Rebound in Serum Bilirubin Level Following Intensive Phototherapy

Maisels, M. Jeffrey; Kring, Elizabeth

doi:10.1001/archpedi.156.7.669

Cited by 68 publications

(46 citation statements)

References 8 publications

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“…3,15 In the present study, both groups had similar bilirubin levels after 48 hours of discharge. Likewise, both therapies had the same rate of readmissions.…”

Section: Discussionsupporting

confidence: 66%

Fototerapia simples versus dupla no tratamento de recém-nascidos a termo com hiperbilirrubinemia não-hemolítica

Silva¹,

Luco²,

Tapia³

et al. 2009

J. Pediatr. (Rio J.)

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Objectives: To compare the effectiveness of single (1 panel) vs. double (2 panels) phototherapy in reducing nonhemolytic hyperbilirubinemia in term newborns. Methods:Term newborns with hyperbilirubinemia were prospectively randomized to receive double or single phototherapy. Bilirubin levels were measured at admission and at 12-hour intervals, as well as at a follow-up 48 hours after discharge. Results:Thirty-seven patients received single and 40 double phototherapy. The mean decrease in bilirubin level in the first 24 hours of treatment was greater in the double phototherapy group (5.1±2.2 mg/dL vs. 4.3±2.1 mg/dL), but without statistical significance (p = 0.18). Readmission rates were similar and no adverse effects were found in either group.Conclusions: Double-surface was not more effective than single-surface phototherapy in the treatment of nonhemolytic hyperbilirubinemia in term newborns. However, our results suggest that double phototherapy may be more effective in those term newborns with higher bilirubin levels at admission. is the most commonly used method, and, when bilirubin levels are close to the threshold for exchange transfusion, intensive phototherapy is indicated. 6 This can be obtained by increasing the surface area of the newborn exposed to light and the intensity of phototherapy using lateral panels, reflecting objects and fiber-optic blankets. Among them, a second lateral panel, also known as double phototherapy (DP), is frequently used.

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“…3,15 In the present study, both groups had similar bilirubin levels after 48 hours of discharge. Likewise, both therapies had the same rate of readmissions.…”

Section: Discussionsupporting

confidence: 66%

Fototerapia simples versus dupla no tratamento de recém-nascidos a termo com hiperbilirrubinemia não-hemolítica

Silva¹,

Luco²,

Tapia³

et al. 2009

J. Pediatr. (Rio J.)

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“…Articles to accommodate transport from outside the vasculature, indicates that the blood compartment is an important site with regard to phototherapy (22).The "rebound" in serum bilirubin sometimes observed after cessation of phototherapy generally reflects continued bilirubin production due to hemolysis and not re-entrance into the blood from extravascular sites (23,24). How would the presence of bilirubin outside the vasculature complicate the model used here?…”

Section: Phototherapy Action Spectrummentioning

confidence: 99%

The effect of hematocrit on the efficacy of phototherapy for neonatal jaundice

et al. 2013

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Background:The therapeutic phototherapy action spectrum ranges from 420 to 500 nm. However, a recent report of improved efficacy of fluorescent "turquoise" light (~490 nm) as compared with blue light (~450 nm) underscores the need to define an optimal action spectrum for precision-targeted phototherapy using very narrow wavelength ranges. Methods: We used a current semi-empirical model of the optical properties of skin for robust calculations of the fraction of light absorbed by bilirubin at various wavelengths that could be confounded by hemoglobin (Hb), melanin, and skin thickness. Applying assumptions regarding the wavelength dependence of bilirubin photochemistry, "action spectra" were assembled from the calculated values. results: All the calculated action spectra displayed a peak between 472 and 480 nm (most at 476 nm), which is a significant shift from the well-reported 460 nm absorption peak of bilirubin. Of note, the relative amplitudes of the action spectra showed an inverse relationship with hematocrit (Hct). conclusion: We speculate that a narrow range of light at 476 nm would be 60% more effective than blue (broadband) fluorescent lamps. Because Hb serves as a major competitor of bilirubin for light absorption, the calculations also predict that the efficacy of phototherapy is dependent on the Hct. A high Hct could reduce therapeutic efficiency. a n in vivo model to better define the optimal wavelength range for precision-targeted phototherapy has been elusive. Advances in understanding of skin optical properties have provided an optical model of neonatal skin in the therapeutic range (400-520 nm) that allows facile calculation of the influences of skin structure, melanin pigmentation, and cutaneous hemoglobin (Hb) on the action spectrum for phototherapy. Of these, Hb absorbs most of the visible light in the skin (1,2). As a result, competition from Hb with bilirubin for light should strongly affect the wavelength region of light that is most effective for phototherapy of neonatal jaundice. Although Hb competition has been recognized and used, in part, to predict the action spectrum for phototherapy (3,4), explicit reference to Hb competition appears to be absent from the recent literature. The reports of clinical studies showing that blue-green or green light may be more effective than blue light (5,6) generally rationalize these observations on the general notion that the longer wavelengths "penetrate deeper into the skin" without specific reference to Hb absorbance.Furthermore, significant competition for light by skin Hb also implies that the hematocrit (Hct) may in turn affect the efficacy of phototherapy. This possibility was recognized in 1974 by Lucey and Hewitt (7), who conjectured that the Hct "may be a contributing factor to the differences in response of serum bilirubin to light that one observes in different infants. " They observed in in vitro irradiation studies that changes in the Hct affect diazo-reactive bilirubin disappearance in blood. Almost a decade elapsed before a clinical st...

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“…The availability of intensive phototherapy led to a prolonged hospitalization with no clear end in sight. In infants who receive phototherapy before discharge from the hospital, the risk of significant rebound ranges from 8 to 15% 12,13 and is likely to be higher in infants who have documented, direct antiglobulin test-positive hemolytic disease. The magnitude of the rebound in this infant (Figure 1) even after 15 days of intensive phototherapy and the declining hemoglobin levels, reflect ongoing hemolysis.…”

Section: Discussionmentioning

confidence: 99%

Tin-mesoporphyrin in the treatment of refractory hyperbilirubinemia due to Rh incompatibility

Maisels

Yang

2012

J Perinatol

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We describe the use of tin-mesoporphyrin (SnMP) in the treatment of an infant with Rh hemolytic disease. The infant's hyperbilirubinemia responded to phototherapy but every time the phototherapy was discontinued, the serum bilirubin rebounded and repeat phototherapy was necessary. A single intramuscular dose of SnMP on day 18 eliminated the need for further phototherapy and allowed us to discharge this infant.

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Rebound in Serum Bilirubin Level Following Intensive Phototherapy

Cited by 68 publications

References 8 publications

Fototerapia simples versus dupla no tratamento de recém-nascidos a termo com hiperbilirrubinemia não-hemolítica

Fototerapia simples versus dupla no tratamento de recém-nascidos a termo com hiperbilirrubinemia não-hemolítica

The effect of hematocrit on the efficacy of phototherapy for neonatal jaundice

Tin-mesoporphyrin in the treatment of refractory hyperbilirubinemia due to Rh incompatibility

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