Skip to main content

Advertisement

Log in

The side effects of phototherapy for neonatal jaundice: what do we know? What should we do?

  • Review
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Neonatal phototherapy (NNPT), a noninvasive, easily available therapy, has been widely used for the treatment of neonatal jaundice for more than half a century. Its efficiency in decreasing plasma bilirubin concentration is well documented, and NNPT leads to greatly reduced exchange transfusion rates for neonates with hyperbilirubinemia. It is generally accepted that the side effects of NNPT are not serious and seem to be well controlled. This review will focus on these possible side effects as well as the approaches to minimize them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Abrol P, Sankarasubramanian R (1998) Effect of phototherapy on behaviour of jaundiced neonates. Indian J Pediatr 65:603–607

    Article  PubMed  CAS  Google Scholar 

  2. Ahlfors CE (2010) Predicting bilirubin neurotoxicity in jaundiced newborns. Curr Opin Pediatr 22:129–133

    Article  PubMed  Google Scholar 

  3. Ahlfors CE, Amin SB, Parker AE (2009) Unbound bilirubin predicts abnormal automated auditory brainstem response in a diverse newborn population. J Perinatol 29:305–309

    Article  PubMed  CAS  Google Scholar 

  4. Ahlfors CE, Parker AE (2008) Unbound bilirubin concentration is associated with abnormal automated auditory brainstem response for jaundiced newborns. Pediatrics 121:976–978

    Article  PubMed  Google Scholar 

  5. Ahlfors CE, Wennberg RP, Ostrow JD, Tiribelli C (2009) Unbound (free) bilirubin: improving the paradigm for evaluating neonatal jaundice. Clin Chem 55:1288–1299

    Article  PubMed  CAS  Google Scholar 

  6. Ambach A, Bonnekoh B, Gollnick H (2006) UVA1 radiation (340–400 nm) interferes with the perforin-granule system of CD8hi + cytotoxic T lymphocytes in vitro. J Photochem Photobiol B 82:236–243

    Article  PubMed  CAS  Google Scholar 

  7. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia (2004) Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 114:297–316

    Article  Google Scholar 

  8. Arya VB, Agarwal R, Paul VK, Deorari AK (2004) Efficacy of oral phenobarbitone in term “at risk” neonates in decreasing neonatal hyperbilirubinemia: a randomized double-blinded, placebo controlled trial. Indian Pediatr 41:327–332

    PubMed  Google Scholar 

  9. Aspberg S, Dahlquist G, Kahan T, Kallen B (2007) Is neonatal phototherapy associated with an increased risk for hospitalized childhood bronchial asthma? Pediatr Allergy Immunol 18:313–319

    Article  PubMed  Google Scholar 

  10. Aspberg S, Dahlquist G, Kahan T, Kallen B (2010) Confirmed association between neonatal phototherapy or neonatal icterus and risk of childhood asthma. Pediatr Allergy Immunol 21:e733–e739

    Article  PubMed  Google Scholar 

  11. Aycicek A, Erel O (2007) Total oxidant/antioxidant status in jaundiced newborns before and after phototherapy. J Pediatr (Rio J) 83:319–322

    Google Scholar 

  12. Aycicek A, Kocyigit A, Erel O, Senturk H (2008) Phototherapy causes DNA damage in peripheral mononuclear leukocytes in term infants. J Pediatr (Rio J) 84:141–146

    Article  Google Scholar 

  13. Baba L, McGrath JM (2008) Oxygen free radicals: effects in the newborn period. Adv Neonatal Care 8:256–264

    PubMed  Google Scholar 

  14. Bader D, Kugelman A, Blum DE et al (2006) Effect of phototherapy on cardiorespiratory activity during sleep in neonates with physiologic jaundice. Isr Med Assoc J 8:12–16

    PubMed  Google Scholar 

  15. Barefield ES, Dwyer MD, Cassady G (1993) Association of patent ductus arteriosus and phototherapy in infants weighing less than 1000 grams. J Perinatol 13:376–380

    PubMed  CAS  Google Scholar 

  16. Basiglio CL, Arriaga SM, Pelusa F et al (2010) Complement activation and disease: protective effects of hyperbilirubinaemia. Clin Sci (Lond) 118:99–113

