Comparison of Continuous and Intermittent Phototherapy in the Treatment of Toxic Neonatal Jaundice: A Double-blind Clinical Trial
الموضوعات :
1 - Department of Pediatrics, Shahrekord University of Medical Sciences, Shaharekord, Iran
الکلمات المفتاحية: Hyperbilirubinemia, Neonatal jaundice, Phototherapy, Icterus,
ملخص المقالة :
Hyperbilirubinemia is most common cause of readmission after early hospital discharge for healthy newborns. Phototherapy is the first line for treating neonate jaundice and preventing any complications. There is a lack of general agreement on whether continuous phototherapy is more effective than intermittent phototherapy. Traditional phototherapy is continuous phototherapy witch causes emotional disorder and inadequate breast feeding. In this research, we are trying to answer this question and also developing quality and quantity of neonatal jaundice treatment. In this clinical trial study, 82 healthy term neonate with jaundice admitted in the neonatal ward of Hajar hospital of Shahrekord city, Iran, were randomly designated into two groups (N=41): the first group treated with 1 hour turn on and 1 hour turn off phototherapy and the second group treated with 0.5 hour turn on and 3 hours turn off phototherapy. In both groups, total and direct bilirubin levels were measured per 12 hours. Serum sodium and potassium levels were measured before and after phototherapy. The average of phototherapy duration and admission duration was 2±0.8 days, and 2.9±1.4 days in the first and second groups, respectively. Mean admission duration in intermittent phototherapy was significantly lower than continuous phototherapy (p <0.0001). There was a significant reduction (p <0.0001) of serum sodium and potassium levels after intermittent phototherapy. Intermittent phototherapy decreases the admission duration and total sodium and potassium concentrations. Intermittent phototherapy (1 hour turn on and 1 hour turn off) is recommended.
1. Akhil M., Waldemar C., 2011. Digestive system disorders. In: Kliegman RM, Stanton BF, Geme JW, Schor NF, Behrman RE, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia, Saunders, 603-612
2. Allegro D., Young M., 2009. Program helps in early identification and treatment of neonatal hyperbilirubinemia. Can Nurse. 105(6), 6-7.
3. Ruud Hansen T.W., 2010. Phototherapy for Neonatal Jaundice. Therapeutic Effects on More Than One Level? Semin Perinatol. 34(3), 231-4.
4. Ehsanipoor F., Khosravi N., Amin R., 2009. Prevalence of Hypocalcemia due to Phototherapy in Icteric Neonates Admitted to Shahid Akbarabadi Hospital. J Iran Uni Med Sci. 68(16), 57-58.
5. Ghotbi F., Tghiloo M., Gashb A., 2009. The effect of Clofibrate on neonatal jaundice. Pejouhesh. 33(1), 31.
6. Varvarigou A., Fouzas S., Skylogianni E., Mantagou L., Bougioukou D., Mantagos S., 2009. Transcutaneous bilirubin nomogram for prediction of significant neonatal hyperbilirubinemia. Pediatrics. 124(4), 1052-9.
7. Madan A., 2005. Phototherapy: old questions, new answers. Acta Paediatr. 94(10), 1360-2.
8. Hosseinpour Sakha S., Gharehbaghi M.M., 2010. Exchange transfusion in severe hyperbilirubinemia: an experience in northwest Iran. Turk J Pediatc. 52(4), 367-71.
9. Xiong T., Chen D., Duan Z., Qu Y., Mu D., 2012. Clofibrate for unconjugated hyperbilirubinemia in neonates: a systematic review. Indian Pediatr. 49(1), 35-41.
10. Stevenson D.K., Wong R.J., 2010. Metalloporphyrins in the management of neonatal hyperbilirubinemia. Semin Fetal Neonatal Med. 15(3), 164-8.
11. Cohen R.S., Wong R.J., Stevenson D.K., 2010. Understanding neonatal jaundice: a perspective on causation. Pediatr Neonatol. 51(3), 143-8.
12. Romagnoli C., Zecca E., Catenazzi P., Barone G., Zuppa A.A., 2012. Transcutaneous bilirubin measurement: comparison of Respironics BiliCheck and JM-103 in a normal newborn population. Clin Biochem. 45(9), 659-62.
13. Khatami F., Soltani M., 2007. Home Phototherapy, an Alternative Method for Treatment of Jaundice in Healthy-Term Newborns. Iranian J Pediatrics. 17(Suppl.2), 193-14.
14. Csoma Z., Tóth-Molnár E., Balogh K., Polyánka H., Orvos H., Ocsai H., Kemény L., Széll M., Oláh J., 2011. Neonatal blue light phototherapy and melanocytic nevi: a twin study. Pediatrics, 128(4), e856-64.
15. Lau S.P., Fung K.P., 1984. Serum bilirubin kinetics in intermittent phototherapy of physiological jaundice. Arch Dis Child. 59(9), 892–894.
16. Myara A., Sender A., Valette V., Rostoker C., Paumier D., Capoulade C., Loridon F., Bouillie J., Milliez J., Brossard Y.,Trivin F.. 1997. Early changes in cutaneous bilirubin and serum bilirubin isomers during intensive phototherapy of jaundiced neonates with blue and green light. Biol Neonate. 71(2), 75-82.
