Changes in Blood Flow in the Skin and Muscle with Phototherapy

Wu, Paul Y K; Wong, Wayne A.; Hodgman, Joan E.; Levan, Norman E.

doi:10.1203/00006450-197404000-00007

Cited by 49 publications

(36 citation statements)

References 8 publications

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“…The optimal time to obtain recordings for preterm infants is between 30 and 90 min postprandial (6). In this study, measurements were obtained nearly 45, 90, and 150 min after a feeding.…”

Section: Patientsmentioning

confidence: 99%

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Impaired Microvascular Perfusion Improves With Increased Incubator Temperature in Preterm Infants

et al. 2007

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ABSTRACT:The optimal thermal environment for sick preterm infants is unknown. Incubator temperature can be regulated to an abdominal wall temperature of 36.5°C [neutral temperature (NT)] or to a minimal temperature difference (Ͻ2°C) between abdominal wall and extremities [comfort temperature (CT)]. This could affect the microcirculation, particularly in infants with impaired perfusion. We assessed the microvascular perfusion with near-infrared photoplethysmography (NIRP) at these two target temperatures between d 1 and 4 of life in preterm infants with normal (NL group) or impaired (RED group) microcirculation as determined by a clinical score. Signal strength variables such as area under the curve (AUC) and the first derivate of the amplitude (FLUX) were calculated. Starting temperature was randomized to NT or to CT and then followed by the other temperature. A significant increase of FLUX and AUC in the RED group was found with NT as starting temperature (FLUX: 282 Ϯ 76 at NT versus 627 Ϯ 211 at CT; p ϭ 0.025; AUC: 73 Ϯ 47 at NT versus 234 Ϯ 112 at CT; p ϭ 0.009), but not with CT. In NL infants, both parameters did not change significantly. Increasing the incubator temperature to CT changes thermoregulatory flow to the extremities in preterm infants with impaired microvascular perfusion and might improve tissue flow. T he optimal thermal environment for nursing sick preterm infants is not known. Neutral thermal zone is traditionally defined as a range of environmental temperatures within which the metabolic rate is minimal and thermoregulation is achieved by nonevaporative means (1,2). NT corresponds to a body surface temperature of about 37°C above the liver, in accordance with a core temperature of approximately 36.5°C regardless of the temperature of the extremities (3,4). CT is defined as a minimal temperature difference between the abdominal wall and the extremities (Ͻ2°C) (3). CT corresponds to an approximate core temperature of 37°C and higher and is close to an intrauterine temperature of 38°C (2,4).Changes in body temperature of about 1°C are primarily associated with changes in total peripheral skin blood flow (5). In term infants with NL exposed to phototherapy an increase of 224% in skin blood flow has been observed using electrocapacitance plethysmography (6). The effect of incubator temperature on circulation and microcirculation of preterm infants with signs of an impaired peripheral microcirculation (e.g. mottled skin) has not yet been reported. In the present study, we compared the effect of different incubator temperatures (NT and CT) on indices of peripheral blood flow in preterm infants matched for gestational age either with infants showing clinical signs of an impaired microcirculation or those without such signs. Microcirculation was assessed noninvasively with NIRP (7).Photoplethysmography was first described by Hertzman and Spealman in 1937 (8). It is a noninvasive technique consisting of a red/infrared light-emitting diode and a photosensitive detector (9). The emitted light is eithe...

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“…The optimal time to obtain recordings for preterm infants is between 30 and 90 min postprandial (6). In this study, measurements were obtained nearly 45, 90, and 150 min after a feeding.…”

Section: Patientsmentioning

confidence: 99%

“…In term infants with NL exposed to phototherapy an increase of 224% in skin blood flow has been observed using electrocapacitance plethysmography (6). The effect of incubator temperature on circulation and microcirculation of preterm infants with signs of an impaired peripheral microcirculation (e.g.…”

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confidence: 99%

Impaired Microvascular Perfusion Improves With Increased Incubator Temperature in Preterm Infants

et al. 2007

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“…Various studies suggest that phototherapy increases skin blood flow by as much as 70% (5)(6)(7)(8). Although in full-term infants an increase in skin blood flow does not account for extra TEWL (29), we suggest that in preterm infants, who lack the ability to sweat, there is a relationship between skin blood flow and TEWL.…”

Section: Subjectsmentioning

confidence: 86%

“…The infants were born after a (mean Ϯ SD) gestational age of 30.6 Ϯ 1.6 wk (range 27-34 wk) and had a weight at birth of 1412 Ϯ 256 g (range 966 -1880 g). The Apgar score at 5 min had a median of 8 (range [3][4][5][6][7][8][9]. At the time of the measurements, the infants had a postnatal age of 5 Ϯ 3 d (range 1-11 d) and their weight had slightly diminished to 1367 Ϯ 308 g (range 1010 -2044 g).…”

