Byline: Sasi. Gottimukkala, Giridhar. Sethuraman, Srinivasan. Kitchanan, Surajit. Pathak
Background & objectives: Phototherapy (PT) has become the standard of care for treating neonatal jaundice. This study was aimed to find out if intermittent PT (IPT) results in comparable rate of fall of bilirubin level to continuous PT (CPT) and results in lesser side effects and better acceptance. Methods: In this non-inferiority trial, 174 neonates [greater-than or equal to]35 wk gestation and >2000 g with jaundice requiring PT were randomized to receive either IPT (one hour on and two hours off) or CPT (with minimum interruptions for feeding) after device stratification [light-emitting diode (LED) or compact fluorescent light (CFL)]. Bilirubin was checked 12th hourly, and calcium, vitamin D and nitric oxide (NO) levels were analyzed along with the clinical side effects and nursing and maternal satisfaction scores (CTRI Registration No. CTRI/2018/01/011072). Results: The rate of fall of bilirubin was similar in both the CPT and IPT groups [0.16 (0.10, 0.22) vs. 0.13 (0.09, 0.20) mg/dl/h, P=0.22]. The median difference with 95 per cent confidence interval of 0.03 (0.03, 0.03) mg/dl was also within the pre-defined inferiority limits. There was no significant change in the duration of PT and side effects such as fall in calcium levels, rise in vitamin D and NO levels or the clinical side effects. Maternal satisfaction favoured the IPT group, but the nurses opined that IPT was difficult to implement. Subgroup analysis for PT devices used showed that efficacy of both CFL and LED devices was equivalent. Interpretation & conclusions: IPT was non-inferior to CPT in reducing bilirubin levels in [greater-than or equal to]35 wk neonates, irrespective of device used, and also mothers reported better satisfaction with IPT. Although IPT appears promising, CPT does not increase clinical and biochemical side effects compared to IPT.
Neonatal hyperbilirubinaemia is a common newborn condition, which, if not identified and treated early, may result in neurological complications. Phototherapy (PT) is the current standard of care for treating neonatal jaundice. To increase effectiveness, continuous PT (CPT) is recommended which involves maintaining the jaundiced neonate under PT virtually all the time with only minimal interruptions ( e.g., during feeding or cleaning). However, this often results in interference with mother-infant bonding and it impedes breastfeeding,. PT exposure is also known to cause a few side effects, mainly due to the duration of PT exposure. Notable among these are body temperature changes, skin rash, diarrhoea, fall in calcium levels, opening up of patent ductus arteriosus, especially in preterm infants, and other haemodynamic changes mainly due to increase in nitric oxide (NO) levels,,. PT may increase plasma levels of vitamin D,.
Photodegradation of bilirubin is a two-step phenomenon, where the first step is the rapid photochemical reaction at the skin level, followed by the slow migration of unbound bilirubin from the blood into the skin for ongoing photodegradation over a period of 1-3 h,. Interruptions in PT during this period potentially cause little alterations in bilirubin levels and also allow for migration of bilirubin to proceed...