Page 155 - 16Neonatal Jaundice_compressed

Neonatal jaundice

Univariate analysis indicated that the number of naevi > 2 mm was higher in the exposed
group (3.5 ± 3.05 for exposed children versus 1.45 ± 1.99 for unexposed children). After
stratification for classic clinical risk factors (age, skin types I and II, medium coloured or light
skin, fair hair and light eye colour), the association between phototherapy exposure and naevus
size 2 mm or larger was statistically significant (P = 0.003). [EL 2−]
Trans-epidermal water loss
A case–control study from Thailand 185 examined trans-epidermal water loss (TEWL) during
phototherapy in term babies. A group of 40 babies with non-haemolytic hyperbilirubinaemia
was compared with 40 healthy controls. The mean gestational age was 39.0 ± 1.2 weeks and
the mean birthweight was 3166 ± 435 g. The mean serum bilirubin of the babies receiving
phototherapy was 248 ± 15 micromol/litre. In all, 44 (55%) of the sample were male. Babies
received conventional phototherapy in an open crib. TEWL increased by 16.7% after 6 hours of
phototherapy. This was statistically significantly higher than the rate of loss in control babies not
requiring phototherapy. [EL 2−]

Another case series, from Israel, 186 examined TEWL during phototherapy in preterm babies. The
study included 31 babies, of whom 15 (48%) were males, with a mean gestational age of
31.2 weeks and a mean birthweight of 1447 g. Babies with respiratory distress, sepsis and those
requiring ventilatory support were excluded. Babies were nursed naked except for eye patches
in incubators and received conventional phototherapy (Air-Shields Micro-Lite). The mean
increase in TEWL was 26.4%. [EL 3]
A second case series, from the Netherlands, 187 examined TEWL in preterm babies during
phototherapy with halogen lamps. This study included 18 babies with a mean gestational age of
30.6 ± 1.6 weeks and a mean birthweight of 1412 ± 256 g who received phototherapy for non-
haemolytic hyperbilirubinaemia. Babies with metabolic disorders and serious skin lesions were
excluded. Phototherapy was applied using a single-quartz lamp (Ohmeda Bililight) positioned
55 cm above the baby with an irradiance of 12.5 microwatt/cm² per nm. There was an increase
of 21.3% in TEWL after 1 hour of phototherapy with halogen lamps. [EL 3]
An RCT in Thailand 188 evaluated the effect of application of a clear topical ointment on TEWL in
preterm babies receiving phototherapy. In this study, 40 babies (22 (55%) were male) with a
mean gestational age of 33.1 ± 2.6 weeks, a mean birthweight of 1443 ± 196 g and a mean
serum bilirubin of 171 ± 39 micromol/litre were randomised to receive phototherapy and
topical ointment or phototherapy alone. The ointment was a 1 : 1 mixture of Vaseline® and
liquid paraffin. After 5 hours, mean TEWL decreased by 13.8% in the group that received
ointment but increased by 14.1 % in the control group. There was no statistically significant
difference between the groups in pre- and post-phototherapy serum bilirubin levels. [EL 1−]
Heart-rate variability
A controlled before and after study from Israel 189 examined the effects of phototherapy on
cardiovascular function. Thirty term babies with Apgar score > 7 at 1 minute and > 8 at
5 minutes who required phototherapy for jaundice were included. Babies with haemolysis,
G6PD deficiency, fever, maternal use of narcotic analgesics during labour or ruptured
membranes > 18 hours were excluded. The mean gestational age was 39.1 ± 1.5 weeks and
the mean birthweight was 3116 ± 392 g. The mean age at entry to study was 53 ± 31 hours and
the mean serum bilirubin was 238 ± 43 micromol/litre. Sixteen participants (53%) were male.
While there were no statistically significant changes in heart rate during phototherapy,
significant changes in heart-rate variability were observed. Mean SD1 measurements before and
during phototherapy were 12 ± 8 ms and 8 ± 4 ms, respectively (P < 0.02); mean SD2
measurements were 33 ± 16 ms and 22 ± 10 ms, respectively (P < 0.01); mean SDDN
measurements were 30 ± 14 ms and 18 ± 7 ms, respectively (P < 0.01), and mean RMSSD
measurements were 18 ± 12 ms and 11 ± 6 ms, respectively (P < 0.02). [EL 3]
Vasodilator effects
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An RCT carried out in Turkey compared close phototherapy (15 cm above the baby) and remote
phototherapy (30–45 cm above the baby) in 61 term and 37 preterm babies. The mean gestational
age of the term babies was 38.7 ± 1.2 weeks and the mean birthweight was 3361 ± 449 g while
for preterm babies the mean gestational age and mean birthweight were 33.5 ± 2.8 weeks and

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