From the Guidelines
The interval between repeating dynamic phototherapy sessions should be determined by serial monitoring of total serum bilirubin (TSB) concentration and clinical judgment, rather than a fixed time interval. The decision to repeat phototherapy is based on the infant's bilirubin level and the risk of exchange transfusion, as well as individual factors such as gestational age and overall health status 1.
Key Considerations
- The American Academy of Pediatrics recommends continuous phototherapy for infants with bilirubin levels approaching the exchange transfusion zone, with interruptions only for feeding or brief parental visits 1.
- Cycled phototherapy, which involves timed intervals of light exposure and non-exposure, is currently under investigation for use in extremely low birth weight infants, but its effectiveness and safety have not been established for other populations 1.
- The total duration of phototherapy is determined by the infant's response to treatment, as measured by serial TSB concentrations, and is typically continued until a target TSB concentration is reached 1.
Clinical Implications
- Clinicians should exercise individual judgment when determining the need for repeated phototherapy sessions, taking into account the infant's clinical condition, bilirubin level, and risk of adverse outcomes.
- The use of more than one phototherapy device has not been shown to improve effectiveness, and care should be taken to avoid interference and ensure a uniformly irradiated light footprint 1.
- Brief interruptions in phototherapy for infant handling, parental bonding, and breastfeeding are acceptable, but prolonged interruptions can increase the risk of bilirubin rebound and adverse outcomes 1.
From the Research
Repeating Dynamic Phototherapy
- The ideal duration between repeating dynamic phototherapy sessions is not explicitly stated in the provided studies.
- However, a study 2 compared two groups of jaundiced newborns receiving either 24 hours or 18 hours of continuous phototherapy, and found that the 18-hour course provided better hourly outcomes and reached its saturation point around the 18th hour.
- Another study 3 investigated the effects of continuous phototherapy (CPT) and intermittent phototherapy (IPT) in the treatment of neonatal indirect hyperbilirubinemia, and found that IPT was applied as 2 cycles of 1 hour on and 2 hours off in a 6-hour session.
- The study 3 also found that the median phototherapy time was 12 hours in the CPT group and 4 hours in the IPT group, with the IPT group having a shorter hospital stay and lower incidence of side effects.
- A study 4 discussed the update on phototherapy in jaundiced neonates, and mentioned that comparison of the efficacy of cycled vs. continuous phototherapy has given divergent results.
Phototherapy Duration and Frequency
- A study 2 suggested that an 18-hour phototherapy course without total serum bilirubin (TSB) monitoring until the end of the phototherapy should be considered for jaundiced newborns lacking neurotoxicity risk factors.
- The study 3 found that IPT was at least as effective as CPT in reducing total serum bilirubin, and that the slower rate of rebound bilirubin, shorter hospital stays, and lower incidence of side effects indicated that intermittent phototherapy is superior to continuous phototherapy.
- Another study 5 demonstrated the effectiveness of phototherapy in achieving prolonged reduction of bilirubin levels and the prevention of neurological complications in neonates with unconjugated hyperbilirubinemia.