Advertisement

Advantages and Disadvantages of Phototherapy (PT) in Neonatal Hyperbilirubinemia

Chapter
  • 142 Downloads

Summary

Phototherapy (PT) with white (day-light) or monochromatic (blue light) lamps is widely used for the prevention and treatment of neonatal hyperbilirubinemia. PT has the following advantages: it is inexpensive and easy to use; the breakdown products of bilirubin are not toxic for the CNS and are rapidly eliminated through the kidneys and liver; it is the most effective of all modes of prevention and treatment of neonatal hyperbilirubinemia, with the exception of exchange-transfusion. Despite the above mentioned advantages, there is still some reluctance in the use of PT for fear of unknown immediate and/or long term side effects. Immediate side effects described in newborn infants include: decreased intestinal transit time, with loose, greenish stools; increased insensible water loss with slow weight gain; skin rashes and, rarely, a brownish discoloration of skin, urines and plasma. Other possible side effects, described in vitro and/or in experimental animals, include: retinal damage; liver cell damage; alterations of the pineal gland with modifications of serotonin metabolism; suppression of cyrcadian rithms; modifications of hormonal secretion and plasma levels; acceleration or delay in sexual maturation; photoxidation of structures or substances in the body, other than bilirubin (i.e. vitamines, aminoacids, albumin, red blood cells, etc.). Further studies are needed in order to exclude, some of the above mentioned side effects. Meanwhile PT, when indicated, should be used with caution and under well controlled circumstances.

