Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 60, Num. 9, 2006, pp. 385-387

Indian Journal of Medical Sciences, Vol. 60, No. 9, September, 2006, pp. 385-387

Letter To Editor

Effect of prophylactic phototherapy on neonatal hyperbilirubinemia of prematures

Tripathi Sandeep, Saili Arvind

Department of Pediatrics, Lady Hardinge Medical College and Asso. Kalawati Saran's Children's Hospital, New Delhi

Correspondence Address:Department of Pediatrics, LHMC and Asso. KSCH, New Delhi Email: sandeeptripathi2000@yahoo.com

Code Number: ms06056

Sir,

Management of hyperbilirubinemia in term healthy infants has been standardized by American Academy of Pediatrics by its recommendations,[1] but it has left the management of preterms as a subject of varying theories, practices and controversies. Because there is no way to predict a safe level of Serum Bilirubin (S. Bil.) in very low birth weight (VLBW) infants,[2] use of phototherapy since birth as a prophylactic measure has been recommended, though this has never been proved.

A prospective unblinded study was carried out over a 3-month period. The study was approved by the institutional ethical committee. All preterm babies weighing < 1250 g born in the hospital during the study period were included in the study after excluding babies with:

1. presence of sepsis risk factors in mothers,
2. positive sepsis screen in the neonates,
3. presence of ABO or Rh incompatibility and
4. presence of birth asphyxia.

A total of 50 babies was enrolled in each group. The sample size of 25 babies in each group was calculated from the review of literature, keeping a power of 80% and an alpha error of 5%. After informed parental consent, infants were randomly assigned to two groups: Group-A control and Group-B prophylactic phototherapy. Phototherapy was administered by standard phototherapy units (Ideal phototherapy units, Nakamura Medical Industry, Japan) using standard procedures. It was started from the time of admission in Group-B, while for Group-A, it was as per the standard protocol of the neonatal ward (phototherapy at S. Bilirubin of 1% of body weight in grams and exchange transfusion at ′that value plus 5′[3]). The criteria to omit phototherapy and to initiate exchange transfusion were same for both the groups. S. Bilirubin was assessed by Capillary method (Ideal bilirubin analyzer A-7001, Nakamura Medical Iindustry) twice a day throughout the study period.

Outcome variables

1. Peak S. Bilirubin levels (primary outcome variable).
2. Age at which peak S. Bilirubin levels were reached (secondary outcome variable)
3. Number of exchange transfusions (secondary outcome variable)

The babies of both the groups were similar with respect to birth weight, gestation, mode of delivery, APGAR scores. Of the two groups, 6 babies from group A and 5 babies from group B expired; they were excluded from the study. (Deaths were due to sepsis or hyaline membrane disease. None of the deaths were related to complications of hyperbilirubinemia or exchange transfusions.) The data was analyzed for 19 babies from Group A and 20 babies from Group B.

Phototherapy was introduced significantly early in the study Group [Table 1]. As was expected from the study protocol, phototherapy was started in the study group at significantly lesser S. Bilirubin levels than the control Group [Table 1]. But in spite of phototherapy being introduced significantly early in the study group, there was no significant difference in the age at which peak S. Bilirubin levels were reached in either Group [Table 1].

The efficacy of prophylactic phototherapy was discredited by Curtis et al[2] about 20 years ago, and but even now, most of the pediatricians are actually practicing this therapy.[4] Various researchers have proposed theories to explain this failure of prophylactic phototherapy, while therapeutic phototherapy has been most successful. Kl Tan and FF Rubaltelli[5] have demonstrated that the effect of phototherapy depends on the S. Bilirubin concentration and that it is only efficacious at S. Bilirubin of> 5 mg/dl, while GG Ballowitz[6] has also shown that in Gunn rats the efficacy of phototherapy is directly proportional to the S. Bilirubin concentration.

Our findings also prove that the use of prophylactic phototherapy in preterm babies is unnecessary and is of no benefit.

References

Copyright 2006 - Indian Journal of Medical Sciences

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