Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Frequency and duration of phototherapy in preterm infants <35 weeks gestation

Journal of Perinatology volume 38, pages 1246–1251 (2018)Cite this article

Subjects

Abstract

Objective

To evaluate the frequency, age at phototherapy (PT) initiation, and duration of PT use in infants 230/7 to 346/7 weeks of gestation in two neonatal intensive care units (NICUs) over 4 time periods.

Study design

We reviewed the charts of all infants born at 230/7–346/7 weeks of gestational age (GA) and admitted to the NICUs of two hospitals between January 2009 and September 2015. We calculated the proportion of infants who received PT and the total duration of PT exposure.

Results

Overall 2023 (81.8%) received PT, and PT use was inversely related to GA and birthweight. More infants received PT when GA was added as a criterion for initiating PT. The median duration (interquartile range (IQR)) of PT for all infants was 50 (27–85) h and in the lowest GA group was 74 (42–111) h.

Conclusions

Recent US consensus guidelines appear to have led to an increased use of PT in our NICUs and studies from Norway indicate that we use PT considerably more frequently and for longer durations than do our Norwegian colleagues.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Eng J Med. 2008;358:920–8.

    Article  CAS  Google Scholar 

  2. Chang PW,Kuzniewica M,McCulloch C,Newman TB. A clinical prediction rule for rebound hyperbilirubinemia following inpatient phototherapy. Pediatrics. 2017;139:pii: e20162896

    Article  Google Scholar 

  3. Mreihil K, Stensvold HJ, Nakstad B, Hansen TWR. Phototherapy treatment (Px) for Neonatal Jaundice (NJ) in Norwegian NICUs - a prospective national survey. San Diego: E-PAS2015:1579582 2015

  4. Mreihil K, Benth J, Stensvold HJ, Nakstad B, Hansen TWR. Phototherapy is commonly used for neonatal jaundice but greater control is needed to avoid toxicity in the most vulnerable infants. Acta Pediatr. 2018;107:611–9.

    Article  Google Scholar 

  5. Mreihil K,Nakstad B,Stensvold HJ,Benth J,Hansen TWR, Uniform guidelines do not prevent wide variations in the clinical application of phototherapy for neonatal jaundice. Acta Pediatrica. 2018;107:620–7.

    Article  Google Scholar 

  6. Maisels MJ, Watchko JF, Bhutani VK, Stevenson DK. An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation. J Perinatol. 2012;32:660–4.

    Article  PubMed  CAS  Google Scholar 

  7. van Imhoff DE, Hulzebos CV, van der Heide M, van den Belt V, Vreman HJ, Dijk PH, Group BS. High variability and low irradiance of phototherapy devices in Dutch NICUs. Arch Dis Child Fetal Neonatol Ed. 2013;98:F112–16.

    Article  Google Scholar 

  8. Morris BH, Oh W, Tyson JE, Stevenson D, Phelps DL, O’Shea TM, McDavid GE, Perritt RL, Van Meurs KP, Vohr BR, Grisby C, Yao Q, Pedroza C, Das A, Poole WK, Carlo WA, Duara S, Laptook AR, Salhab WA, Shankaran S, Poindexter BB, Fanaroff AA, Walsh MC, Rasmussen MR, Stoll BJ, Cotten CM, Donovan EF, Ehrenkranz RA, Guillet R, Higgins RD. Aggressive vs. conservative phototherapy for infants with extremely low birth weight. New Eng J Med. 2008;359:1885–96.

    Article  PubMed  CAS  Google Scholar 

  9. Bratlid D, Nakstad B, Hansen TWR. National guidelines for treatment of jaundice in the newborn. Acta Paediatr. 2011;100:499–505.

    Article  PubMed  CAS  Google Scholar 

  10. Tatli MM, Minnet C, Kocyigit A, Karadag A. Phototherapy increases DNA damage in lymphocytes of hyperbilirubinemic neonates. Mutat Res. 2008;654:93–5.

    Article  PubMed  CAS  Google Scholar 

  11. Ramy N, Ghany EA, Alsharany W, Nada A, Darwish RK, Rabie WA, Aly H. Jaundice, phototherapy and DNA damage in full term neonates. J Perinatol. 2016;36:132–6.

    Article  PubMed  CAS  Google Scholar 

  12. Aycicek A, Kocyigit A, Erel O, Senturk H. Phototherapy causes DNA damage in peripheral mononuclear leukocytes in term infants. J Pediatr (Rio J). 2008;84:141–6.

