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One hundred and ten full-term newborns were treated with integral phototherapy (IP) in the first week of life for hyperbilirubinemia (peak bilirubin concentration, 19.5 +/- 2.8 mg/dl). IP was provided by an apparatus which irradiated the infants over the entire skin surface with four visible blue light lamps placed around the body at a mean distance of only 20 cm. The irradiance of the lamps at the skin surface was 0.350 mW/sq cm, in the wavelength range between 425 and 475 nm. The IP resulted in a 48-hour bilirubin decline rate of 0.163 mg/dl/h. After a mean exposure of 78 +/- 32 h, the mean plasma bilirubin level was 8.4 +/- 0.8 mg/dl. One hundred and ten comparable nonjaundiced infants were studied as controls. At 6 years of age, both groups of subjects were called for a follow-up concerning growth, visual, and hearing functions, and neuro-developmental status. The follow-up was completed in 81 children of the IP group (73.6%) and in 89 of the controls (80.6%). There were no significant differences in the studied parameters between the two groups. The study concludes that IP appears to be an effective and safe treatment for jaundiced infants. IP employs less radiant energy from the lamp source than the traditional apparatus, but delivers this energy to a larger skin surface area.

In order to investigate the main sites of action of phototherapy in the treatment of neonatal jaundice we studied (a) the in vivo and in vitro relationship between the hematocrit and the effectiveness of phototherapy, and (b) the effect of varying the skin area exposed to light. The results show that the hematocrit does not influence in vivo the efficacy of phototherapy, while they confirm that the total skin surface exposed to light is important in determining the effectiveness of light treatment. The authors have also studied the possible action of phototherapy on bilirubin solutions placed into the postmortem brain or the stomach. The results suggest that blue light does not penetrate strongly enough to photomodify the exposed pigment.

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