EFFECTIVENESS OF EARLY PHOTOTHERAPY IN VERY-LOW-BIRTH-WEIGHT (VLBW) INFANTS

Routine initiation of phototherapy (PT) within a few hours of birth in VLBW infants has been suggested as a means of modifying the severity and duration of hyperbilirubinemia (HB). The purpose of this study was to determine whether early PT alters the course of HB in VLBW infants. 16 preterm infants, (BW 878 ± 56 g; EGA 27.6 ± 0.4 weeks - mean ± SEM) were randomly assigned to receive PT either within 8 h of birth (E) or after BR reached 5 mg/dl (L). Irradiance at 450 nm was controlled at 12uw/cm2/nm with a Healthdyne Cavitron PT unit. BR values were measured B.I.D., and specimens for configurational (ZE) and structural (LUM) photoisomers were obtained once each day for analysis by HPLC. Age and BR at the onset of PT, peak BR, age at peak, rate of rise of BR, and total duration of PT were compared for both treatment groups. A significant rise in both ZE and LUM (p<.005) independent of BR concentration was seen following the onset of PT in all patients. This data suggests that the clinical course of HB is not altered in infants receiving early PT compared with infants whose PT was begun at 5 mg/dl. In addition, infants receiving early PT were exposed to PT for a significantly longer time. Since PT may be associated with serious side effects, its prophylactic use does not appear to be justified. (NIH Grant RR-00240)