The Behavior of Jaundiced Infants undergoing Phototherapy

Abstract

SUMMARY Ten full‐term jaundiced infants were examined with the Brazelton Scale before, during and following phototherapy. They were compared with 10 non‐jaundiced control infants examined at the same post‐partum ages. All infants were appropriate for gestational age and free of perinatal complications other than hyperbilirubinemia. Differences on the orienting items of the Brazelton examinations (primarily visual orienting) were found prior to the onset of phototherapy or separation, and persisted for the length of the study. The greatest over‐all differences were noted during phototherapy and separation from the mother, at which times the treatment group had lower scores on four of the six orienting items. They also had lower scores on muscle tonus, pull‐to‐sit and cuddliness while undergoing phototherapy, and poorer scores on orienting items, self‐quieting and tremulousness were also evident three days following treatment. It is suggested that the differences found in mother‐infant interaction following separation for the management of minor medical problems may be related to changes in infant behaviour which are already evident prior to separation. In the cases of jaundiced infants requiring phototherapy, these changes appear to be related primarily to hyperbilirubinemia. The possibility of these effects being prolonged or confounded by phototherapy or separation cannot be discounted. RÉSUMÉ Comportement de nourrissons ictériques sous phototherapie Dix nourrissons icteriques nes a terme ont été examines a partir de l'échelle de Brazelton avant, durant et a la suite d'une phototherapie. lis ont été compares a dix nourrissons non‐icteriques exammines au meme age post‐natal. Tous les nourrissons etaient aparies pour l'âgé de gestation et sans complications perinatales autres que l'hyperbilirubinemie. Des differences aux items d'orientation de l'échelle de Brazelton (orientation visuelle principalement) ont été notées avant le debut de la phototherapie ou de la separation et ont persiste tout au long de l'etude. Les differences les plus importantes ont été notées durant la phototherapie et la separation d'avec la mere et a ce moment le groupe traite avait des reussites inferieures pour quatre des six items d'orientation. lis avaient aussi des scores inferieurs pour le tonus musculaire, le tire‐assis et le pelotonnement sous phototherapie; des scores plus pauvres aux items d'orientation, a l'aptitude a se calmer et a l'etat d'excitation etaient egalement evidents durant les trois jours suivant le traitement. Les auteurs suggerent que les differences trouvees dans les interactions mere‐enfant a la suite d'une separation pour le traitement de problemes medicaux mineurs peuvent etre liees a des modifications dans le comportement de l'enfant deja manifestes avant la separation. Dans le cas de nourrissons icteriques requerant une phototherapie, ces modifications apparaissent dues avant tout a l'hyperbilirubinemie. On ne peut evidemment eliminer le fait que ces effets soient prolonges ou renforces par la phototherapie ou...

When should phototherapy be stopped? A pilot study comparing two targets of serum bilirubin concentration

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Short- and Long-Term Outcome of Severe Neonatal Nonhemolytic Hyperbilirubinemia

“…Phototherapy is useful for the acute management of neonatal hyperbilirubinemia, although some studies reported possible adverse effects. [32][33][34][35][36][37][38][39] The suggestion that photometabolic products might interfere with albumin binding of bilirubin raised the possibility that phototherapy might contribute to the neurotoxicity of bilirubin. 52 There was the possibility of delayed effects of phototherapy concerning neurodevelopment, [32][33][34][35][36] vision, 37 and skin abnormalities.…”

“…[32][33][34][35][36][37][38][39] The suggestion that photometabolic products might interfere with albumin binding of bilirubin raised the possibility that phototherapy might contribute to the neurotoxicity of bilirubin. 52 There was the possibility of delayed effects of phototherapy concerning neurodevelopment, [32][33][34][35][36] vision, 37 and skin abnormalities. 38,39 However, recent studies, 40,52 including a multicenter randomized controlled study, 40 concluded that phototherapy effectively controlled neonatal hyperbilirubinemia without adverse outcome at 6 years and was at least as effective as exchange transfusion alone.…”

“…[29][30][31] Serial brainstem auditory evoked potentials were performed at different ages: 15 to 80 months, 28 2 to 6 years, 30,31 and 8 to 13 years. 29 The possibility of delayed effects on growth and development, [32][33][34][35][36] vision, 37 and skin abnormalities 38,39 had been reported for phototherapy. However, a recent multicenter randomized controlled study concluded that phototherapy can effectively control neonatal hyperbilirubinemia without adverse outcome at 6 years.…”

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