Abstract:Nursing babies in supine position when compared with periodic position change during phototherapy does not decrease the duration of phototherapy.
“…But rotating the infant from prone to supine or supine to prone (thus exposing unblanched skin to the light) had no effect on the rate at which the bilirubin level was lowered. These observations confirm the data from 3 studies (25)(26)(27) all of which demonstrated that turning the infant does not improve the efficacy of phototherapy. Thus, while phototherapy certainly decreases the bilirubin in the skin and subcutaneous tissues, this effect cannot be responsible for the ability of phototherapy to decrease the bilirubin in the plasma.…”
Section: Changing the Position Of The Infant And Where Photo-therapysupporting
“…But rotating the infant from prone to supine or supine to prone (thus exposing unblanched skin to the light) had no effect on the rate at which the bilirubin level was lowered. These observations confirm the data from 3 studies (25)(26)(27) all of which demonstrated that turning the infant does not improve the efficacy of phototherapy. Thus, while phototherapy certainly decreases the bilirubin in the skin and subcutaneous tissues, this effect cannot be responsible for the ability of phototherapy to decrease the bilirubin in the plasma.…”
Section: Changing the Position Of The Infant And Where Photo-therapysupporting
“…Having said so, Bhethanabhotla et al . () did generally explain in their report concerning blinding:Owing to obvious nature of intervention, blinding was not possible in our study. (Bhethanabhotla et al .…”
Section: Resultsmentioning
confidence: 73%
“…Amid the five studies, one (Bhethanabhotla et al . ) evidently analysed the key outcome of all subjects initially allocated to groups. There was no loss of follow up.…”
Section: Resultsmentioning
confidence: 99%
“…Similarly, Bhethanabhotla et al . () performed the statistical analysis by intention to treat whilst the other four trials (Chen et al . , Shinwell et al .…”
“…Pursuant to this understanding, infants in phototherapy were routinely alternated from prone to supine position to increase the efficacy of phototherapy (12). However, this routine was largely discontinued when it was found that the efficacy of phototherapy is independent of alternating the position of the infant (10,(13)(14)(15). Other observations also support the hypothesis that the effect of phototherapy is predominantly intravascular.…”
BackgroundPhototherapy is the routine treatment for neonatal hyperbilirubinemia. Absorption of light in the skin transforms the native Z,Z-bilirubin to photobilirubins. This study investigates whether the hemoglobin concentration has an impact on efficacy of phototherapy, expressed by the decline of total serum bilirubin concentration (TsB).MethodsA trial was conducted on 93 infants, gestational age ≥33 weeks, with uncomplicated hyperbilirubinemia. The infants were treated with conventional phototherapy using LED light for 24 h. The median light irradiance was 66.8 μW/cm/nm.ResultsThe median decrease in TsB after 24 h was 121 (57-199) μmol/l; the median hemoglobin was 12.0 (7.0-14.7) mmol/l. There was a significant effect of hemoglobin concentration on the decrease in TsB of -3.61 μmol/mmol hemoglobin (P=0.022), after adjusting for initial TsB and postnatal age. That is, assuming the same initial TsB and postnatal age, for each mmol/l increase in hemoglobin, the decrease in TsB was 3.61 μmol/l smaller. In our hemoglobin range, the decrease in TsB is reduced by 28 μmol/l (23%).ConclusionIncreasing hemoglobin levels led to a decrease in the efficacy of phototherapy. Our data provide additional support for the conclusion that the transformation of bilirubin to photobilirubins takes place mainly in the superficial capillaries of the skin.
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