Comparison of the efficacy of fiberoptic and conventional phototherapy for neonatal hyperbilirubinemia.

A comparative evaluation of the efficacy of fiberoptic phototherapy using the Ohmeda Billiblanket fiberoptic device, conventional phototherapy using daylight fluorescent lamps, and a combination of the two forms of phototherapy was made in 165 term healthy infants and 105 preterm infants with hyperbilirubinemia. In the term infants, the 24-hour decline rate for fiberoptic phototherapy was 9.2% +/- 1.6% (mean +/- SEM) versus 21.5% +/- 1.8% for daylight phototherapy (p < 0.01), and the overall decline rate was 0.49% +/- 0.03%/hr versus 0.70% +/- 0.04%/hr (p < 0.001). Combination phototherapy, with a 24-hour decline rate of 29.9% +/- 1.0% and an overall decline rate of 0.97% %/- 0.04%/hr, was significantly better than daylight phototherapy in both respects (p < 0.01 and < 0.01, respectively). The duration of exposure for fiberoptic phototherapy was significantly longer than that for daylight phototherapy, which in turn was significantly longer than that for combination phototherapy. Response to exposure in the preterm infants was significantly better than that in the term infants with the respective types of phototherapy. The nursing personnel unanimously felt more comfortable with fiberoptic phototherapy, which did not disturb the swaddled infants as much as conventional phototherapy. The parents also felt more reassured. Fiberoptic phototherapy proved adequate in controlling hyperbilirubinemia in preterm infants; in term infants, failures often occurred. Combination phototherapy can be recommended for severe or rapidly increasing jaundice in preterm infants, but its efficacy in term infants is uncertain.

Phototherapy and the brain-stem auditory evoked response in neonatal hyperbilirubinemia.

The latencies of peak V and interpeaks I-V and III-V in the brain-stem auditory evoked response of infants with hyperbilirubinemia before phototherapy were significantly greater than those in a control group of infants. These values of the brain stem auditory-evoked response improved significantly during phototherapy and correlated significantly with the declining bilirubin levels. Improvement continued after phototherapy, despite a rebound of serum bilirubin concentrations.

Efficacy of fluorescent daylight, blue, and green lamps in the management of nonhemolytic hyperbilirubinemia.

The efficacy of fluorescent daylight, green, and blue lamps in reducing bilirubin levels was compared in two groups of infants with nonhemolytic hyperbilirubinemia: healthy infants in a term nursery and infants in an intensive care unit. The decline of serum bilirubin concentration was most rapid with the blue lamps, with the duration of exposure required being significantly shorter than that with the other two types of light in both groups. The rate of decline over the first 24 hours, as well as the overall rate of decline for the whole duration of phototherapy, was also significantly greater with the blue lamps, the rate being about twice that for the green lamps in the infants in the intensive care unit; the daylight lamps were intermediate in efficacy. The daylight lamps permitted easy clinical monitoring with minimal side effects, whereas the green and blue lamps were equally disturbing to the attending personnel. The green lamps caused severe erythema and tanning in the initial 200 hours of phototherapy. It appears preferable to use either daylight lamps, which permit enhanced clinical monitoring with adequate efficacy, or special blue lamps, which provide maximal therapeutic effect, rather than green lamps, which offer neither.

The nature of the dose-response relationship of phototherapy for neonatal hyperbilirubinemia.

The nature of the dose response relationship of phototherapy for neonatal hyperbilirubinemia was studied in 110 infants divided into ten comparable groups; each group was subjected to phototherapy of different intensity. The response to phototherapy increases with increasing dose, but the rate of this response progressively decreases with increasing radiance till a "saturation point" is reached, beyond which no further increase in response occurs to further increase in radiance, i.e., an asymptotic regression was demonstrated. The minimal radiance at which phototherapy begins to be effective for neonatal hyperbilirubinemia was also determined. The rebound after cessation of phototherapy was similar in all groups of infants, despite the shorter duration of exposure required for the groups subjected to intense phototherapy.

Comparison of the effectiveness of phototherapy and exchange transfusion in the management of nonhemolytic neonatal hyperbilirubinemia.

The relative effectiveness of phototherapy and exchange transfusion for nonhemolytic neonatal hyperbilirubinemia was compared in two closely matched groups of infants. Although the exchange transfusion achieved an immediate reduction of bilirubin level, the "rebound" was rapid and tended to offset this reduction. The more gradual and steady effect of phototherapy resulted in a significantly lower serum bilirubin level at 1, 2, and 3 days after commencement of therapy; the rebound after phototherapy was small. Phototherapy was demonstrated to be more effective than exchange transfusion in achieving prolonged reduction of bilirubin levels for nonhemolytic hyperbilirubinemia. With more efficient lamps delivering more energy in the desired spectrum, it would seem feasible to treat hyperbilirubinemia of whatever etiology with this safer and more convenient form of therapy, though sometimes only as in adjunct therapy.