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Randomized trial of prophylactic phototherapy in the infant with very low birth weight
Insights
Prophylactic phototherapy for preterm infants did not alter the clinical course of hyperbilirubinemia compared to routine treatment. Starting phototherapy early did not significantly change peak bilirubin levels or their rate of rise in very low birth weight infants.
Area of Science:
- Neonatal care
- Pediatric gastroenterology
- Bilirubin metabolism
Background:
- Hyperbilirubinemia is common in preterm infants.
- The optimal timing for initiating phototherapy in very low birth weight infants remains debated.
- Early phototherapy may prevent severe hyperbilirubinemia but could prolong treatment duration.
Purpose of the Study:
- To compare the clinical course of hyperbilirubinemia in very low birth weight preterm infants receiving prophylactic phototherapy versus routine phototherapy.
- To assess the impact of early versus delayed phototherapy initiation on bilirubin levels and photo-isomer formation.
Main Methods:
- Randomized controlled trial involving 22 preterm infants (birth weight 850 +/- 220 gm).
- Infants were assigned to either prophylactic phototherapy (initiated soon after birth) or routine phototherapy (initiated when serum bilirubin reached 5 mg/dl).
- Serum bilirubin concentrations, peak levels, age at peak, and photo-isomer levels were monitored.
Main Results:
- Prophylactic phototherapy group received treatment earlier and at lower bilirubin levels (P < 0.001).
- No significant differences were observed in peak serum bilirubin, age at peak, or rate of bilirubin rise between groups.
- Infants in the prophylactic group were treated for a longer duration (P < 0.05).
- Significant increases in configurational and structural photo-isomers were noted post-phototherapy in all infants.
Conclusions:
- Prophylactic phototherapy does not alter the clinical course of hyperbilirubinemia in very low birth weight infants compared to initiating treatment at a serum bilirubin concentration of 5 mg/dl.
- Early phototherapy initiation leads to longer treatment duration without significant clinical benefits regarding bilirubin levels.
- Phototherapy induces photo-isomer formation regardless of treatment timing or serum bilirubin concentration.
Abstract:
Twenty-two preterm infants (birth weight 850 +/- 220 gm) were randomly assigned to receive phototherapy either soon after birth or after the serum bilirubin concentration reached 5 mg/dl. Infants receiving prophylactic phototherapy were placed under lights at a significantly earlier age and lower serum bilirubin concentration than infants in the routine group (P less than 0.001). There was no significant difference between groups in peak serum bilirubin concentration, age at which it peaked, rate of rise in serum bilirubin concentration, or serum bilirubin concentration at any time during the study. Infants assigned to the prophylactic phototherapy group were under lights for a significantly longer time than those in the routine group (P less than 0.05). There was a significant rise in both configurational and structural photo-isomers (P less than 0.005) independent of serum bilirubin concentration after phototherapy in all patients. These data suggest that the clinical course of hyperbilirubinemia is not altered in infants with very low birth weight receiving prophylactic phototherapy compared with infants with phototherapy begun at a bilirubin concentration of 5 mg/dl.