    Article  CAS  Google Scholar 

  17. Batenburg WW, Kappers MH, Eikmann MJ et al (2009) Light-induced vs. bradykinin-induced relaxation of coronary arteries: do S-nitrosothiols act as endothelium-derived hyperpolarizing factors? J Hypertens 27:1631–1640

    Article  PubMed  CAS  Google Scholar 

  18. Bauer J, Buttner P, Luther H et al (2004) Blue light phototherapy of neonatal jaundice does not increase the risk for melanocytic nevus development. Arch Dermatol 140:493–494

    Article  PubMed  Google Scholar 

  19. Benders MJ, Van Bel F, Van de Bor M (1999) Cardiac output and ductal reopening during phototherapy in preterm infants. Acta Paediatr 88:1014–1019

    Article  PubMed  CAS  Google Scholar 

  20. Berg P, Lindelof B (1997) Is phototherapy in neonates a risk factor for malignant melanoma development? Arch Pediatr Adolesc Med 151:1185–1187

    PubMed  CAS  Google Scholar 

  21. Bertini G, Dani C, Fonda C et al (2005) Bronze baby syndrome and the risk of kernicterus. Acta Paediatr 94:968–971

    Article  PubMed  Google Scholar 

  22. Bhutani VK, Maisels MJ, Stark AR, Buonocore G (2008) Management of jaundice and prevention of severe neonatal hyperbilirubinemia in infants > or = 35 weeks gestation. Neonatology 94:63–67

    Article  PubMed  Google Scholar 

  23. Bjorksten B (2008) Environmental influences on the development of the immune system: consequences for disease outcome. Nestle Nutr Workshop Ser Pediatr Program 61:243–254

    Article  PubMed  Google Scholar 

  24. Boo NY, Chew EL (2006) A randomised control trial of clingfilm for prevention of hypothermia in term infants during phototherapy. Singapore Med J 47:757–762

    PubMed  CAS  Google Scholar 

  25. Brewster DH, Tucker JS, Fleming M et al (2010) Risk of skin cancer after neonatal phototherapy: retrospective cohort study. Arch Dis Child 95:826–831

    Article  PubMed  Google Scholar 

  26. Bryla DA (1985) Randomized, controlled trial of phototherapy for neonatal hyperbilirubinemia. Development, design, and sample composition. Pediatrics 75:387–392

    PubMed  CAS  Google Scholar 

  27. Canadian Paediatric Society (2007) Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks' gestation)—summary. Paediatr Child Health 12:401–418

    Google Scholar 

  28. Chen A, Du L, Xu Y et al (2005) The effect of blue light exposure on the expression of circadian genes: bmal1 and cryptochrome 1 in peripheral blood mononuclear cells of jaundiced neonates. Pediatr Res 58:1180–1184

    Article  PubMed  CAS  Google Scholar 

  29. Csoma Z, Hencz P, Orvos H et al (2007) Neonatal blue-light phototherapy could increase the risk of dysplastic nevus development. Pediatrics 119:1036–1037, author reply 1037–1038

    Article  PubMed  Google Scholar 

  30. Csoma Z, Hencz P, Orvos H et al (2007) Neonatal blue-light phototherapy could increase the risk of dysplastic nevus development. Pediatrics 119:1269

    Article  PubMed  Google Scholar 

  31. Csoma Z, Kemeny L, Olah J (2008) Phototherapy for neonatal jaundice. N Engl J Med 358:2523–2524, author reply 2524–2525

    PubMed  CAS  Google Scholar 

  32. De Luca D (2010) NICE guidelines on neonatal jaundice: at risk of being too nice. Lancet 376:771

    Article  PubMed  Google Scholar 

  33. De Luca D, Picone S, Fabiano A, Paolillo P (2010) Images in neonatal medicine. Bronze baby syndrome: pictorial description of a rare condition. Arch Dis Child Fetal Neonatal Ed 95:F325

