Author : K. Ali, Ziad
Double-surface intensive phototherapy versus single-surface conventional phototherapy in treatment of neonatal hyperbilirubinemia
Annals of the College of Medicine, Mosul,
Volume 39, Issue 1, Pages 25-31
Objective: To compare the efficacy of double-surface intensive phototherapy (DSIPT) and single-surface conventional phototherapy (SSCPT) in treatment of neonatal jaundice.
Patients and methods: This is a case control study conducted in Ibn Al Atheer Pediatric Hospital (Mosul) included 110 jaundiced neonates subjected to the newly used (DSIPT) during the period between 1st of Jan. 2011 to 30th of June 2011 compared to142 jaundiced neonates underwent phototherapy using SSCPT during the period between1st of July 2010 to 31st of December 2010. Patients with acute bilirubin encephalopathy, sepsis, meningitis and asphyxia were excluded from this study as well as those aged > 1 week. The medical files data of included infants were analyzed regarding their gestational age, body weight, sex, age, type of feeding and total serum bilirubin level (TSB) at initiation of phototherapy. Levels of TSB at intervals of approximately 6 hours during the first 24 hours of treatment, the need of exchange transfusion and duration of hospitalization were registered.
Results: Demographic characteristics apart from gestational age were similar in both groups. The initial mean serum bilirubin level had no statistically significant difference between DSIPT and the SSCPT group. DSIPT group had significantly greater TSB decline rates than SSCPT in term and preterm infants with hyperbilirubinemia. The mean percentages of TSB decline per hour was significantly higher within 6, 12, and 24 hours after starting DSIPT compared to SSCPT type. The mean percentages of TSB decline of DSIPT group within the second 12 hours after phototherapy was significantly higher and more than double the value of SSCPT type (43.45 ± 14.83 vs. 17.03 ± 14.22, p<0.001). Duration of hospitalization was significantly shorter in DSIPT subjected infants. At initial TSB level between 20- 25 mg/dl exchange transfusion was avoidable among intensively treated patients whereas it was inevitable in 86.36 % of patients in the SSCPT group. At TSB on exchange line 91.56% of infants received SSCPT type required an exchange transfusion whereas such intervention was eliminated in patients treated by DSIPT.
Conclusions: DSIPT was significantly more effective than SSCPT in treatment of neonatal hyperbilirubinemia. When initial TSB level is on and below exchange line on nomogram, exchange transfusion can be avoided with the use of DSIPT.