Azizullah Langah¹, Sara Sadiq^2*, Ali Akbar Siyal¹

Show more
¹ Department of Pediatric Medicine, Peoples University of Health Sciences, Nawabshah, Pakistan.
² Department of Physiology, CMH Institute of Medical Sciences, Bahawalpur, Pakistan.
Show less

Abstract: Introduction: Phototherapy is the treatment of choice for neonatal hyperbilirubinemia. It converts the unconjugated bilirubin from polar and neurotoxic Z-Z-bilirubin to the more polar photobilirubin. It has been hypothesized that high level of hemoglobin or hematocrit interferes in the effectiveness of phototherapy. The objective of the current study is to find out the association of hemoglobin/hematocrit to change in total serum bilirubin concentration during phototherapy. Methods: A prospective cohort study was conducted on 296 neonates with uncomplicated hyperbilirubinemia. Before initiating the phototherapy, hemoglobin, hematocrit and total serum bilirubin levels were measured. After treating the neonates with phototherapy using LED-light for 24 hours, the total serum bilirubin level was measured again. The data were analyzed by using SPSS version-20. Results: The majority of study participants were male (60.8%), with mean postnatal age of 4.66 ± 1.65, having mean birth weight of 2.41 ± 0.41. Considering Pearson correlation, the hemoglobin had a significant inverse association with ΔTsB_0-24 while birth weight and postnatal age also had inverse association but p-values were non-significant, while TsB₀ had presented a very weak but significant positive association. The results might be evident of the fact that increase in hemoglobin concentration results in minimal change in total serum bilirubin concentration during phototherapy. Conclusion: Current study found a significant effect of hemoglobin on efficacy of phototherapy, as the change in total serum bilirubin concentration is inversely correlated with the level of hemoglobin. This is important for the physician in treating neonates with hyperbilirubinemia by using phototherapy.

Keywords: Hyperbilirubinemia, Neonatal Jaundice, Phototherapy

Cite this paper: Langah, A. , Sadiq, S. and Siyal, A. (2019) Ghost Haemoglobin Affecting the Efficacy of Phototherapy. International Journal of Clinical Medicine, 10, 523-530. doi: 10.4236/ijcm.2019.1010042.

References

[1]   Donneborg, M.L., Vandborg, P.K., Hansen, B.M., Rodrigo-Domingo, M. and Ebbesen, F. (2017) The Impact of Hemoglobin on the Efficacy of Phototherapy in Hyperbilirubinemic Infants. Pediatric Research, 82, 947.
https://doi.org/10.1038/pr.2017.186

[2]   Maisels, M. (2015) Sister Jean Ward, Phototherapy, and Jaundice: A Unique Human and Photochemical Interaction. Journal of Perinatology, 35, 671.
https://doi.org/10.1038/jp.2015.56

[3]   Ebbesen, F., Hansen, T.W. and Maisels, M.J. (2017) Update on Phototherapy in Jaundiced Neonates. Current Pediatric Reviews, 13, 176-180.
https://doi.org/10.2174/1573396313666170718150056

[4]   Ebbesen, F., Madsen, P.H., Vandborg, P.K., Jakobsen, L.H., Trydal, T. and Vreman, H.J. (2016) Bilirubin Isomer Distribution in Jaundiced Neonates during Phototherapy with LED Light Centered at 497 nm (Turquoise) vs. 459 nm (Blue). Pediatric Research, 80, 511.
https://doi.org/10.1038/pr.2016.115

[5]   Mostovnikov, V.A., Mostovnikova, G.R. and Plavski, V.Y. (1995) Spectral and Photochemical Parameters Which Define the Higher Efficacy of Laser Phototherapy in Hyperbilirubinemia in Newborns. 5th International Conference on Laser Applications in Life Sciences, Vol. 2370, 558-561.
https://doi.org/10.1117/12.197489

[6]   Onishi, S., Isobe, K., Itoh, S., Manabe, M., Sasaki, K., Fukuzaki, R., et al. (1986) Metabolism of Bilirubin and Its Photoisomers in Newborn Infants during Phototherapy. The Journal of Biochemistry, 100, 789-795.
https://doi.org/10.1093/oxfordjournals.jbchem.a121772