    Article  PubMed  Google Scholar 

  34. Dennery PA (2002) Pharmacological interventions for the treatment of neonatal jaundice. Semin Neonatol 7:111–119

    Article  PubMed  Google Scholar 

  35. Dijk PH, de Vries TW, de Beer JJ (2009) Guideline ‘Prevention, diagnosis and treatment of hyperbilirubinemia in the neonate with a gestational age of 35 or more weeks’. Ned Tijdschr Geneeskd 153:A93

    PubMed  Google Scholar 

  36. Dobson V (1976) Editorial: phototherapy and retinal damage. Invest Ophthalmol 15:595–598

    PubMed  CAS  Google Scholar 

  37. Ebrahim M, Ahmad RS, Mohammad M (2010) Incidence and risk factors of retinopathy of prematurity in Babol, north of Iran. Ophthalmic Epidemiol 17:166–170

    Article  PubMed  Google Scholar 

  38. Eghbalian F, Monsef A (2002) Phototherapy-induced hypocalcemia in icteric newborns. Iran J Med Sci 27:169–171

    Google Scholar 

  39. Gleissner MW, Spantzel T, Bucker-Nott HJ, Jorch G (2003) Risk factors of retinopathy of prematurity in infants 32 to 36 weeks gestational age. Z Geburtshilfe Neonatol 207:24–28

    Article  PubMed  CAS  Google Scholar 

  40. Gloria-Bottini F, Bottini E (2010) Is there a role of early neonatal events in susceptibility to allergy? Int J Biomed Sci 6:8–12

    Google Scholar 

  41. Grimm C, Wenzel A, Williams T et al (2001) Rhodopsin-mediated blue-light damage to the rat retina: effect of photoreversal of bleaching. Invest Ophthalmol Vis Sci 42:497–505

    PubMed  CAS  Google Scholar 

  42. Hansen TW (2010) Twists and turns in phototherapy for neonatal jaundice. Acta Paediatr 99:1117–1118

    Article  PubMed  Google Scholar 

  43. Hooman N, Honarpisheh A (2005) The effect of phototherapy on urinary calcium excretion in newborns. Pediatr Nephrol 20:1363–1364

    Article  PubMed  Google Scholar 

  44. Horn AR, Kirsten GF, Kroon SM et al (2006) Phototherapy and exchange transfusion for neonatal hyperbilirubinaemia: neonatal academic hospitals’ consensus guidelines for South African hospitals and primary care facilities. S Afr Med J 96:819–824

    PubMed  CAS  Google Scholar 

  45. Ju SH, Lin CH (1991) The effect of moderate non-hemolytic jaundice and phototherapy on newborn behavior. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 32:31–41

    PubMed  CAS  Google Scholar 

  46. Juzeniene A, Setlow R, Porojnicu A et al (2009) Development of different human skin colors: a review highlighting photobiological and photobiophysical aspects. J Photochem Photobiol B 96:93–100

    Article  PubMed  CAS  Google Scholar 

  47. Karadag A, Yesilyurt A, Unal S et al (2009) A chromosomal-effect study of intensive phototherapy versus conventional phototherapy in newborns with jaundice. Mutat Res 676:17–20

    PubMed  CAS  Google Scholar 

  48. Karamifar H, Pishva N (2002) Prevalence of phototherapy-induced hypocalcemia. Iran J Med Sci 27:166–168

    Google Scholar 

  49. Kernt M, Hirneiss C, Neubauer AS et al (2010) Protective effect of blue light-absorbing IOLs on the human retinal pigment epithelium. Ophthalmologe 107:150–157

    Article  PubMed  CAS  Google Scholar 

  50. Kernt M, Neubauer AS, Liegl R et al (2009) Cytoprotective effects of a blue light-filtering intraocular lens on human retinal pigment epithelium by reducing phototoxic effects on vascular endothelial growth factor-alpha, Bax, and Bcl-2 expression. J Cataract Refract Surg 35:354–362

    Article  PubMed  Google Scholar 

  51. Keshavan P, Deem TL, Schwemberger SJ et al (2005) Unconjugated bilirubin inhibits VCAM-1-mediated transendothelial leukocyte migration. J Immunol 174:3709–3718

