Clinical Features and Factors Associated with the Frequency of Phototherapy in Premature Birth Gestation < 35 Weeks and Birth Weight ≤2,500 g

Article information

Kosin Med J. 2012;27(2):133-139

Publication date (electronic) : 2012 December 27

doi : https://doi.org/10.7180/kmj.2012.27.2.133

So Yoon Choi ¹, Ho Yeon Hwang ¹, Yoo Rha Hong ¹, Yu Jin Jung ²

¹Department of Pediatrics, College of Medicine, Kosin University, Gospel Hospital, Busan, Korea.

²Department of Pediatrics, College of Medicine, Inje University, Haeundae Paik Hospital, Busan, Korea.

Corresponding Author: Yu Jin Jung, Department of Pediatrics, College of Medicien, Inje University, Haeundae Paik Hospital, 1435, Jwa-dong, Haeundae-gu, Busan, 612-030, Korea. TEL: +82-51-797-2000, FAX: +82-51-797-2668, hasaohjung@hanmail.net

Received 2012 August 07; Revised 2012 October 22; Accepted 2012 October 25.

Abstract

Objectives

Clinical features according to the frequency of phototherapy and clinical risk factors on the number of phototherapy were investigated in premature births with gestation <35 weeks and birth weight ≤2,500 g.

Methods

The 186 infants with gestation <35 weeks and birth weight ≤2,500 g were admitted to the neonatal intensive care unit of Kosin University Gospel Hospital from March 2009 to August 2010. The 171 infants were alive and had jaundice requiring phototherapy. Phototherapy was usually started to 50-70% of the maximal bilirubin level. They were divided into two groups according to the frequency of phototherapy as single phototherapy group (group I) and multiple phototherapy group (group II). We retrospectively reviewed the medical records of all patients.

Results

The mean gestational age and birth weight of group I were 31.0±2.9 weeks and 1,596±485 g and those of group II were 31.1±2.6 weeks and 1,592±430 g. Compared with group I, albumin and Apgar score at 1 minute of group II were significantly higher and the day of peak bilirubin was also late. Duration of phototherapy in group II was statistically longer than that group I but duration of ventilator and aminophylline use for apnea was significantly shorter. The frequency of antibiotic use, incidence of bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) of group II were significantly lower than those of group I.

Conclusions

The day of peak bilirubin was late and the frequency of antibiotic use, incidence of BPD, and IVH were low in group II. The aggressive phototherapy may be considered in premature births with jaundice.

Keywords: Jaundice; Phototherapy; Premature birth

References

1. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004. 114297–316.

2. Kliegman RM. In : Kliegman RM, Stanton RM, St. Geme JW, Schor NF, Behrman RE, eds. Jaundice and hyperbilirubinemia in the newborn. Nelson Textbook of Pediatrics 2011. 19th edth ed. Philadelphia: WB Saunders Co; 603–608.

3. de Almeida MF. When should we start phototherapy in preterm newborn infant? J Pediatr (Rio J) 2004. 80256–258.

4. Benders MJ, van Bel F, van de Bor M. The effect of phototherapy on renal blood flow velocity in preterm infants. Biol Neonate 1998. 73228–234.

5. Mesner O, Miller MJ, Iben SC, Prabha KC, Mayer CA, Haxhiu MA, et al. Hyperbilirubinemia diminishes respiratory drive in a rat pup model. Pediatr Res 2008. 64270–274.

6. Choi CW, Min KW, Kim MN, Hwang JH, Shim JW, Koh SY, et al. Bilirubin cytotoxicity in primary mouse cerebral cortical cell culture. J Korean Soc Neonatol 2003. 10241–247.

7. Choi CW, Hwang JH, Kang S, Shim JW, Chung SH, Koh SY, et al. Effect of hyperbilirubinemia on the brainstem auditory evoked response in newborn piglets. J Korean Soc Neonatol 2003. 10248–253.

8. O'Shea TM, Dillard RG, Klinepeter KL, Goldstein DJ. Serum bilirubin levels, intracranial hemorrhage, and the risk of developmental problems in very low birth weight neonates. Pediatrics 1992. 90888–892.

9. Maisels MJ. Phototherapy--traditional and nontraditional. J Perinatol 2001. 21Suppl 1. S93. S97. discussion S104-7.

10. Maisels MJ, Watchko JF. Treatment of jaundice in low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2003. 88F459–F463.

11. DeJonge MH, Khuntia A, Maisels MJ, Bandagi A. Bilirubin levels and severe retinopathy of prematurity in 23-26 week estimated gestational age infants. J Pediatr 1999. 135102–104.

12. McDonagh AF. Is bilirubin good for you? Clin Perinatol 1990. 17359–369.

13. Dani C, Martelli E, Bertini G, Pezzati M, Filippi L, Rossetti M, et al. Plasma bilirubin level and oxidative stress in preterm infants. Arch Dis Child Fetal Neonatal Ed 2003. 88F119–F123.

14. Hegyi T, Goldie E, Hiatt M. The protective role of bilirubin in oxygen-radical diseases of the preterm infant. J Perinatol 1994. 14296–300.

15. Gopinathan V, Miller NJ, Milner AD, Rice-Evans CA. Bilirubin and ascorbate antioxidant activity in neonatal plasma. FEBS Lett 1994. 349197–200.

16. Rosenfeld W, Sadhev S, Brunot V, Jhaveri R, Zabaleta I, Evans HE. Phototherapy effect of the incidence of patent ductus arteriosus in premature infants: prevention with chest shielding. Pediatrics 1986. 7810–14.

17. Barefield ES, Dwyer MD, Cassady G. Association of patent ductus arteriosus and phototherapy in infants weighing less than 1000 grams. J Perinatol 1993. 13376–380.

Article information Continued

Fig. 1

Summary of preterm infants by the frequency of phototherapy

Abbreviations: GA, Gestational age; BW, Birth weight; PT, Phototherapy

Table 1

Demographic factors of preterm infants by the frequency of phototherapy (mean±SD)

Abbreviations: PROM, premature rupture of membranes; GDM, gestational diabetes mellitus; PIH, pregnancy induced hypertension.

Table 2

Clinical features of preterm infants by the frequency of phototherapy (mean±SD)

Abbreviations: PT, Phototherapy; AMP, aminophylline; TPN, total parenteral nutrition.

Table 3

Outcomes of preterm infants by the frequency of phototherapy

Abbreviations: RDS, respiratory distress syndrome; PDA, patent ductus arteriosus; ROP, retinopathy of prematurity; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia.

Table 4

Logistic regression results of outcomes