Original Paper Biol Neonate 1992;61:358-365

K

L

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T a n

K. W. Boev

Phototherapy for ABO Haemolytic Hyperbilirubinaemia

Keywords

Abstract

Phototherapy ABO-haemolytic disease Non-haemolytic Hyperbilirubinaemia

The efficacy of ‘standard’ daylight phototherapy and ‘high intensity’ blue light phototherapy for neonatal jaundice from A BO -H D , or of a non-haemolytic nature was evaluated. Alto­ gether 77 full-term infants with A BO -H D and 3,020 with nonhaemolytic jaundice were studied. Both groups of infants responded well to standard daylight phototherapy; the re­ sponse in non-haemolytic hyperbilirubinaemia was signifi­ cantly greater. High intensity blue light phototherapy was sig­ nificantly more effective in reducing bilirubin levels than stan­ dard daylight phototherapy in both groups of infants with no failure being encountered. Four infants with non-haemolytic jaundice did not respond adequately to white light (1.4/1,000); they needed high intensity blue light for adequate response. Bilirubin rebound was mild. Four infants in the blue light group needed a second exposure (28.3/1,000) compared with 20 in the white light group (6.9/1,000), a difference that was significant. Standard white light phototherapy is usually ade­ quate for A B O -H D as well as non-haemolytic hyperbilirubi­ naemia. High intensity blue light would be preferable where a more rapid and greater response is desirable.

Introduction Phototherapy is now an accepted form of treatment for neonatal jaundice. It has been used effectively for non-haemolytic jaundice

[ 1] as well as for severe jaundice associated with G6PD deficiency [2], In Singapore, neo­ natal jaundice is a very common condition even among healthy newborn babies [3]; its frequency is even higher in those with G6PD

Professor K. L. Tan Department o f Neonatology National University Hospital 5 Lower Kent Ridge Road Singapore 0511 (Republic o f Singapore)

© 1992 S. Kargcr A G , Basel 0006-3126/92/ 0616-0358$2.75/0

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Departments o f Neonatology (National University Hospital), Sociology, and Social Work and Psychology, National University o f Singapore, Singapore

Materials and Methods In the Kandang Kerbau Hospital, Singapore, in­ fants requiring phototherapy were investigated as pre­ viously described [1,7]. The screening for G 6 P D defi­ ciency was performed by a modification o f Bernstein’s method [8]. Birth weight and gestational age were recorded. The gestational age was obtained from ma­ ternal history as well as from the infant’s neurological and physical characteristics [9]; where a discrepancy was observed the latter was used. The diagnosis o f A B O -H D in a case o f hyperbilirubinaemia was based on the following: jaundice occurring in the first 24 h o f age, a positive direct Coombs’ test in the absence o f Rh isoimmunisation, mother o f blood group O with infant o f group A or B with a maternal (IgG) anti-A or anti-B antibody titre > 64, and presence o f microspherocyto­ sis in the infant blood film. The criteria for non-hae­ molytic hyperbilirubinaemia has been previously de­ scribed [1,7]. The ‘standard’ form o f phototherapy was the open 7-daylight lamp setup (Philips TL20W/54) which at

