Neonatal phototherapy and risk of epilepsy-A Danish population based study.

To evaluate the risk of epilepsy in children who received neonatal phototherapy. A cohort of live singletons born at a Danish hospital (2002-2016) with a gestational age ≥ 35 weeks. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of epilepsy in children treated with neonatal phototherapy compared to children not treated with neonatal phototherapy in the general population, and in a subpopulation of children who had serum bilirubin measurement. Adjusted HRs (aHR) were computed using multivariable and propensity score matching models to take maternal and neonatal factors into consideration. Children were followed from day 29 after birth to diagnosis of epilepsy, death, emigration, or December 31, 2016. Among 65,365 children, 958 (1.5%) received neonatal phototherapy. Seven children (incidence rates (IRs): 10.8 /10,000 person-years) who received neonatal phototherapy and 354 children (IR: 7.7) who did not receive neonatal phototherapy were diagnosed with epilepsy. Neonatal phototherapy was not associated with an increased risk of epilepsy using the multivariable (aHR 0.95, 95% CI: 0.43-2.09) and propensity score matched (aHR 0.94, 95% CI: 0.39-2.28) models. In the subpopulation of 9,378 children with bilirubin measurement, 928 (9.9%) received neonatal phototherapy. In the analysis of the subpopulation in which bilirubin level and age at the time of bilirubin measurement were further taking into consideration, neonatal phototherapy was not associated with an increased risk of epilepsy using the multivariable (aHR 1.26, 95% CI: 0.54-2.97) and propensity score matched (aHR 1.24, 95% CI: 0.47-3.25) models,Conclusions: Neonatal phototherapy was not associated with an increased risk of epilepsy after taking maternal and neonatal factors into consideration. What is known: • A few studies have suggested that neonatal phototherapy for hyperbilirubinemia may increase the risk of childhood epilepsy. • Whether the observed associations contribute to hyperbilirubinemia, phototherapy, or underlying factors requires further investigation. What is new: • This study revealed no increased risk of epilepsy in children treated with neonatal phototherapy compared to children not treated with phototherapy after taking maternal and neonatal factors into consideration. • After further taking bilirubin level and age at the time of bilirubin measurement into consideration, neonatal phototherapy was not associated with an increased risk of epilepsy.

Is neonatal phototherapy associated with a greater risk of childhood cancers?

BACKGROUND: Neonatal phototherapy (NNPT) has long been used as an effective and relatively safe method of treating neonatal hyperbilirubinemia. Considering the subsequent evidence of long-term impacts of NNPT such as malignancies, this study was conducted to evaluate the relationship between NNPT and childhood cancers. METHODS: This case-control study assessed 116 children up to 4 years old with every kind of cancer referred to the Oncology department of Afzalipour hospital, Kerman, Iran, from 2011 to 18. Moreover, 116 pediatric patients without cancer hospitalized at the same Center were included after sex and age matching as the control group. The history of phototherapy and its duration were evaluated in these two groups. RESULTS: We found no association between the NNPT and malignancies in children. However, high intensive phototherapy was higher historically among affected cancerous patients than in non-cancerous cases without any statistically significant difference (25% vs 19%; P = 0.26). Maternal educational level and history of maternal infection during pregnancy, which initially appeared to be two factors associated with malignancy in single variable regression analyses, were not significant based on the adjusted models. CONCLUSIONS: The results did not show a positive correlation between NNPT and childhood cancers, which may partly be due to the relatively small sample size of the study. However, some other evidence is worrisome enough that NNPT should not be considered risk-free. Additional multi-centric studies should be undertaken to specify that phototherapy is really safe.

Preliminary observations of a system for determination of phototherapy exposure over a neonate body shape.

While it is possible to determine the irradiance and spectral content for a given neonatal phototherapy device at various locations over a neonate's surface, this does not allow estimation of the total rate of energy delivery within a specific spectral range over the neonate's exposed body surface. A series of 192 blue wavelength enhanced silicon photodiodes was distributed over the surface of a commercially available newborn body shape and connected to a specially designed interface circuit. Placement of photosensors over the surface of the baby shape was determined with consideration of the surface area of twelve specific anatomical areas where each was allocated 16 individual photodiodes. Calibration of detection channels for specific wavelength intervals was undertaken using a Bentham dmc150 spectroradiometer system and also a separate hand held spectroradiometer. This made it possible to estimate the effective integrated dose rate in Watts for specific wavelength intervals such as 460 nm to 490 nm as identified by the American Academy of Pediatrics for phototherapy lamp devices. This allowed identification of dose rate contributions from specific anatomical areas. Initial observations are reported for a range of phototherapy lamp systems and the findings are discussed in terms of their predicted relative clinical effectiveness. Options are also discussed in relation to the future development of the reported measurement system.

