PEDIATRICS Vol. 99 No. 5 May 1997, pp. e13 (doi:10.1542/peds.99.5.e13)
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PEDIATRICS Vol. 99 No. 5 May 1997, p. e13
Copyright ©1997 by the American Academy of Pediatrics

ELECTRONIC ARTICLE:
Efficacy of Bidirectional Fiber-optic Phototherapy for Neonatal Hyperbilirubinemia

Received Sep 5, 1996; accepted Sep 5, 1996.

K. L. Tan

From the Department of Neonatology, National University Hospital, Singapore.

Objective.  To evaluate the efficacy of fiber-optic phototherapy using the standard Ohmeda Biliblanket, a large version, double standard Biliblankets, and conventional phototherapy using daylight fluorescent lamps in full-term, healthy infants with nonhemolytic hyperbilirubinemia.

Methods.  Full-term, healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 µmol/L or 222 µmol/L at <48 hours of age) were allocated randomly to one of four modes of phototherapy: standard fiber-optic mat (Ohmeda Biliblanket), a large version, double standard Biliblankets, and conventional phototherapy. Bilirubin levels were monitored every 12 hours. Exposure was stopped when bilirubin levels were less than 185 µmol/L, the minimum duration being 24 hours.

Results.  A total of 171 infants were studied; 42 were exposed to standard fiber-optic phototherapy, 43 to large fiber-optic phototherapy, 42 to double-fiber-optic phototherapy, and 44 to conventional phototherapy. Durations of exposure were 87.05 ± 6.09 (SEM), 82.57 ± 5.84, 64.85 ± 5.43, and 62.61 ± 3.74 hours, respectively; the 24-hour decline rates were 10.26% ± 1.84%, 14.50% ± 1.53%, 21.82% ± 1.71%, and 19.00% ± 1.65%, respectively; the overall decline rates over the whole exposure period were 0.47% ± 0.03%, 0.52% ± 0.04%, 0.71% ± 0.05%, and 0.75% ± 0.04% per hour, respectively. The efficacy of double-fiber-optic phototherapy and conventional phototherapy was similar and significantly better than that of the large fiber-optic mat and the standard fiber-optic mat in duration, 24-hour decline rate, and overall decline rate. The large mat was slightly better than the standard-size mat with regard to 24-hour decline rate and overall decline rate, but this difference was not significant. Failure of phototherapy occurred only in the large fiber-optic mat group (3 of 43) and the standard fiber-optic mat group (4 of 42); none occurred in the other two groups, but differences not statistically significant. The nursing personnel were more comfortable with single fiber-optic phototherapy, which caused no initial disturbance to the swaddled infants as did conventional phototherapy, but found double-fiber-optic phototherapy difficult to use.

Conclusion.  For efficacy of fiber-optic phototherapy in full-term infants to be comparable to that of our conventional phototherapy, the light dose of the standard mats needs to be doubled. fiber-optic phototherapy, neonatal hyperbilirubinemia, efficacy.




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