 257 mumol/l in term infants with hyperbilirubinaemia.

Bilirubin↗
PubMed1985

Home phototherapy treatment of neonatal jaundice.

A home phototherapy program for healthy, term newborns with hyperbilirubinemia (n = 62) was implemented, and results were compared prospectively with a group of term neonates who met enrollment criteria but were treated in-hospital (n = 55). The purpose of the study was to prospectively assess the feasibility, safety, and effectiveness of home phototherapy in treating uncomplicated neonatal jaundice. Infants were required to be greater than 24 hours old and to weigh at least 2,270 g (5 lb). Enrolling physicians were instructed to select infants whose clinical diagnoses and bilirubin levels allowed an adequate margin of error for a trial of home phototherapy and whose parents were capable of managing the added responsibilities of home therapy. At the time the phototherapy equipment was delivered and set up in their home, parents received extensive instruction, including how to record pertinent ongoing data on a home flow sheet. Serum bilirubin levels were measured at least daily. The preponderant diagnosis listed by enrolling physicians was "physiologic jaundice." No parent reported significant complications, and no infant required rehospitalization. Bilirubin levels decreased as rapidly in the home group as in the hospitalized control group, and duration of treatment averaged 2.8 days. About $18,000 was saved by treating these 62 infants at home compared with in-hospital costs in our community. We found home phototherapy to be a feasible, safe, and effective alternative to in-hospital phototherapy for otherwise healthy, jaundiced infants with motivated and capable parents.

Age Factors↗
PubMed1984

Home versus hospital phototherapy for term infants with hyperbilirubinemia: a comparative study.

Twenty-five term infants with hyperbilirubinemia were selected for phototherapy administered at home if they fulfilled clinical and laboratory criteria designed to exclude any pathologic cause of hyperbilirubinemia. Ongoing nursing surveillance of home phototherapy was provided to assure adequate nursing care. No phototherapy-related complications were noted in the study infants. Effectiveness of phototherapy at home was compared with results in a similar group of 33 infants who underwent standard hospital phototherapy. The average decrease in serum bilirubin concentration was similar for the two groups after the first day of treatment. Duration of phototherapy was longer for infants treated at home. The major motivating factor for study entry appeared to be avoidance of parent-infant separation.

Bilirubin↗
PubMed1995

Fiberoptic phototherapy systems.

According to the American Academy of Pediatrics (AAP), about 60% of all newborns in the United States each year are diagnosed with jaundice, a major symptom of hyperbilirubinemia. Even though only a small percentage of these infants will have bilirubin levels that, according to the current AAP practice parameters, are high enough to require treatment, many of these infants will be treated with phototherapy (past research has associated very high bilirubin levels with brain damage). Because jaundice is unlikely to be noticed within the typical 24-hour period before discharge from the hospital, a phototherapy device that is convenient and safe for use in the home, as well as in the hospital, is desirable. In the following study, we address the performance, safety, and convenience of three fiberoptic phototherapy systems (which consist of pads and light sources), from three manufacturers, that can be used in either a hospital or the home. We also assess the advantages and disadvantages of this technology compared with those of the conventional overhead phototherapy lamps that are still commonly used. Two systems are rated Acceptable based on their light performance and are ranked equally; one system is rated Acceptable--Not Recommended because it does not provide the typical power levels obtainable with either of the other two evaluated fiberoptic systems or conventional overhead lamps. Readers are cautioned not to base purchasing or use decisions on our ratings alone, but on a thorough understanding of the issues surrounding fiberoptic phototherapy systems, which can be gained by reading this issue in its entirety. Also see the Clinical Perspective, "Hyperbilirubinemia--When and How to Treat?," for pertinent clinical background information; the supplementary articles "Uses and Limitations of Radiometers" and "Uniformity of Light" for additional technical background information; and the supplementary article "Operating Costs of Phototherapy Devices" for additional purchasing information.

Electric Wiring↗
PubMed1994

[Use of phototherapy for in newborns with pathologic jaundice].

An analysis was done of 596 newborns with intermediate hyperbilirubinaemia treated with phototherapy. The causes of hyperbilirubinaemia were determined. The effectiveness of phototherapy was compared in three groups of newborns: in 300 newborns irradiated by continuous method, in 178 newborns irradiated by intermittent method, and in 118 newborns treated with exchange transfusion and phototherapy. It was found that the effectiveness of phototherapy depended on the initial bilirubinaemia and was similar both after continuous irradiation and intermittent phototherapy. In one-third of the newborns subjected to phototherapy side effects were observed mainly in the form of loose stools.

Humans↗