In vitro and in vivo Effects of Erythrocyte Phototherapy on Newborns

Tozzi, E.; Ciancarelli, Maria Giuliana Tozzi; Giulio, Antonio Di; A, D'Alfonso; Farello, Giovanni; Spennati, G F; Matteis, Federico De

doi:10.1159/000243124

Cited by 27 publications

(15 citation statements)

References 13 publications

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“…Alternatively, a higher rate of death with aggressive phototherapy might result from oxidative injury to cell membranes 37-39. Such injury is particularly probable in the smallest, most immature infants whose gelatinous, thin skin readily transmits light 40…”

Section: Discussionmentioning

confidence: 99%

Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

Morris¹,

Tyson³

et al. 2008

N Engl J Med

231

195

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Background It is unclear whether aggressive phototherapy to prevent neurotoxic effects of bilirubin benefits or harms infants with extremely low birth weight (1000 g or less). Methods We randomly assigned 1974 infants with extremely low birth weight at 12 to 36 hours of age to undergo either aggressive or conservative phototherapy. The primary outcome was a composite of death or neurodevelopmental impairment determined for 91% of the infants by investigators who were unaware of the treatment assignments. Results Aggressive phototherapy, as compared with conservative phototherapy, significantly reduced the mean peak serum bilirubin level (7.0 vs. 9.8 mg per deciliter [120 vs. 168 μmol per liter], P<0.01) but not the rate of the primary outcome (52% vs. 55%; relative risk, 0.94; 95% confidence interval [CI], 0.87 to 1.02; P = 0.15). Aggressive phototherapy did reduce rates of neurodevelopmental impairment (26%, vs. 30% for conservative phototherapy; relative risk, 0.86; 95% CI, 0.74 to 0.99). Rates of death in the aggressive-phototherapy and conservative-phototherapy groups were 24% and 23%, respectively (relative risk, 1.05; 95% CI, 0.90 to 1.22). In preplanned subgroup analyses, the rates of death were 13% with aggressive phototherapy and 14% with conservative phototherapy for infants with a birth weight of 751 to 1000 g and 39% and 34%, respectively (relative risk, 1.13; 95% CI, 0.96 to 1.34), for infants with a birth weight of 501 to 750 g. Conclusions Aggressive phototherapy did not significantly reduce the rate of death or neurodevelopmental impairment. The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. This reduction may be offset by an increase in mortality among infants weighing 501 to 750 g at birth. (ClinicalTrials. gov number, NCT00114543.)

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Section: Discussionmentioning

confidence: 99%

Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

Morris¹,

Tyson³

et al. 2008

N Engl J Med

231

195

View full text Add to dashboard Cite

show abstract

“…The rate of death or neurodevelopmental impairment was not significantly reduced by aggressive phototherapy. Conversely, aggressive phototherapy was associated with increased mortality in infants with birthweight between 501 and 750 g. The reduction of antioxidant protection in aggressive phototherapy could explain this result, as bilirubin presents antioxidant effects [2] and phototherapy may cause oxidative injury by photodegradation of antioxidant molecules [23]–[24].…”

Section: Discussionmentioning

confidence: 99%

Hyperbilirubinemia and Neurodevelopmental Outcome of Very Low Birthweight Infants: Results from the LIFT Cohort

Mazeiras¹,

Rozé

Ancel

et al. 2012

PLoS ONE

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BackgroundBilirubin-related neurotoxicity is an important clinical issue in very low birthweight (VLBW) infants, and the existing literature is inconsistent.ObjectiveTo analyze the relationship between maximal serum unconjugated bilirubin levels (SBL) and neurodevelopmental outcome at 2-year corrected age in VLBW infants.MethodsPhototherapy was initiated in all infants born before 33 weeks of gestation, according to Maisels' recommendations. Neurodevelopmental assessment at 2-year corrected age was performed in all infants that survived. SBLs collected during the first week of life were used to define three tertiles of max-SBL. The first tertile corresponded to infants with the lowest max-SBL.Results and ConclusionsA total of 724 infants were included in the study, and among them, 631 (87%) were evaluated at two years old. The infants of the first tertile were younger and smaller than the infants of the other two tertiles, in accordance with Maisels' recommendations for very small infants. No difference in the risk of impaired functional outcome among the three groups was observed. However, among infants weighing less than 1001 g, those in the third tertile had a poorer neurodevelopmental prognosis as compared to those in the second tertile (adjusted odds ratio = 6.8, 95% CI: 1.2–36.7, p = 0.03). Considering the results obtained, we propose 196 µmol/L (11.5 mg/dL) when birthweight varies between 1001 and 1500 g, and 170 µmol/L (9.9 mg/dL) when birthweight is less than 1001 g, as recommended max-SBLs (defined as maximal levels of 95th percentile curves of SBLs in infants with an optimal outcome). When Maisels' recommendations were applied, max SBLs were higher in 8% of infants weighing 1001–1500 g and in 15% of infants weighing less than 1001 g. Our data seems to validate Maisels' recommendations in the overall population of infants born before 33 weeks of gestation, but not in infants weighing less than 1001 g.

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“…The reasons for these findings are not clear, but these tiny, immature infants have gelatinous, thin skin, through which light will penetrate readily reaching more deeply into the subcutaneous tissue. There is some evidence that phototherapy can produce oxidative injury to cell membranes and DNA, [38][39][40][41] and such injury could have a negative effect on these immature infants. In the Neonatal Research Network study, the average irradiance level was reported as 22 to 23 mW cm À2 nm À1 and the 'target irradiance level' was 15 to 40 mW cm À2 nm À1 .…”

Section: Phototherapymentioning

confidence: 99%

An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation

et al. 2012

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We provide an approach to the use of phototherapy and exchange transfusion in the management of hyperbilirubinemia in preterm infants of <35 weeks of gestation. Because there are limited data for evidence-based recommendations, these recommendations are, of necessity, consensusbased. The recommended treatment levels are based on operational thresholds for bilirubin levels and represent those levels beyond which it is assumed that treatment will likely do more good than harm. Long-term follow-up of a large population will be needed to evaluate whether or not these recommendations should be modified.

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In vitro and in vivo Effects of Erythrocyte Phototherapy on Newborns

Cited by 27 publications

References 13 publications

Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

Aggressive vs. Conservative Phototherapy for Infants with Extremely Low Birth Weight

Hyperbilirubinemia and Neurodevelopmental Outcome of Very Low Birthweight Infants: Results from the LIFT Cohort

An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation

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