Comparison of Two Phototherapy Methods (Prophylactic vs Therapeutic) for Management of Hyperbilirubinemia in Very Low Birth Weight Newborns|
Iranpour, Ramin; Mohammadizadeh, Majid & Nazem-Sadati, Seyedeh-Sarah
Objective: Preterm and low birth weight (LBW) infants are at greater risk of developing bilirubinassociated
brain damage compared with term infants. Certainly, phototherapy, if used appropriately,
is capable of controlling the bilirubin levels in LBW infants; but there is not a unique phototherapy
treatment strategy in LBW infants. This study was designed to compare the prophylactic
phototherapy and late treatment of jaundiced newborns weighing 1000-1500 grams.
Methods: Sixty newborns with birth weight 1000–1500 g were studied. They were divided into two
groups: the "Prophylactic" group, in which phototherapy started within six hours after birth and
continued for at least 96 hours, and the "Treatment" group, which received phototherapy when
indicated according to birth weight and suspended when bilirubin level fell below 50% of bilirubin
level for blood exchange. Mean value of daily transcutaneous bilirubin (TCB), duration of
phototherapy, the need for blood exchange, and the highest TCB value in both groups were analyzed.
Findings: In the prophylactic group, the highest daily mean rate of TCB was 7.71±1.84 mg/dl, which
happened on the third day. In the treatment group, it was 8.74±1.72 mg/dl on the fourth day after
birth. The TCB values in prophylactic group were significantly less than those of the treatment group
only on the fourth and fifth days after birth (P<0.001). Although the median duration of phototherapy
in the treatment group was shorter than that of the prophylactic group (137.60±57.39 vs
168.71±88.01 hours, respectively), this difference was not statistically significant. Only one neonate
needed blood exchange in the treatment group.
Conclusion: The prophylactic phototherapy treatment for babies weighing 1000–1500 g significantly
decreases bilirubin levels on the fourth and fifth days after birth but the clinical course of
hyperbilirubinemia does not alter in LBW infant, as indicated by the non-significant change in the
duration of phototherapy.
Phototherapy; Neonatal jaundice; Preterm Neonate; VLBW infant