PEDIATRICS Vol. 65 No. 4 April 1980, pp. 740-750
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New Concepts in Phototherapy: Photoisomerization of Bilirubin IXagr and Potential Toxic Effects of Light

Arnold N. Cohen MD1 and J. Donald Ostrow MD1

1 Gastroenterology Section, Department of Medicine, Veterans Administration Lakeside Medical Center, and Northwestern University Medical School, Chicago

New information is summarized, indicating that configurational photoisomerization of bilirubin at the 5 and 15 carbon bridges is the major mechanism of bilirubin photocatabolism in vivo, and that singlet oxygen photooxidation plays only a minor role. The literature is reviewed concerning potentially damaging photodynamic reactions that are observed in vitro with vitamins, proteins, lipids, and nucleic acids, and their possible relationship to the limited number of toxic side-effects that have been detected with clinical phototherapy of neonatal jaundice. Secondary toxic effects, mediated by bilirubin photoderivatives or by retina-neuroendocrine pathways are also considered. Areas requiring further investigation are delineated.

Submitted on September 10, 1979
Accepted on September 10, 1979




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