Double phototherapy in jaundiced term infants with hemolysis

Abstract

Objective: To compare the efficacy of double phototherapy and conventional phototherapy in term newborn infants with hemolytic jaundice.

Method: Full-term infants with evidence of severe hemolysis on the peripheral blood smear, whose serum bilirubin levels were between 15-21 mg/dl were divided into 2 groups, depending on the availability of the phototherapy bed. Group 1 infants received double phototherapy consisting of conventional (single) phototherapy plus an extra light source from a phototherapy bed (Medela Billibed, Switzerland). Group 2 infants received only conventional phototherapy. Maternal and infants' blood groups and Rh, direct Coomb's test, G6PD screening test and hematocrit were determined on every infant. Phototherapy was given until the serum bilirubin level dropped to < or = 13 mg/dl. Exchange transfusion was indicated when the serum bilirubin level was > or = 21 mg/dl after phototherapy had been given for 4-6 hours.

Results: There were 110 infants included in this study, 62 and 48 in group 1 and 2 respectively. There was no statistical difference in terms of birth weight, sex ratio, proportion of breast feeding infants and the initial hematocrit level. However, the initial mean +/- SD of bilirubin level of group 1 infants was higher than that of group 2, (17.7 +/- 1.6 mg/dl vs 16.2 +/- 0.9 mg/dl, p < 0.001). Causes of hemolysis could be determined in 74 infants; 27 (24.5%), 39 (35.5%) and 8 (7.3%) infants had ABO incompatibility, G6PD deficiency and both ABO incompatibility and G6PD deficiency respectively. Rate of bilirubin reduction in group 1 infants was significantly faster, (3.3 +/- 2.4 mg/dl/24 h vs 2.1 +/- 1.1 mg/dl/24 h, p < 0.01). Duration of phototherapy was also shorter in group 1 infants, (45.8 +/- 29.7 hours vs 58.5 +/- 26.0 hours, p < 0.05). Four infants failed to respond to the phototherapy that was assigned. Two infants in group 2 had to be switched to receive double phototherapy because of rapid rising of serum bilirubin. One in each group needed exchange transfusion.

Conclusion: The study demonstrated that double phototherapy is more efficient than conventional phototherapy in term infants with severe jaundice caused by hemolysis.