Use of a hand-held spectroradiometer for the measurement of neonatal phototherapy lamp outputs.

The measurement capability of a hand-held spectroradiometer for validation of phototherapy light treatment for neonates is described. This function is compared with that of a double grating monochromator system with photomultiplier detector, where parameters evaluated included wavelength accuracy and accuracy of irradiance within set wavelength intervals - 460 nm to 490 nm and 400 nm to 550 nm. Measurements carried out in a clinical setting revealed that the hand-held spectroradiometer provided an acceptable level of accuracy for determining output characteristics of the phototherapy devices investigated. It was observed that measurement errors were more significant for studies involving direct contact with light emitting surfaces. It was identified that the spectral resolution of the MSC15 device could act to degrade the accuracy of the device where narrow spectrum peaks occurred around the limits of specific identified bandwidths - such as at 460 nm and 490 nm. This was identified not to be an issue with typical light emitting diode phototherapy systems, where the spectral outputs do not contain narrow spectral components. The device lends itself also to use by clinical staff in the clinical environment to verify the output of phototherapy lamps. The availability of such hand-held spectroradiometer devices represents an advance on the use of output meters suppled by equipment manufacturers.

Neonatal Phototherapy: A Novel Therapy to Prevent Allergic Skin Disease for At Least 5 Years.

BACKGROUND: Preventing the development of allergic skin disease in children is the best way to treat the disease. OBJECTIVES: Ultraviolet (UV)-free blue light phototherapy has been reported to treat atopic eczema. We evaluated the effect of neonatal phototherapy on allergic skin disease in children. METHODS: We randomly recruited 117,041 children from an insurance research database. Those with neonatal jaundice and receiving neonatal phototherapy were classified as the icteric-phototherapy group (n = 4,744), those with neonatal jaundice and not receiving phototherapy were classified as the icteric-non-phototherapy group (n = 5,003), and those without jaundice were classified as the non-icteric group (n = 107,294). We reviewed claims from birth to age 5 years. The prevalence of atopic dermatitis (AD), clinical visit times, and topical prescriptions for allergic skin disease at different ages were compared among groups. RESULTS: AD prevalence was lower in the icteric-phototherapy group than in the icteric-non-phototherapy group. Moreover, clinical visit times for allergic skin disease were lower at age 1-4 years, and topical agent prescription for allergic skin disease were lower at age 1-5 years, in the icteric-phototherapy group than in the icteric-non-phototherapy group. The decreased use of topical agents could reach 64.29%. The 5-year complications of skin disease and cancer in the phototherapy group were not higher. CONCLUSIONS: To our knowledge, this is the first study to report on the effect of UV-free blue light therapy on allergic skin disease in newborns. Blue light therapy in newborns may be a novel method to efficiently prevent allergic skin disease for at least 5 years.

Neonatal phototherapy radiometers: current performance characteristics and future requirements.

Hand held radiometers provide a convenient means of monitoring the output of neonatal phototherapy treatment devices as part of planned programs of device maintenance and output monitoring. It was considered appropriate to determine the wavelength and angular response of a selection of such meters and compare their indicated values with that derived from spectral analysis of phototherapy light sources. This was undertaken using a Bentham DMc150 double grating spectroradiometer and a series of 10nm band pass optical filters in the range 400-640 nm used in conjunction with a fiber optic light source. Specific meters investigated included a GE Biliblanket Light Meter II, a NeoBLUE radiometer and a Bio-TEK radiometer 74345 device. Comparisons were made of measurements made using the hand held meters and the Bentham DMc 150 system for a range of neonatal phototherapy treatment devices. The use of such meters is discussed in relation to applicable equipment standards and recommendations of intensive phototherapy from clinical groups such as the American Academy of Pediatrics and a specification for a spectroradiometer based measurement system is proposed.