    Article  Google Scholar 

  13. Sirota L, Staussberg R, Gurary N, Aloni D, Bessler H. Phototherapy for neonatal hyperbilirubinemia affects cytokine production by peripheral blood mononuclear cells. Eur J Pediatr. 1999;158:910–3.

    Article  PubMed  CAS  Google Scholar 

  14. Kurt A, Aygun AD, Kurt AN, Godekmerdan A, Akarsu S, Yilmaz E. Use of phototherapy for neonatal hyperbilirubinemia affects cytokine production and lymphocyte subsets. Neonatology. 2009;95:262–6.

    Article  PubMed  CAS  Google Scholar 

  15. Aycicek A, Erel O. Total oxidant/antioxidant status in jaundiced newborns before and after phototherapy. J Pediatr (Rio J). 2007;83:319–22.

    Google Scholar 

  16. Vreman HJ, Knauer Y, Wong RJ, Chan M-L, Stevenson DK. Dermal carbon monoxide excretion in neonatal rats during light exposure. Pediatr Res. 2009;66:66–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Stevenson DK, Wong RJ, Arnold CC, Pedroza C, Tyson JE. Phototherapy and the risk of photo-oxidative injury in extremely low birth weight infants. Clin Perinatol. 2016;43:291–5.

    Article  PubMed  Google Scholar 

  18. Lamola AA, Bhutani VK, Wong RJ, Stevenson DK, McDonagh AF. The effect of hematocrit on the efficacy of phototherapy for neonatal jaundice. Pediatr Res. 2013;74:54–60.

    Article  PubMed  CAS  Google Scholar 

  19. Lamola AA. A pharmacologic view of phtotherapy. Clin Perinatol. 2016;43:259–76.

    Article  PubMed  Google Scholar 

  20. Wickremasinghe AC, Kuzniewicz MW, Grimes BA, McCullouch CE, Newman TB. Neonatal phototherapy and infantile cancer. Pediatrics. 2016;127:e20151353.

    Article  Google Scholar 

  21. Podvin D, Kuehn CM, Mueller BA, Williams M. Maternal and birth characteristics in relation to childhood leukaemia. Paediatr Perinat Epidemiol. 2006;20:312–22.

    Article  PubMed  Google Scholar 

  22. Cnattingius S, Zack M, Ekbom A, Gunnarskog J, Linet M, Adami HO. Prenatal and neonatal risk factors for childhood myeloid leukemia. Cancer Epidemiol Biomark Prev. 1995;4:441–5.

    CAS  Google Scholar 

  23. Maimburg RD, Olsens J, Sun Y. Neonatal hyperbilirubinemia and the risk of febrile seizures and childhood epilepsy. Epliepsy Res. 2016;124:67–72.

    Article  CAS  Google Scholar 

  24. Tyson JE, Pedroza C, Langer J, Green C, Morris B, Stevenson D, Van Meurs KP, Oh W, Phelps D, O’Shea M, McDavid GE, Grisby C, Higgins R. Does aggressive phototherapy increase mortality while decreasing profound impairment among the smallest and sickest newborns? J Perinatol. 2012;32:677–84.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Hansen TWR. Let there be light - but should there be less? J Perinatol. 2012;32:649–51.

    Article  PubMed  CAS  Google Scholar 

  26. Arnold CC, Tyson AG, Dempsey AM, Khan AM, Pedroza C. Cycled phototherapy is a safe and effective treatment for small premature infants with hyperbilirubinemia. 2017. E-PAS2017:2668915.3315

  27. Valaes T, Petmezaki S, Henschke C, Drummond GS, Kappas A. Control of jaundice in preterm newborns by an inhibitor of bilirubin production: studies with tin-mesoporphyrin. Pediatrics. 1994;93:1–11.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Beaumont Children’s Hospital and Department of Pediatrics, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA

    Devashis Mukherjee & M. Jeffrey Maisels

  2. Research Institute, Biostatistics, Beaumont Health, Royal Oak, MI, USA

    Mary Coffey

Authors
  1. Devashis Mukherjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mary Coffey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Jeffrey Maisels
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Jeffrey Maisels.

Ethics declarations

Conflict of interest

MJM is a consultant to Mallinckrodt Pharmaceuticals, the current marketer of tin-mesoporphyrin (Stannate), a drug that has been used in the treatment and prevention of hyperbilirubinemia but is currently not approved by the FDA. D.M. and M.C. declare that they have no conflict of interest.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mukherjee, D., Coffey, M. & Maisels, M.J. Frequency and duration of phototherapy in preterm infants <35 weeks gestation. J Perinatol 38, 1246–1251 (2018). https://doi.org/10.1038/s41372-018-0153-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-018-0153-4

This article is cited by

Search

Advanced search

Quick links