17. No authors listed. Detection and treatment of neonatal jaundice. Lancet. 2010, 29; 375(9729), 1845.
18. Okwundu C.I., Okoromah C.A., Shah P.S. 2012. Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants. Cochrane Database Syst Rev. 18, 1: CD007966.
19. Naderi S., Safdarian F., Mazloomi D., Bushehri E., Hamidian R., 2009. Efficacy of double and triple phototherapy in term newborns with hyperbilirubinemia: the first clinical trial. Pediatr Neonatol. 50(6), 266-9.
20. Donneborg M.L., Knudsen K.B., Ebbesen F., 2010. Effect of infants' position on serum bilirubin level during conventional phototherapy. Acta Paediatr. 99(8), 1131-4.
21. Kumar P., Chawla D., Deorari A., 2011. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. Cochrane Database Syst Rev. 7(12), CD007969.
22. Chang R.J., Chou H.C., Chang Y.H., Chen M.H., Chen C.Y., Hsieh W.S., Tsao P.N. 2012. Weight loss percentage prediction of subsequent neonatal hyperbilirubinemia in exclusively breastfed neonates. Pediatr Neonatol. 53(1), 41-4.
23. Tan K.L., Jacob E., 1981. Effect of phototherapy on neonatal fluid and electrolyte status. Acta Paediatr Acad Sci Hung. 22(3), 187-94.
23. Khosravi N., Aminian A., Taghipour R., 2011. Total serum magnesium level in icteric neonates before and after phototherapy. Tehran Uni Med J. 69(7), 432-437.
24. Dijk P.H., Hulzebos C.V., 2012. An evidence-based view on hyperbilirubinaemia. Acta Paediatr Suppl. 101(464), 3-10.
25. Tridente A., De Luca D., 2012. Efficacy of light-emitting diode versus other light sourcesfor treatment of neonatal hyperbilirubinemia: a systematic review and meta-analysis. Acta Paediatr, 101(5), 458-65.
26. Slusher T.M., Zipursky A., Bhutani V.K., 2011. A global need for affordable neonataljaundice technologies. Semin Perinatol. 35(3), 185-91.
27. No authors listed. 2011. Hyperbilirubinemia in neonates: prevention, early identification,and treatment. Adv Neonatal Care, 11(5 Suppl), S22-7.
28. Moritz M.L., Manole M.D., Bogen D.L., Ayus J.C., 2005. Breastfeeding-associatedhypernatremia: are we missing the diagnosis? Pediatrics. 116(3), e343-7.
29. Unal S., Arhan E., Kara N., Uncu N., Aliefendioğlu D., 2008. Breast-feeding-associatedhypernatremia: retrospective analysis of 169 term newborns. Pediatr Int. 50(1), 29-34.
30. Boskabadi H., Maamouri G., Ebrahimi M., Ghayour-Mobarhan M., Esmaeily H., Sahebkar A., Gordon A.A., 2010. Neonatal hypernatremia and dehydration in infants receiving inadequate breastfeeding. Asia Pac J Clin Nutr. 19(3), 301-7.
31. Eftekhari Z., 2020. Garlic: A brief overview of its interaction with chemical drugs. Plant Biotechnol Persa. 2(2), 31-32.
32. Bahmani M., Jalilian A., Salimikia I., Shahsavari S., Abbasi N., 2020. Phytochemical screening of two Ilam native plants Ziziphus nummularia (Burm.f.) Wight & Arn. And Ziziphus spina-christi (Mill.) Georgi using HS-SPME and GC-MS spectroscopy. Plant Science Today. 7(2), 275-280.
33. Abbasi N., Khalighi Z., Eftekhari Z., Bahmani M., 2020. Extraction and phytoanalysis of chemical compounds of Eucalyptus globulus leaf native to Dehloran, Ilam province, Iran by HS-SPME and GC-MS. Adv Animal Vet Sci. 8(6), 647-652.
34. Gholami-Ahangaran M., Ostadpoor M., Heidari H., 2020. An Overview of Cinnamon Properties Effects on Blood Glucose and Hemoglobin A1C in Diabetic People. Plant Biotechnol Persa. 2(2), 33-37.
35. Aidy A., Karimi E., Ghaneialvar H., Mohammadpour S., Abbasi N., 2020. Protective effect of Nectaroscordum tripedale extract and its bioactive component tetramethylpyrazine against acetaminophen-induced hepatotoxicity in rats. Adv Trad Med. 20(3), 471-477.
36. Karimian M., 2019. Natural remedies for vascular diseases. Plant Biotechnol Persa. 1(1), 1-3.
37. Karimi E., Abbasi S., Abbasi N., 2019. Thymol polymeric nanoparticle synthesis and its effects on the toxicity of high glucose on OEC cells: Involvement of growth factors and integrin-linked kinase. Drug Design, Development and Therapy. 13, 2513-2532.
38. Bahmani M., Taherikalani M., Khaksarian M., Rafieian-Kopaei M., Ashrafi B., Nazer M., Soroush S., Abbasi N., Rashidipour M., 2019. The synergistic effect of hydroalcoholic extracts of Origanum vulgare, Hypericum perforatum and their active components carvacrol and hypericin against Staphylococcus aureus. Future Science OA. 5(3), Article number FSO371.
39. Abbasi N., Khosravi A., Aidy A., Shafiei M., 2016. Biphasic response to luteolin in MG-63 osteoblast-like cells under high glucose-induced oxidative stress. Iran J Med Sci. 41(2), 118-125.