Section: Subjectsmentioning

confidence: 99%

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Transepidermal Water Loss During Halogen Spotlight Phototherapy in Preterm Infants

et al. 2002

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Among preterm infants there is a relationship between skin blood flow and transepidermal water loss (TEWL). The aim of this study was to assess whether halogen spotlight phototherapy without significant heat stress increases TEWL and affects maintenance fluid requirements in preterm infants. TEWL was measured noninvasively before the start and after 1 h of halogen spotlight phototherapy in a group of preterm infants, nursed in double-walled incubators with moderately high relative humidity. Relative humidity and ambient temperature in the incubator were tightly controlled. Mean Ϯ SD birth weight of the 18 infants was 1412 Ϯ 256 g, gestational age 30.6 Ϯ 1.6 wk, and age at measurement 5 Ϯ 3 d. Nine infants received ventilatory assistance. Relative humidity was 40 -80% (mean 52%). Average TEWL increased from 13.6 to 16.5 g/m 2 /h during phototherapy. These data show that TEWL increases by approximately 20% during phototherapy despite constant skin temperature and relative humidity. Maintenance fluids of preterm infants should be increased by 0.35 mL/kg/h during exposure to halogen spotlight phototherapy. (Pediatr Res 51: 402-405, 2002) Abbreviations H conv , heat exchange through convection H evap , heat exchange through evaporation H rad , heat exchange through radiation H tot , total heat loss RH, relative humidity TEWL, transepidermal water loss T amb , ambient temperature in the incubator T roof , temperature of the incubator roof T skin , skin temperature Phototherapy is a standard therapy for hyperbilirubinemia in the newborn. Although it has proven to be an effective and relatively safe treatment (1), uncertainty still exists about whether phototherapy influences the fluid balance of the infant. Previously, studies on the effect of phototherapy upon insensible water loss reported a range of extra water loss between 0 and well over 100% (2-4). All of these studies were using bank lights.The present study is designed to assess the amount of extra water loss through evaporation during phototherapy, given by the currently used halogen spotlights instead of the older bank lights. Various studies have demonstrated that the radiative energy of the phototherapy lamp increases skin blood flow (5-8). We therefore expect that the heat balance of a newborn infant during phototherapy is affected by heat loss through evaporation. Extra fluid intake will then be necessary. We measured TEWL in 18 preterm infants receiving halogen spotlight phototherapy to examine this hypothesis. METHODS Subjects.All subjects were admitted to the neonatal intensive care unit of the Leiden University Medical Center/the Juliana Children's Hospital for treatment of prematurity and developed nonhemolytic hyperbilirubinemia during their nursery course for which they received phototherapy. Infants selected for this study were born after a gestational age of Ͻ34 wk, appropriate for gestational age, and nursed in a doublewalled incubator (type 8000, Dräger, Lübeck, Germany) in which the RH was at least 40% at the time of the measurements. The infa...

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Insensible Water Loss in the Critically Ill Neonate

et al. 1981

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\s=b\To quantitate radiant power and insensible water loss under phototherapy, 12 neonates were studied under radiant warmers for one hour each with and without phototherapy. Warmer power was measured by wattmeter and thermopile. Power density received from phototherapy was 4.4 mW/sq cm. Addition of phototherapy to the servocontrolled warmer caused a decrease in power density received from the warmer (17.1 to 12.9 mW/sq cm). However, the total radiant\x=req-\ power density received with phototherapy and the warmer combined (17.3 mW/sq cm) did not differ from net power density received without phototherapy (17.1 mW/ sq cm). Insensible water loss, measured with a metabolic balance, increased from 2.54 to 3.73 mL/kg/hr, with addition of phototherapy. Since the total radiant-power density did not change, mechanisms other than increased radiant-power delivery must exist to explain the increased insensible water loss observed with phototherapy.(Am J Dis Child 1981;135:516-520)

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Changes in Blood Flow in the Skin and Muscle with Phototherapy

Cited by 49 publications

References 8 publications

Impaired Microvascular Perfusion Improves With Increased Incubator Temperature in Preterm Infants

Impaired Microvascular Perfusion Improves With Increased Incubator Temperature in Preterm Infants

Transepidermal Water Loss During Halogen Spotlight Phototherapy in Preterm Infants

Insensible Water Loss in the Critically Ill Neonate

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