Mechanisms of Action of Phototherapy: New Concepts

  • John F. Ennever
  • William T. Speck


Visible light phototherapy is the most common method for treating neonatal hyperbilirubinemia. It is estimated that 2% to 6% of all infants born in the United States and Britain receive phototherapy (1,2). This treatment has long been considered both safe and effective. Reported side effects of phototherapy are generally of little clinical significance and all disappear following cessation of illumination (1,3). However, recent in vitro studies showing that light of wavelengths between 350 and 450 nm is mutagenic for procaryotic and eucaryotic cells (4,5,6), and therefore potentially carcinogenic, have caused concern because all commonly-used phototherapy lamps emit radiation in this region (7).


Human Serum Albumin Premature Infant Serum Bilirubin Wavelength Dependence Structural Isomer 
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  1. 1.
    A.K. Brown and A.F. McDonagh, Phototherapy for neonatal hyperbilirubinemia: Efficiency, mechanism and toxicity, Adv. Pediatr 27: 341 (1980).PubMedGoogle Scholar
  2. 2.
    H.M. Lewis, R.H.A. Campbell, and G. Hambleton, Use or abuse of phototherapy for physiological jaundice of newborn infants, Lancet 2: 408 (1982).PubMedGoogle Scholar
  3. 3.
    M.J. Maisels, Neonatal jaundice, in: “Neonatology,” G.B. Avery, ed., Lippincott Co., Philadelphia (1981).Google Scholar
  4. 4.
    W.T. Speck and H.S. Rosencranz, Base substitution mutations induced in Salmonella strains by visible light (450 nm), Photochem. Photobiol 21:369 (1975).Google Scholar
  5. 5.
    R. Parshand, K.K. Sanford, G.M. Jones, and R.E. Tarone, Fluores-cent light-induced chromosome damage and its prevention in mouse cells in culture, Proc. Natl Acad. Sci. USA 75: 1830 (1978).Google Scholar
  6. 6.
    E.G. Sideris, G.C. Papageorgiou, S.C. Charalampous, and E.M. Vitsa, A spectrum response study on single strand DNA breaks, sister chromatid exchanges and lethality induced by photo-therapy lights, Pediatr Res. 15: 1019 (1981).Google Scholar
  7. 7.
    J.F. Ennever, M. Sobel, A.F. McDonagh, and W.T. Speck, Photo-therapy for neonatal jaundice: In vitro comparison of light sources, manuscript in preparation.Google Scholar
  8. 8.
    A.F. McDonagh and L.A. Palma, Hepatic excretion of circulating bilirubin photoproducts in the Gunn rat, J. Clin. Invest 66: 1182 (1980).PubMedCrossRefGoogle Scholar
  9. 9.
    S. Onishi, K. Isobe, S. Itoh, N. Kawade, and S. Sugiyoima, Demonstration of a geometric isomer of bilirubin IXa in the serum of a hyperbilirubinaemic newborn infant and the mechanism of jaundice phototherapy, Biochem J. 190: 533 (1980).Google Scholar
  10. 10.
    A.A. Lamola, W.E. Blumberg, R. McClead, and A. Fanaroff, Photoisomerized bilirubin in blood from infants receiving phototherapy, Proc Natl. Acad Soi. USA 78: 1882 (1981).CrossRefGoogle Scholar
  11. 11.
    A.F. McDonagh, L.A. Palma, F.R. Trull, and D.A. Lightner, Photo-therapy for neonatal jaundice: Configurational isomers of bilirubin, J. Am. Chem Soc. 104: 6865 (1982).CrossRefGoogle Scholar
  12. 12.
    A.A. Lamola, J.Flores, and F.H. Doleiden, Quantum yield and equilbrium position of the configurational photoisomerization of bilirubin bound to human serum albumin, Photochem. Photobiol 35:649 (1982).Google Scholar
  13. 13.
    A.F. McDonagh, J.F. Ennever, and L.A. Palma, Phototherapy for neonatal jaundice: Configurational photoisomerization of bilirubin in babies is regioselective, manuscript in preparation.Google Scholar
  14. 14.
    A.F. McDonagh, L.A. Palma, and D.A. Lightner, Phototherapy for neonatal jaundice: Stereospecific and regioselective photoisomerization of bilrubin bound to human serum albumin and NMR characterization of intramolecularly syslized photoproducts, J. Am. Chem Soc. 104: 6867 (1982).CrossRefGoogle Scholar
  15. 15.
    J.F. Ennever, A.F. McDonagh, and W.T. Speck, Phototherapy for neonatal jaundice: Optimal wavelengths of light, J. Pediatr in press.Google Scholar
  16. 16.
    A.T.Costarino, J.F. Ennever, S.Baumgart, M.Paul, W.T. Speck, and R.A. Polin, Bilirubin photoisomerization in premature neonates under low and high dose phototherapy, manuscript in preparation.Google Scholar
  17. 17.
    J.F. Ennever, I.Knox, S.C. Denne, and W.T. Speck, Phototherapy for neonatal jaundice: In vivo clearance of bilirubin photo-products, submitted for publication.Google Scholar
  18. 18.
    R. Schmid and L.Hammaker, Metabolism and disposition of C14bilirubin in congenital nonhemolytic jaundice, J. Clin. Invest 42: 1720 (1963).PubMedCrossRefGoogle Scholar
  19. 19.
    R.R. Anderson and J.A. Parrish, The optics of human skin, J. Invest. Dermatol 77:13 (1981).Google Scholar
  20. 20.
    K.L. Tan, The pattern of bilirubin response to phototherapy for neonatal hyperbilirubinemia, Pediatr Res. 16: 670 (1982).Google Scholar
  21. 21.
    L. Ballowitz, G.Geutler, J.Krochmann, R. Pannitschka, G. Roemer, and I. Roemer, Phototherapy in Gunn rats - a study to assess the photobiologically most effective radiant energy and dose/response relationships, Biol. Neonate 31: 229 (1977).Google Scholar
  22. 22.
    J.B. Warshaw, J.Gagliardi, and A. Patel, A comparison of fluorescent and non-fluorescent light sources for phototherapy, Pediatrics 65: 795 (1980).Google Scholar

Copyright information

© Springer Science+Business Media New York 1984

Authors and Affiliations

  • John F. Ennever
    • 1
  • William T. Speck
    • 1
  1. 1.Department of Pediatrics, Rainbow Babies and Childrens HospitalCase Western Reserve University School of MedicineClevelandUSA

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