Efficacy of Phototherapy in Prevention and Management of Neonatal Hyperbilirubinemia

Abstract

This report concerns the efficacy of phototherapy in preventing hyperbilirubinemia in infants with birth weight less than 2,000 g and in controlling already established hyperbilirubinemia in infants weighing more than 2,000 g in the National Institute of Child Health and Human Development (NICHHD, also called NICHD) phototherapy study initiated in 1974.

The details of the protocol have been reported by Bryla.¹⁸

STUDY POPULATION

The study included 1,339 infants from the six participating institutions: 672 were randomly assigned to the phototherapy group and 667 to the control group. As described previously, these infants were studied according to specific protocols in three birth weight groups.¹⁸

In infants weighing less than 2,000 g at birth (group A), the efficacy of phototherapy begun at 24 ± 12 hours of age in preventing hyperbilirubinemia was examined. In the other two birth weight groups infants with birth weight 2,000 to 2,499 g [group B] and infants with birth weight 2,500 g or more [group C], the effect of phototherapy on already-established hyperbilirubinemia was examined.

MODE OF USE OF PHOTOTHERAPY

Phototherapy using Westinghouse daylight fluorescent bulbs in an Air Shields unit was administered continuously. Duration of phototherapy was 96 hours for all treated infants.

In each study group, an attempt was made to apply phototherapy in a manner that mimicked common usage, except that control subjects were used. Further, because no infant was to be exposed to bilirubin levels considered "unsafe," maximum bilirubin levels were established for each weight group and exchange transfusions were performed in both phototherapy-treated and control infants when these levels were reached.