[7]   Lamola, A.A., Bhutani, V.K., Wong, R.J., Stevenson, D.K. and McDonagh, A.F. (2013) The Effect of Hematocrit on the Efficacy of Phototherapy for Neonatal Jaundice. Pediatric Research, 74, 54.
https://doi.org/10.1038/pr.2013.67

[8]   Linfield, D.T., Lamola, A.A., Mei, E., Hwang, A.Y., Vreman, H.J., Wong, R.J., et al. (2016) The Effect of Hematocrit on in Vitro Bilirubin Photoalteration. Pediatric Research, 79, 387.
https://doi.org/10.1038/pr.2015.240

[9]   Curran, S., McMurdy, J.W., Carr, S.R., Muratore, C.S., O’Brien, B.M., Crawford, G.P., et al. (2010) Reflectance Spectrometry for Real-Time Hemoglobin Determination of Placental Vessels during Endoscopic Laser Surgery for Twin-to-Twin Transfusion Syndrome. Journal of Pediatric Surgery, 45, 59-64.
https://doi.org/10.1016/j.jpedsurg.2009.10.009

[10]   Sikurova, L., Balis, P. and Zvarik, M. (2011) Penetration of Laser Light through Red Blood Cell Ghosts. Journal of Photochemistry and Photobiology B: Biology, 103, 230-233.
https://doi.org/10.1016/j.jphotobiol.2011.03.015

[11]   Granati, B., Felice, M., Fortunato, A., Giancola, G. and Rubaltelli, F.F. (1983) Sites of Action of Light during Phototherapy. Neonatology, 43, 1-8.
https://doi.org/10.1159/000241630

[12]   Donneborg, M., Knudsen, K.B. and Ebbesen, F. (2010) Effect of Infants’ Position on Serum Bilirubin Level during Conventional Phototherapy. Acta Paediatrica, 99, 1131-1134.
https://doi.org/10.1111/j.1651-2227.2010.01885.x

[13]   Mreihil, K., Madsen, P., Nakstad, B., Benth, J.S., Ebbesen, F. and Hansen, T.W.R. (2015) Early Formation of Bilirubin Isomers during Phototherapy for Neonatal Jaundice: Effects of Single vs. Double Fluorescent Lamps vs. Photodiodes. Pediatric Research, 78, 56.
https://doi.org/10.1038/pr.2015.61

[14]   Hansen, T.W.R. (1996) Therapeutic Approaches to Neonatal Jaundice: An International Survey. Clinical Pediatrics, 35, 309-316.
https://doi.org/10.1177/000992289603500604

[15]   Bhethanabhotla, S., Thukral, A., Sankar, M., Agarwal, R., Paul, V. and Deorari, A. (2013) Effect of Position of Infant during Phototherapy in Management of Hyperbilirubinemia in Late Preterm and Term Neonates: A Randomized Controlled Trial. Journal of Perinatology, 33, 795.
https://doi.org/10.1038/jp.2013.54

[16]   Chen, C.M., Liu, S.H., Lai, C.-C., Hwang, C.C. and Hsu, H.-H. (2002) Changing Position Does Not Improve the Efficacy of Conventional Phototherapy. Acta Paediatrica Taiwanica, 43, 255-258.

[17]   Mohammadzadeh, A., Bostani, Z., Jafarnejad, F. and Mazloom, R. (2004) Supine versus Turning Position on Bilirubin Level during Phototherapy in Healthy Term Jaundiced Neonates. Saudi Medical Journal, 25, 2051-2052.

[18]   Lamola, A.A. (2016) A Pharmacologic View of Phototherapy. Clinics in Perinatology, 43, 259-276.
https://doi.org/10.1016/j.clp.2016.01.004

[19]   Okada, H., Masuya, K., Yasuda, S., Okubo, K., Kawada, K., Kusaka, T., et al. (2005) Developmental Changes in Serum Half-Life of (EZ)-Cyclobilirubin. Early Human Development, 81, 619-622. https://doi.org/10.1016/j.earlhumdev.2005.03.014