the infant skin provided an average irradiance o f 295 pW/cm2 in the 400-480 nm range, 250 pW/cm2 in the 425-475 nm range, and 140 pW/cm2 in the 440-480 nm range and a total light intensity o f 4,630 lx. The ‘high intensity’ blue light phototherapy used the same 7 overhead lamp setup with an extra bank o f lights below the infant; special Philips T L 20W/52 lamps with a spectral emission similar to the bilirubin ab­ sorption spectrum [6] were used. The irradiance was 1,850 pW/cm2, 1,690 pW/cm2, 1,070 pW/cm2 respec­ tively and the total light intensity 1,881 lx; this pro­ vided the optimum dose required to achieve maximal bilirubin reduction [6]. The method o f measurement had been previously described [7], The lamps were changed after every 2,000 h o f use, at which time the irradiance was still 80% o f the original [10]. Phototherapy was started when the bilirubin con­ centration was > 2 5 6 pmol/1 (15 mg/dl) regardless o f the time of the day; in infants with rapid onset o f jaun­ dice, visible on the first day, phototherapy was started when bilirubin concentration exceeded 222 pmol/1 (13 mg/dl) in the first 48 h o f life. A t start o f phototherapy, the haemoglobin (Hb) and packed cell volume (PCV) were determined. All the infants were exposed com­ pletely unclothed with their eyes covered to contin­ uous phototherapy, interrupted only for feeding, clean­ ing and blood sampling. Fluid intake was increased during exposure to offset the increased fluid loss. The type o f phototherapy utilised dependend on the avail­ ability o f the type o f phototherapy setups, there being more ‘daylight’ stands that ‘high intensity’ blue ones. The medical and nursing personnel also tended to prefer the high intensity phototherapy for the infants with rapidly increasing or very severe jaundice and the ‘standard’ daylight setup for the more ‘standard’ cases. Capillary blood was sampled at start o f photother­ apy and at 6- to 12-hourly intervals; the lights were switched o ff and the infants removed from the cots for sampling Where the bilirubin concentration increased on two consecutive determinations beyond the initial pre-exposure value, phototherapy was deemed to have failed. Phototherapy was terminated when the biliru­ bin concentration had declined to pre-photo­ therapy values were again exposed to phototherapy fol­ lowing the same guidelines.

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deficiency. In a significant minority of infants A BO haemolytic disease (ABO-HD) is re­ sponsible for neonatal jaundice. Photother­ apy in such infants has been documented pre­ viously [4, 5] with a fair degree of success. ‘High intensity' blue light phototherapy has been demonstrated to be much more effective than the usual daylight phototherapy in nonhaemolytic jaundice [6]. However, the effi­ cacy of such high intensity phototherapy in A BO -H D jaundice has not been previously evaluated. It was therefore felt that it would be timely and worthwhile to evaluate the effi­ cacy of standard daylight phototherapy and ‘high intensity’ blue light phototherapy in A BO -H D jaundice as well as non-haemolytic jaundice; such a report has as yet to be docu­ mented. In the present paper the efficacy of ‘standard’ daylight phototherapy and ‘high in­ tensity’ blue light phototherapy in ABO hyperbilirubinaemia and non-haemolytic hyperbilirubinaemia in a normal clinical situation is evaluated.

Capillary samples were placed in labelled red drinking straws and kept in a light-proof box till the moment o f bilirubin determination which was per­ formed under standard conditions with an A O Bilirubinometer (American Optical C o , U SA ) checked regu­ larly against known standards. The bilirubin concen­ tration in paired samples o f capillary blood were also randomly determined to assess the reliability and re­ producibility o f the determinations. Direct acting bili­ rubin was determined in random samples as well as in those from infants who were not responding to photo­ therapy as previously described [1, 6]. The data was compiled and stored in an IB M computer in a fixed input format and analysed with the statistical package for the social sciences [11]. Statistical analysis involved the Students t test and y} test. In this paper, we report

our clinical experience o f phototherapy in full-term ‘healthy’ infants with hyperbilirubinaemia from AB O H D or o f a non-haemolytic nature.

Results Altogether 77 full-term infants with ABO haemolytic hyperbilirubinaemia and 3,020 with non-haemolytic hyperbilirubinaemia (table 1) were exposed to phototherapy during the same period. The Hb and P CV values of the ABO -H D infants were significantly lower that those of the non-haemolytic infants (p

Phototherapy for ABO haemolytic hyperbilirubinaemia.

The efficacy of 'standard' daylight phototherapy and 'high intensity' blue light phototherapy for neonatal jaundice from ABO-HD, or of a non-haemolyti...
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