Page 154 - 16Neonatal Jaundice_compressed

Treatment

Description of included studies
Thirteen studies 177-189 of varying quality (EL 2− to EL 1++) from France, 181;182 Israel, 186;189 the
Netherlands, 187 Sweden, 180 Thailand, 185;188 Turkey 178;179;183 and the USA 177;184 were identified.

Review findings

DNA damage
A non-systematic review of in vivo studies 177 demonstrated that phototherapy had DNA-
modifying properties that could induce genetic and carcinogenic effects. [EL 1+].
A second study from Turkey 178 examined the effects on DNA in 33 term babies who received
phototherapy for jaundice compared with 14 otherwise healthy controls with jaundice who did
not receive phototherapy. There were no significant differences between the groups at entry.
The mean gestational age was 39.3 ± 0.9 weeks, the mean birthweight was 3021 ± 450 g, and
the mean age at entry was 113 ± 46 hours. Twenty-nine (61.7%) of the sample were male.
Phototherapy was applied using a standard Air-Shields unit with four 18 W blue-fluorescent
tubes and two 18 W white fluorescent tubes. The light range was between 480 and 520 nm and
the irradiance was 12 microwatt/cm² per nm. DNA was collected and analysed according to
standard practice. Images of 100 randomly selected cells were analysed visually. Each image
was classified according to the intensity of fluorescence in the comet tail (which is caused if a
damaged cell is exposed to an electric current – the cell fragments get drawn out into a comet
tail) and given a value of 0, 1, 2, 3 or 4 (from undamaged (class 0) to maximally damaged (class
4)) so that the total score of a slide could be between 0 and 400 arbitrary units. The mean DNA
damage scores were statistically significantly different between the groups: 58.4 ± 3.2 for the
phototherapy group and 23.1 ± 4.9 for the control group. [EL 2−]
179
A second study, from Turkey also examined the effects on DNA in 46 term babies who received
phototherapy (23 each received conventional and intensive phototherapy) for jaundice compared
with 19 otherwise healthy controls with jaundice who did not receive phototherapy. The
gestational age ranged from 38 to 41 weeks and age at entry was between 3 and 10 days. No other
demographic details were reported. Phototherapy was applied using a standard BiliCrystal® unit
with either six 20 W white fluorescent tubes placed 45 cm above the baby or, for intensive
phototherapy, twelve 20 W white fluorescent tubes placed 20 cm above the baby. The irradiance
was 12–16 microwatt/cm² per nm for conventional phototherapy and 30–34 microwatt/cm² per nm
for intensive phototherapy. DNA was collected and analysed according to standard practice.
Images of 100 randomly selected cells were analysed visually. Each image was classified using the
same methods as the previous study. The mean DNA damage scores were statistically significantly
different between the groups: 32 ± 9 for the intensive phototherapy group, 28 ± 9 for the
conventional phototherapy group and 21 ± 10 for the control group (P < 0.001). [EL 2−]

Malignant melanoma
A matched case–control study 180 from Sweden retrospectively examined the risk of developing
malignant melanoma after treatment with phototherapy for neonatal jaundice. The hospital
records of 30 adolescents with malignant melanoma were compared with the records of 120
controls matched for date of birth, hospital and gender. No statistically significant risk of
developing childhood malignant melanoma after phototherapy of babies with
hyperbilirubinaemia was found. [EL 2−]
A second study 181 examined data from an RCT of photoprotection educational programmes for
8- to 9-year-old children in France. From a total of 828 children participating, 180 (22%) had
been exposed to neonatal blue light phototherapy. A melanocytic naevus count was conducted
by a nurse who was unaware of the childrens’ history of exposure to phototherapy. Naevus size
on exposed body parts (arms and back) was recorded as < 2 mm, 2–5 mm or > 5 mm.
Children who had received phototherapy showed no statistically significant difference in naevus
counts than those who had not. [EL 1+]

A small case–control study from France 182 assessed the role of blue light phototherapy used to
treat hyperbilirubinaemia on naevus acquisition in children aged 8–9 years. A total of 58
children were included, of whom 18 (31%) had received phototherapy. The children were
examined by a dermatologist and naevus size was recorded as < 2 mm, 2–5 mm or > 5 mm.

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