    PubMed  CAS  Google Scholar 

  52. Khatami SF, Yousefi A, Bayat GF, Mamuri G (2008) Retinopathy of prematurity among 1000–2000 gram birth weight newborn infants. Iran J Pediatr 18:137–142

    Google Scholar 

  53. King A, Gottlieb E, Brooks DG et al (2004) Mitochondria-derived reactive oxygen species mediate blue light-induced death of retinal pigment epithelial cells. Photochem Photobiol 79:470–475

    Article  PubMed  CAS  Google Scholar 

  54. Kumar A, Pant P, Basu S et al (2007) Oxidative stress in neonatal hyperbilirubinemia. J Trop Pediatr 53:69–71

    Article  PubMed  Google Scholar 

  55. Kumar P, Murki S, Malik GK et al (2010) Light emitting diodes versus compact fluorescent tubes for phototherapy in neonatal jaundice: a multi center randomized controlled trial. Indian Pediatr 47:131–137

    Article  PubMed  Google Scholar 

  56. Kurt A, Aygun AD, Kurt AN et al (2009) Use of phototherapy for neonatal hyperbilirubinemia affects cytokine production and lymphocyte subsets. Neonatology 95:262–266

    Article  PubMed  CAS  Google Scholar 

  57. Leiter U, Garbe C (2008) Epidemiology of melanoma and nonmelanoma skin cancer—the role of sunlight. Adv Exp Med Biol 624:89–103

    Article  PubMed  Google Scholar 

  58. Liu GS, Wu H, Wu BQ et al (2008) Effect of phototherapy on blood endothelin and nitric oxide levels: clinical significance in preterm infants. World J Pediatr 4:31–35

    Article  PubMed  Google Scholar 

  59. Luna MS, Alonso CR, Mussons FB et al (2009) Recommendations for the care of the healthy normal newborn at delivery and during the first postnatal hours. An Pediatr (Barc) 71:349–361

    Article  Google Scholar 

  60. Maayan-Metzger A, Yosipovitch G, Hadad E, Sirota L (2001) Transepidermal water loss and skin hydration in preterm infants during phototherapy. Am J Perinatol 18:393–396

    Article  PubMed  CAS  Google Scholar 

  61. Maisels MJ, Kring EA, DeRidder J (2007) Randomized controlled trial of light-emitting diode phototherapy. J Perinatol 27:565–567

    Article  PubMed  CAS  Google Scholar 

  62. Maisels MJ, McDonagh AF (2008) Phototherapy for neonatal jaundice. N Engl J Med 358:920–928

    Article  PubMed  CAS  Google Scholar 

  63. Matichard E, Le Henanff A, Sanders A et al (2006) Effect of neonatal phototherapy on melanocytic nevus count in children. Arch Dermatol 142:1599–1604

    Article  PubMed  Google Scholar 

  64. Maverakis E, Miyamura Y, Bowen MP et al (2010) Light, including ultraviolet. J Autoimmun 34:J247–J257

    Article  PubMed  CAS  Google Scholar 

  65. McDonagh AF (2011) Bilirubin, copper-porphyrins, and the bronze-baby syndrome. J Pediatr 158:160–164

    Article  PubMed  Google Scholar 

  66. Mehta S, Kumar P, Narang A (2005) A randomized controlled trial of fluid supplementation in term neonates with severe hyperbilirubinemia. J Pediatr 147:781–785

    Article  PubMed  CAS  Google Scholar 

  67. Mills JF, Tudehope D (2001) Fibreoptic phototherapy for neonatal jaundice. Cochrane Database Syst Rev CD002060

  68. Moll M, Goelz R, Naegele T et al (2010) Are recommended phototherapy thresholds safe enough for extremely low birth weight (ELBW) infants? A report on 2 ELBW infants with kernicterus despite only moderate hyperbilirubinemia. Neonatology 99:90–94

    Article  PubMed  Google Scholar 

  69. Morris BH, Oh W, Tyson JE et al (2008) Aggressive vs. conservative phototherapy for infants with extremely low birth weight. N Engl J Med 359:1885–1896

    Article  PubMed  CAS  Google Scholar 

  70. Murki S, Dutta S, Narang A et al (2005) A randomized, triple-blind, placebo-controlled trial of prophylactic oral phenobarbital to reduce the need for phototherapy in G6PD-deficient neonates. J Perinatol 25:325–330

