Can exchange transfusion be replaced by double-LED phototherapy?

Phototherapy is a conventional treatment for neonatal jaundice and widely considered as a safe procedure. Recent developments in light-emitting diode (LED) phototherapy devices have made more effective treatments possible. Exchange transfusion (ET) is typically applied for cases of refractory severe hyperbilirubinemia despite its risk of various complications. Since the therapeutic effect of phototherapy is correlated with its irradiance, ET may be avoided by performing phototherapy with higher irradiation. Recently, we adopted double-LED phototherapy as a bridging treatment to ET to treat a case of severe hyperbilirubinemia. In this case, the continual increase of bilirubin levels was suppressed immediately after its administration, and ET was not required. Throughout the treatment, no complications or increase in oxidative stress was observed. In addition, neurodevelopment was appropriate for the patient's age at the 1-year follow-up, and no findings of kernicterus, including physical and magnetic resonance imaging findings, were observed. We hypothesized that double-LED phototherapy may be a good treatment strategy to replace ET for infants with severe hyperbilirubinemia; however, further investigations regarding safety issues including acute and long-term complications are needed before clinical adaptation.

Bilirubin/albumin (B/A) ratios correlate with unbound bilirubin levels in preterm infants.

BACKGROUND: A strong correlation between the bilirubin/albumin (B/A) ratio and unbound bilirubin (UB) levels in newborns ≥35 weeks of gestation has been reported. However, in preterm infants, the usefulness of B/A ratios remains unclear. METHODS: We obtained serum from 381 newborns <35 weeks of gestation. UB levels were measured using the glucose oxidase-peroxidase method. Total serum bilirubin (TB) and albumin (Alb) concentrations were measured spectrophotometrically. Samples were then stratified into two groups based on the infant's phototherapy use. B/A ratios were calculated and correlated with UB levels. Samples taken from infants prior to or never receiving phototherapy (No PTx) were then stratified by gestational age (GA) epochs: 22-27, 28-29, 30-31, and 32-34 weeks and B/A ratios correlated with UB levels. RESULTS: B/A ratios significantly correlated with UB levels in samples from the No PTx cohort (n = 1250; y = 1.83x - 0.15, r2 = 0.93) when compared with samples from infants post-phototherapy (Post-PTx, n = 2039; y = 1.05x + 0.09, r2 = 0.69). Even when stratified by GA, the correlation remained. CONCLUSIONS: In preterm infants <35 weeks of gestation, B/A ratios correlated with UB levels better in infants prior to or never receiving phototherapy than in those infants receiving phototherapy. IMPACT: The bilirubin/albumin (B/A) ratio significantly correlates with unbound bilirubin (UB) levels in preterm infants <35 weeks of gestation. The B/A ratio can be used as an index of UB levels in preterm infants <35 weeks of gestation. The B/A ratio is useful, especially when UB measurements are not available, for managing hyperbilirubinemia in preterm infants.

Hyperbilirubinemia in Term Newborns Needing Phototherapy within 48 Hours after Birth in a Japanese Birth Center.

BACKGROUND: Hyperbilirubinemia in term newborns needing phototherapy within 48 hours after birth, early-onset hyperbilirubinemia, has not been evaluated in recent Japanese healthy birth centers. In this study, we sought to determine the cause of early-onset hyperbilirubinemia in a Japanese healthy birth center and to evaluate the 1992 Kobe University phototherapy treatment criterion requiring total serum bilirubin (TSB) and unbound bilirubin (UB). METHODS: In this retrospective observational study, we collected data on newborns diagnosed with early-onset hyperbilirubinemia between 2009 and 2016 at the Chibune General Hospital. Causes of the disease were investigated, as well as which index (TSB or UB) was used for treatment decisions. RESULTS: Overall, 76 term newborns were included in the analysis. Twenty-seven newborns (36%) found the cause (ABO blood type incompatibility [n=17, 22%], polycythemia [n=8, 11%], and cephalohematoma [n=2, 3%]). However, 49 newborns (64%) did not find any causes (i.e., idiopathic hyperbilirubinemia). Of these, 27 observed more than 5% weight loss from birth weight. Seventy (92%) newborns had abnormal TSB only, and 5 (7%) had abnormal TSB and UB values. Only 1 (1%) newborn with only abnormal UB values received phototherapy. CONCLUSIONS: Altogether, data from this Japanese healthy birth center suggest that many apparently healthy newborns with or without excessive weight loss develop early-onset hyperbilirubinemia. In the 1992 Kobe University phototherapy treatment criterion, TSB, not UB, was the main index used to make treatment decisions in these patients.

Novel treatment strategy for Japanese newborns with high serum unbound bilirubin.

BACKGROUND: Serum unbound bilirubin (UB) is a measure of bilirubin not bound to albumin, and has been reported to be better than total bilirubin level at identifying infants at risk of developing bilirubin-induced neurotoxicity, including auditory abnormalities. A detailed treatment strategy for newborns with high serum UB has not been established. The aim of this study was to assess auditory outcomes in newborns with serum UB ≥1.00 µg/dL who were treated according to a novel treatment protocol. METHODS: A prospective clinical study was conducted in newborns weighing >1500 g with serum UB ≥1.00 µg/dL who were admitted to Kobe University Hospital and Kakogawa Municipal Hospital, Japan from 2006 to 2011. Enrolled newborns were treated as follows: (i) if serum UB was 1.00-1.50 µg/dL, phototherapy and infusion were given with or without albumin or immunoglobulin therapy; and (ii) if serum UB was >1.50 µg/dL, exchange transfusion was performed immediately. Auditory brainstem responses were evaluated at the time of discharge. RESULTS: A total of 89 Japanese newborns with UB ≥1.00 µg/dL were enrolled at a median age of 4 days. Of these, 85 had UB 1.00-1.50 µg/dL and four had UB >1.50 µg/dL. After being treated according to the protocol, no newborns were diagnosed with auditory brainstem response abnormalities. CONCLUSIONS: The present treatment protocol for Japanese newborns with serum UB ≥1.00 µg/dL may be useful for the prevention of bilirubin-induced auditory abnormalities.