Is phototherapy exposure associated with better or worse outcomes in 501- to 1000-g-birth-weight infants?

Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Acta Paediatrica (Impact Factor: 1.67). 07/2011; 100(7):960-5. DOI: 10.1111/j.1651-2227.2011.02175.x
Source: PubMed


 To compare risk-adjusted outcomes at 18- to 22-month-corrected age for extremely low birth weight (ELBW) infants who never received phototherapy (NoPTx) to those who received any phototherapy (PTx) in the NICHD Neonatal Research Network randomized trial of Aggressive vs. Conservative Phototherapy.
Outcomes at 18 to 22-month-corrected age included death, neurodevelopmental impairment (NDI) and Bayley Scales Mental Developmental Index (MDI). Regression models evaluated the independent association of PTx with adverse outcomes controlling for centre and other potentially confounding variables.
Of 1972 infants, 216 were NoPTx and 1756 were PTx. For the entire 501- to 1000-g-BW cohort, PTx was not independently associated with death or NDI (OR 0.85, 95% CI: 0.60-1.20), death or adverse neurodevelopmental endpoints. However, among infants 501-750 g BW, the rate of significant developmental impairment with MDI < 50 was significantly higher for NoPTx (29%) than PTx (12%) (p = 0.004).
Phototherapy did not appear to be independently associated with death or NDI for the overall ELBW group. Whether PTx increases mortality could not be excluded because of bias from deaths before reaching conservative treatment threshold. The higher rate of MDI < 50 in the 501- to 750-g-BW NoPTx group is concerning and consistent with NRN Trial results.

Download full-text


Available from: Ronald J Wong
  • Source
    • "Additionally, phototherapy has been shown to have limited effect in modulating elevated TB levels due to Coombs-positive hemolytic disease and cannot be considered as a substitute for exchange transfusion (Maurer et al., 1985). It is also conceivable that hyperbilirubinemia treatment with Mps could be beneficial for premature infants, which have very thin skin, thus light can penetrate deeper into tissue and cause photooxidative injury (Vreman et al., 2004; Hintz et al., 2011). This effect might be reduced with Mps treatment, if they are used alone and not in combination with phototherapy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Metalloporphyrins are structural analogs of heme and their potential use in the management of neonatal hyperbilirubinemia has been the subject of considerable research for more than three decades. The pharmacological basis for using this class of compounds to control bilirubin levels is the targeted blockade of bilirubin production through the competitive inhibition of heme oxygenase (HO), the rate-limiting enzyme in the bilirubin production pathway. Ongoing research continues in the pursuit of identifying ideal metalloporphyrins, which are safe and effective, by defining therapeutic windows and targeted interventions for the treatment of excessive neonatal hyperbilirubinemia.
    Full-text · Article · Apr 2012 · Frontiers in Pharmacology
  • [Show abstract] [Hide abstract]
    ABSTRACT: We believe that the syndrome of bilirubin-induced neurologic dysfunction [BIND] represents a spectrum of neurologic manifestations among vulnerable infants who have experienced an exposure to bilirubin of lesser degree than generally described in previous publications. Clinical neuro-motor manifestations extend to a range of subtle processing disorders with objective disturbances of visual-motor, auditory, speech, cognition, and language among infants with a previous history of moderate-to-severe hyperbilirubinemia of varied duration. Confounding effects include prematurity, hemolysis, perinatal-neonatal complications, altered bilirubin-albumin binding, severity and duration of bilirubin exposure, and the individual vulnerability of the infant related to genetic, family, social, and educational predilection, regardless of the cause of neonatal jaundice. Tools to better assess BIND specific domains of multisensory processing disorders, identified by pyschometric, audiologic, speech, language and visual-motor, and neuromotor examination would allow for prospective surveillance of infants at risk for the syndrome.
    No preview · Article · Jun 2011 · Seminars in perinatology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background:Neonatal hyperbilirubinemia arises from increased bilirubin production and decreased bilirubin elimination. Although phototherapy safely and effectively reduces bilirubin levels, recent evidence shows that it has adverse effects. Therefore, alternative treatments are warranted. Metalloporphyrins, competitive inhibitors of heme oxygenase (HO), the rate-limiting enzyme in bilirubin production, effectively reduce bilirubin formation; however, many are photoreactive. Here, we investigated possible photosensitizing effects of chromium mesoporphyrin (CrMP) and zinc deuteroporphyrin bis-glycol (ZnBG).Methods and Results:Administration of CrMP or ZnBG to 3-day-old pups (3.75-30.0 µmol/kg i.p.) and exposure to cool white (F20T12CW) and blue (TL20W/52) fluorescent lights (+L) for 3h, resulted in a dose-dependent mortality (LD50=21.5 and 19.5 µmol/kg, respectively). In contrast to ZnBG, there was no significant difference in survival between CrMP+L and CrMP groups. Following 30 µmol/kg ZnBG+L, we found significant weight loss, decreased liver antioxidant capacities, and increased aspartate aminotransaminase (AST) levels. 6-days post-light exposure, ZnBG+L-treated pups showed gross and histologic skin changes at doses >7.5 µmol/kg. No lethality was observed following treatment with 30 µmol ZnBG/kg plus exposure to blue light-emitting diodes. Phototoxicity of ZnBG was dependent on light source, emission spectrum, and irradiance.Conclusions:Low doses of ZnBG (<3.75 µmol/kg) retained maximal HO inhibitory potency without photosensitizing effects, and thus are potentially useful in treating neonatal hyperbilirubinemia.
    Full-text · Article · May 2012 · Pediatric Research
Show more