    Article  PubMed  CAS  Google Scholar 

  71. Neill WA, Halliday KE, Norval M (1998) Differential effect of phototherapy on the activities of human natural killer cells and cytotoxic T cells. J Photochem Photobiol B 47:129–135

    Article  PubMed  CAS  Google Scholar 

  72. Parra EJ (2007) Human pigmentation variation: evolution, genetic basis, and implications for public health. Am J Phys Anthropol 45:85–105

    Article  PubMed  Google Scholar 

  73. Procianoy RS, Silveira RC, Fonseca LT et al (2010) The influence of phototherapy on serum cytokine concentrations in newborn infants. Am J Perinatol 27:375–379

    Article  PubMed  Google Scholar 

  74. Rennie J, Burman-Roy S, Murphy MS (2010) Neonatal jaundice: summary of NICE guidance. BMJ 340:c2409

    Article  PubMed  Google Scholar 

  75. Rennie JM, Sehgal A, De A et al (2009) Range of UK practice regarding thresholds for phototherapy and exchange transfusion in neonatal hyperbilirubinaemia. Arch Dis Child Fetal Neonatal Ed 94:F323–F327

    Article  PubMed  CAS  Google Scholar 

  76. Rosenfeld W, Sadhev S, Brunot V et al (1986) Phototherapy effect on the incidence of patent ductus arteriosus in premature infants: prevention with chest shielding. Pediatrics 78:10–14

    PubMed  CAS  Google Scholar 

  77. Rubaltelli FF, Jori G, Reddi E (1983) Bronze baby syndrome: a new porphyrin-related disorder. Pediatr Res 17:327–330

    Article  PubMed  CAS  Google Scholar 

  78. Seidman DS, Moise J, Ergaz Z et al (2000) A new blue light-emitting phototherapy device: a prospective randomized controlled study. J Pediatr 136:771–774

    Article  PubMed  CAS  Google Scholar 

  79. Seidman DS, Moise J, Ergaz Z et al (2003) A prospective randomized controlled study of phototherapy using blue and blue-green light-emitting devices, and conventional halogen-quartz phototherapy. J Perinatol 23:123–127

    Article  PubMed  Google Scholar 

  80. Sharafi R, Mortazavi Z, Sharafi S, Parashkouh R (2010) The effect of clofibrate on decreasing serum bilirubin in healthy term neonates under home phototherapy. Iran J Pediatr 20:48–52

    Google Scholar 

  81. Siegfried EC, Stone MS, Madison KC (1992) Ultraviolet light burn: a cutaneous complication of visible light phototherapy of neonatal jaundice. Pediatr Dermatol 9:278–282

    Article  PubMed  CAS  Google Scholar 

  82. Sola A (2007) Turn off the lights and the oxygen, when not needed: phototherapy and oxidative stress in the neonate. J Pediatr (Rio J) 83:293–296

    Article  Google Scholar 

  83. Stevenson DK, Wong RJ (2010) Metalloporphyrins in the management of neonatal hyperbilirubinemia. Semin Fetal Neonatal Med 15:164–168

    Article  PubMed  Google Scholar 

  84. Stokowski LA (2006) Fundamentals of phototherapy for neonatal jaundice. Adv Neonatal Care 6:303–312

    Article  PubMed  Google Scholar 

  85. Tatli MM, Minnet C, Kocyigit A, Karadag A (2008) Phototherapy increases DNA damage in lymphocytes of hyperbilirubinemic neonates. Mutat Res 654:93–95

    PubMed  CAS  Google Scholar 

  86. Tobin AM, Maguire B, Enright H, Kirby B (2009) The effects of phototherapy on the numbers of circulating natural killer cells and T lymphocytes in psoriasis. Photodermatol Photoimmunol Photomed 25:109–110

    Article  PubMed  CAS  Google Scholar 

  87. Travadi J, Simmer K, Ramsay J et al (2006) Patent ductus arteriosus in extremely preterm infants receiving phototherapy: does shielding the chest make a difference? A randomized, controlled trial. Acta Paediatr 95:1418–1423

