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Phototherapy and risk of developmental delay: the Japan Environment and Children’s Study

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A Correction to this article was published on 01 April 2023

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Abstract

This observational cohort study aimed to examine the association between the duration of phototherapy for neonatal jaundice and the risk of developmental delay at 3 years of age using nationwide birth cohort data. Data from 76,897 infants were analyzed. We divided participants into four groups: no phototherapy, short phototherapy (1–24 h), long phototherapy (25–48 h), and very long phototherapy (> 48 h). The Japanese version of the Ages and Stages Questionnaire-3 was used to evaluate the risk of developmental delay at 3 years of age. Logistic regression analysis was performed to assess the impact of phototherapy duration on the prevalence of developmental delay. After adjustment for potential risk factors, a dose–response relationship was identified between the duration of phototherapy and Ages and Stages Questionnaire-3, and the differences were significant in four domains; odds ratio for communication delay was associated with short, long, and very long phototherapy = 1.10 (95% confidence interval 0.97–1.26), 1.32 (1.04–2.66), and 1.48 (1.11–1.98), respectively; for gross motor delay = 1.01 (0.89–1.15), 1.28 (1.03–2.58), and 1.26 (0.96–1.67); for problem solving delay = 1.13 (1.03–1.25), 1.19 (0.99–1.43), and 1.41 (1.11–1.79); and for personal social delay = 1.15 (0.99–1.32), 1.10 (0.84–1.44), and 1.84 (1.38–2.45).

Conclusion: Longer duration of phototherapy is a predictive factor for developmental delay, making it important to avoid extended periods of phototherapy. However, whether it increases the prevalence of developmental delay remains unclear.

What is Known:

• Phototherapy is a common treatment for neonatal jaundice, associated with both short-term and long-term complications.

• However, an association between phototherapy and the prevalence of developmental delay has not been revealed in a large cohort study.

What is New:

• We identified that a long duration of phototherapy was a predictive factor for developmental delay at 3 years of age.

• However, whether a long duration of phototherapy increases the prevalence of developmental delay remains unclear.

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Data availability

Data are unsuitable for public deposition due to ethical restrictions and legal framework of Japan. It is prohibited by the Act on the Protection of Personal Information (Act No. 57 of 30 May 2003, amendment on 9 September 2015) to publicly deposit the data containing personal information. Ethical Guidelines for Medical and Health Research Involving Human Subjects enforced by the Japan Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health, Labour and Welfare also restricts the open sharing of the epidemiologic data. All inquiries about access to data should be sent to: jecs-en@nies.go.jp. The person responsible for handling enquiries sent to this e-mail address is Dr Shoji F. Nakayama, JECS Programme Office, National Institute for Environmental Studies.

Change history

Abbreviations

ASQ-3:

The Ages and Stages Questionnaires third edition

CI:

Confidence interval

DNA:

Deoxyribonucleic acid

IL:

Interleukin

JECS:

Japan Environment and Children’s Study

LED:

Light-emitting diode

OR:

Odds ratio

UV:

Ultraviolet

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Acknowledgements

We are grateful to all the JECS participants and all individuals involved in data collection. This study was funded by the Ministry of Environment, Japan. The findings and conclusions of this study are solely the responsibility of the authors and do not represent the official views of the Ministry of the Environment. Members of the JECS Group as of 2022: Michihiro Kamijima (principal investigator, Nagoya City University, Nagoya, Japan), Shin Yamazaki (National Institute for Environmental Studies, Tsukuba, Japan), Yukihiro Ohya (National Center for Child Health and Development, Tokyo, Japan), Reiko Kishi (Hokkaido University, Sapporo, Japan), Nobuo Yaegashi (Tohoku University, Sendai, Japan), Koichi Hashimoto (Fukushima Medical University, Fukushima, Japan), Chisato Mori (Chiba University, Chiba, Japan), Shuichi Ito (Yokohama City University, Yokohama, Japan), Zentaro Yamagata (University of Yamanashi, Chuo, Japan), Hidekuni Inadera (University of Toyama, Toyama, Japan), Takeo Nakayama (Kyoto University, Kyoto, Japan), Tomotaka Sobue (Osaka University, Suita, Japan), Masayuki Shima (Hyogo Medical University, Nishinomiya, Japan), Hiroshige Nakamura(Tottori University, Yonago, Japan), Narufumi Suganuma (Kochi University, Nankoku, Japan), Koichi Kusuhara (University of Occupational and Environmental Health, Kitakyushu, Japan), and Takahiko Katoh (Kumamoto University, Kumamoto, Japan).

Funding

This study was funded by the Ministry of the Environment, Japan. The Ministry of the Environment, Japan had no role in the design and conduct of the study. The findings and conclusions of this article are solely the responsibility of the authors and do not represent the official views of the government.

Author information

Authors and Affiliations

  1. Department of Neonatal Medicine, Osaka Women’s and Children’s Hospital, Izumi, Osaka, Japan

    Masashi Hotta & Kazuko Wada

  2. Maternal & Child Health Information Center, Osaka Women’s and Children’s Hospital, Izumi, Osaka, Japan

    Kimiko Ueda & Kanami Tanigawa

  3. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan

    Satoyo Ikehara, Kanami Tanigawa & Tomotaka Sobue

  4. Osaka Regional Center for Japan Environment and Children’s Study (JECS), Osaka University, 1-3 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Satoyo Ikehara, Kanami Tanigawa, Hirofumi Nakayama, Tomotaka Sobue & Hiroyasu Iso

  5. Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Hirofumi Nakayama & Keiichi Ozono

  6. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Tadashi Kimura

  7. Bureau of International Health Cooperation, National Center for Global Health and Medicine, Institute for Global Health Policy Research, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan

    Hiroyasu Iso

Authors
  1. Masashi Hotta
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  2. Kimiko Ueda
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  3. Satoyo Ikehara
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  9. Tomotaka Sobue
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Consortia

Japan Environment, Children’s Study Group

Contributions

Masashi Hotta conceptualized and designed the study, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. Kimiko Ueda, Satoyo Ikahara, Kanami Tanigawa, Hirofumi Nakayama, Kazuko Wada, Tadashi Kimura, Keiichi Ozono, Tomotaka Sobue, and Hiroyasu Iso contributed to the writing and revising of the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Hiroyasu Iso.

Ethics declarations

Ethics approval

The Japan Environment and Children’s Study protocol was reviewed and approved by the Ministry of the Environment’s Institutional Review Board for Epidemiological Studies and the Ethics Committees of all participating institutions (Ethical Number: No.100910001).

Consent to participate

Written informed consent was obtained from all the participants and their parent/legal guardian/next of kin to participate in the study.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca.

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The original online version of this article was revised due to missing row heading “Continuous variables, Mean (Standard deviation)” in last entry of Table 1, now added.

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Hotta, M., Ueda, K., Ikehara, S. et al. Phototherapy and risk of developmental delay: the Japan Environment and Children’s Study. Eur J Pediatr 182, 2139–2149 (2023). https://doi.org/10.1007/s00431-022-04785-1

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