Page 156 - 16Neonatal Jaundice_compressed

Treatment

2088 ± 604 g, respectively. No statistically significant differences were found in body temperature,
heart rate and blood pressure, serum nitric oxide (NO) levels, or vascular endothelial growth factor
(VEGF) levels in babies receiving close or distant phototherapy. [EL 1−]
Patent ductus arteriosus
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An RCT from the USA evaluated the use of foil shields placed over the chest of preterm babies
(n = 74) receiving phototherapy to prevent patent ductus arteriosus. The mean gestational age of the
population was 29.3 weeks and the mean birthweight was 1035 g. The mean duration of
phototherapy was 8.3 days for the shield group and 8.5 days for the no shield group. Use of the foil
shield was associated with a statistically significantly lower frequency of patent ductus arteriosus
(P < 0.009) but with a non-statistically significant trend to increased later mortality (up to
167 days), with ten versus four deaths (P = 0.056). The majority of deaths were due to complication
of preterm birth or sepsis and were not related to the course of therapy in the first 4 weeks. [EL 1+]

Evidence summary
Studies of mixed quality reported that TEWL increased significantly (by up to 25%) in babies
receiving conventional phototherapy. An RCT [EL 1−] of close and distant phototherapy found no
statistically significant differences in clinical variables, including body temperature, heart rate and
blood pressure, during phototherapy. Three studies, one EL 1+ and two EL 2−, examined the
association between history of exposure to phototherapy and later naevus acquisition in primary-
school children. No statistically significant association was identified. One small study reported a
statistically significant link after stratification for risk factors. One study reported that phototherapy
was associated with DNA damage. However, there is no evidence that this effect on DNA at a
microscopic level can lead to long-term adverse effects in phototherapy-treated babies.

GDG translation from evidence
Good clinical practice should ensure that babies are kept hydrated while undergoing phototherapy.
Hydration can be assessed by changes in body weight, and observation of wet and dirty nappies.
The evidence suggests that neither fluorescent nor LED lights contribute significantly to increased
TEWL, whereas halogen lights do increase such water losses. Conventional phototherapy should be
interrupted to facilitate breastfeeding, and mothers should be offered lactation support.
Breastfeeding mothers should be taught how to express their milk if their baby needs additional
fluids, and encouraged to express frequently if their baby requires continuous phototherapy.

When multiple phototherapy is required, phototherapy should be continuous. Most babies
requiring continuous phototherapy can continue to receive milk feeds. Long-term concerns
about adverse effects of phototherapy, serve as a reminder that phototherapy is a powerful tool
and should not be used without specific indications.
No evidence was found to suggest that preterm babies or other vulnerable groups of babies are
at increased risk of adverse effects from phototherapy.

Recommendations – 7.2.3 Feeding and hydration during phototherapy

During conventional ‘blue light’ phototherapy:
• using clinical judgement, encourage short breaks (of up to 30 minutes) for breastfeeding,
nappy changing and cuddles
• continue lactation/feeding support
• do not give additional fluids or feeds routinely.
Maternal expressed milk is the additional feed of choice if available, and when additional
feeds are indicated
During multiple phototherapy:
• do not interrupt phototherapy for feeding but continue administering intravenous/enteral feeds
• continue lactation/feeding support so that breastfeeding can start again when treatment stops.
Maternal expressed milk is the additional feed of choice if available, and when additional
feeds are indicated

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