    Article  PubMed  Google Scholar 

  88. Usatin D, Liljestrand P, Kuzniewicz MW et al (2010) Effect of neonatal jaundice and phototherapy on the frequency of first-year outpatient visits. Pediatrics 125:729–734

    Article  PubMed  Google Scholar 

  89. van Imhoff DE, Dijk PH, Hulzebos CV (2009) Uniform intervention criteria for jaundice in hyperbilirubinemia in preterm infants. Ned Tijdschr Geneeskd 153:A94

    PubMed  Google Scholar 

  90. Varsila E, Pitkanen O, Hallman M, Andersson S (1994) Immaturity-dependent free radical activity in premature infants. Pediatr Res 36:55–59

    Article  PubMed  CAS  Google Scholar 

  91. Venturini CM, Palmer RM, Moncada S (1993) Vascular smooth muscle contains a depletable store of a vasodilator which is light-activated and restored by donors of nitric oxide. J Pharmacol Exp Ther 266:1497–1500

    PubMed  CAS  Google Scholar 

  92. Vreman HJ (2010) Phototherapy: the challenge to accurately measure irradiance. Indian Pediatr 47:127–128

    Article  PubMed  Google Scholar 

  93. Vreman HJ, Wong RJ, Murdock JR, Stevenson DK (2008) Standardized bench method for evaluating the efficacy of phototherapy devices. Acta Paediatr 97:308–316

    Article  PubMed  CAS  Google Scholar 

  94. Vreman HJ, Wong RJ, Stevenson DK et al (1998) Light-emitting diodes: a novel light source for phototherapy. Pediatr Res 44:804–809

    Article  PubMed  CAS  Google Scholar 

  95. Wales JK, Walker V, Moore IE, Clayton PT (1986) Bronze baby syndrome, biliary hypoplasia, incomplete Beckwith–Wiedemann syndrome and partial trisomy 11. Eur J Pediatr 145:141–143

    Article  PubMed  CAS  Google Scholar 

  96. Walsh SA, Murphy JF (2010) Neonatal jaundice—are we over-treating? Ir Med J 103:28–29

    PubMed  CAS  Google Scholar 

  97. Watchko JF, Jeffrey Maisels M (2010) Enduring controversies in the management of hyperbilirubinemia in preterm neonates. Semin Fetal Neonatal Med 15:136–140

    Article  PubMed  Google Scholar 

  98. Weissman A, Berkowitz E, Smolkin T, Blazer S (2009) Effect of phototherapy on neonatal heart rate variability and complexity. Neonatology 95:41–46

    Article  PubMed  Google Scholar 

  99. Wennberg RP, Ahlfors CE, Aravkin AY (2009) Intervention guidelines for neonatal hyperbilirubinemia: an evidence based quagmire. Curr Pharm Des 15:2939–2945

    Article  PubMed  CAS  Google Scholar 

  100. Whitelaw A, Odd D (2007) Postnatal phenobarbital for the prevention of intraventricular hemorrhage in preterm infants. Cochrane Database Syst Rev CD001691

  101. Yeo KL, Perlman M, Hao Y, Mullaney P (1998) Outcomes of extremely premature infants related to their peak serum bilirubin concentrations and exposure to phototherapy. Pediatrics 102:1426–1431

    Article  PubMed  CAS  Google Scholar 

  102. Zecca E, Romagnoli C, De Carolis MP et al (2009) Does ibuprofen increase neonatal hyperbilirubinemia? Pediatrics 124:480–484

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by grants from National Natural Science Foundation of China (No. 30825039, No. 30973236, and No. 30770748), Ministry of Education of China (IRT 0935; 20070610092), Science and Technology Department of Sichuan Province (No. 2010SZ0280), and Health Department of Sichuan Province (No. 090230).

Conflicts of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dezhi Mu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xiong, T., Qu, Y., Cambier, S. et al. The side effects of phototherapy for neonatal jaundice: what do we know? What should we do?. Eur J Pediatr 170, 1247–1255 (2011). https://doi.org/10.1007/s00431-011-1454-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-011-1454-1

Keywords

Navigation