Keywords

Newborn Infant Pineal Gland Serum Bilirubin Level Neonatal Jaundice Intense Light 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1).
    Maisels M,J,: Bilirubin, On understanding and influencing its metabolism in the newborn infant. Ped.Clin. N. Amer., 19: 447, 1972.Google Scholar
  2. 2).
    Stern L.,Doray B,,Chan G, and Schiff D.: Bilirubin metabolism and the induction of kernicterus.Natl,Found, Birth Defects.Orig,Art.Ser. vol. 12,N°2,pg 255,1976.Google Scholar
  3. 3).
    Boggs T.R.Jr.,Hardy J.R. and Frazier T.M.: Correlation of neonatal serum total bilirubin concentration and developmental status at age 6 months. J.Pediat. 71: 553, 1967.CrossRefGoogle Scholar
  4. 4).
    Sisson T.R.C.: Visible light therapy of neonatal hyperbilirubinemia. Photochem.Photobiol.Rev. 1: 241, 1976.Google Scholar
  5. 5).
    McDonagh A.F.: Photochemistry and photometabolism of bilirubin IX. Natl.Found.Birth.Defects.Orig.Art.Ser. vol.12, N° 2, pg. 30, 1976.Google Scholar
  6. 6).
    Indyk L.: Physical aspects of phototherapy. Natl.Found. Birth.Def.Orig.Art.Ser. vol.12,N° 2,pg 23, 1976.Google Scholar
  7. 7).
    Ostrow J.D.,Berry C.S.,Knodell R.G. and Zarembo J.F.: Effect of phototherapy on bilirubin excretion in man and the rat. Natl.Found.Birth.Def.Orig.Art.Ser. vol.12,N°2, pg 81, 1976.Google Scholar
  8. 8).
    Lund H.T. and Jacobsen J.: Influence of phototherapy on the biliary bilirubin excretion pattern in newborn infants with hyperbilirubinemia. J.Pediat.,85,262,1974.CrossRefGoogle Scholar
  9. 9).
    Orzalesi M., Panero A. e Tambucci S.: Vantaggi e svantaggi della fototerapia nell’ittero neonatale, in “Problemi Attuali di Nutrizione in Pediatria”.Plasmon 1975.Google Scholar
  10. 10).
    Lucey J.F.: Neonatal Jaundice and Phototherapy. Ped. Clin.N.Amer., 19, 827, 1972.Google Scholar
  11. 11).
    Kopelman A.E., Brown R.S. and Odell G.B.: The “bronze” baby syndrome: A complication of phototherapy. J. Pediat., 81, 466, 1972.CrossRefGoogle Scholar
  12. 12).
    Wurtman R.J. and Cardinali D.P.: The effects of light on man. Natl.Found.Birth.Def.Orig.Art.Ser. vol. 12,N° 2, pg 100, 1976.Google Scholar
  13. 13).
    Sisson T.R.C., Glauser S.C.,Glauser E.M.,Tasman W. and Kuwabara T.: Retinal changes produced by phototherapy. J.Pediat., 77, 221, 1970.CrossRefGoogle Scholar
  14. 14).
    Halaris A. and Matussek N.: Effect of continuous illumination on mitochondria of the pineal body. Experientia, 25, 486, 1969.CrossRefGoogle Scholar
  15. 15).
    Nir I.,Hirschmann and Sulman F.G.: The effect of light and darkness on lactic acid content of the pineal gland. Proc.Soc.Exp.Biol.Med., 133, 452, 1970.Google Scholar
  16. 16).
    Spennati G.F.,Girotti F. and Orzalesi M.: Urinary excretion of 5-hydroxyindolacetic acid in low birth weight infants with and without phototherapy. J.Pediat., 82, 286, 1973.CrossRefGoogle Scholar
  17. 17).
    Iester A.,Quazza G.F.,Bertolotti E.,Moscatelli P., Fregonese B.,Lanzavecchia G. e Cordone G.: Studio sperimentale sulle modificazioni indotte dalla fototerapia sulle cellule epatiche. Min.Ped., 20, 870, 1969.Google Scholar
  18. 18).
    Fregonese B.,Moscatelli P.,Lanzavecchia L. e Cordone G.: Variazioni indotte dalla fototerapia sul contenuto in glicogeno del fegato di ratto neonato. Min.Ped., 21, 984, 1969.Google Scholar
  19. 19).
    Quazza G.F.,Cordone G.,Iester A,,Fregonese B.,Moscatelli P. e Lanzavecchia C.: Enzimoistochimica del fegato e fototerapia. Min.Ped., 21, 1233, 1960.Google Scholar
  20. 20).
    Orzalesi M., Natoli G.,Panero A. and Ciocca M.: Plasma hepatic enzymes in jaundiced newborn infants treated with phototherapy. Natl.Found.Birth.Def.Orig.Art.Ser. vol.12,N° 2, pg 93, 1976.Google Scholar
  21. 21).
    Casadei A.M.,Panerò A.,Tambucci S. and Orzalesi M.: Blood glucose response to the administration of glucagon in jaundiced newborn infants treated with phototherapy. To be published.Google Scholar
  22. 22).
    Ballowitz L.,Heller R.,Natzschka J. and Oh H.: The effect of blue light on infant Gunn rats. Natl.Found. Birth.Def.Orig.Art.Ser. 6, 106, 1971.Google Scholar
  23. 23).
    Kendall S.,Golberg S. and Sisson T.: Influence of visible light on growth rates of Gunn rats. Clin.Res., 28, 377. 1970.Google Scholar
  24. 24).
    Sisson T.R.C.,Goldberg S. and Slaven B.: The effect of visible light on the Gunn rat: convulsive threshold, bilirubin concentration and brain color. Pediat.Res., 8, 647, 1974.Google Scholar
  25. 25).
    Hodgman J.E.:Clinical application of phototherapy in neonatal jaundice. Natl.Found.Birth.Def.Orig.Art.Ser., vol. 12, N° 2, pg 3,1976.Google Scholar
  26. 26).
    Odell G.,Brown R. and Holtzman N.: Dye-sensitized photo-oxidation of albumin associated with a decreased capacity for protein-binding of bilirubin. Natl.Found. Orig.Art.Ser., 6, 31, 1970.Google Scholar
  27. 27).
    Odell G.B.,Brown R.S.,Kopelman A.E.: The photodynamic action of bilirubin on erythrocytes. P.Pediat., 8l, 473, 1972.Google Scholar
  28. 28).
    Blackburn M.G.,Orzalesi M. and Pigram P.: Effect of light and bilirubin on fetal red blood cells in vitro. Biol.Neonate, 21, 35, 1972.CrossRefGoogle Scholar
  29. 29).
    Castro M.,Tambucci S.,Panero A.,Giardini O. e Orzalesi M.: Studio in vitro degli effetti della luce sui lipidi del globulo rosso. Min.Ped., 28, 391, 1976.Google Scholar
  30. 30).
    Blackburn M.G.,Orzalesi M. and Pigram P.:Effect of light on fetal red blood cells in vivo. J.Pediat.,80, 640,1972.CrossRefGoogle Scholar
  31. 31).
    Sisson T.R.C.,Slaven B. and Hamilton P.B.: Effect of broad and narrow spectrum fluorescent light on blood constituents. Natl.Found.Birth.Def.Or ig.Art.Ser.,, vol. 12,N° 2, pg 122, 1976.Google Scholar
  32. 32).
    Meloni T.,Costa S.,Dore A. and Cutillo S.: Phototherapy for neonatal hyperbilirubinemia in mature newborn infants with erythrocyte G-6-PD deficiency, J.Pediat., 65, 560, 1974.CrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1977

Authors and Affiliations

  1. 1.Univ. of Naples, 2nd Med. Sch.NaplesItaly

Personalised recommendations