659 - Bringing Real-World Irradiance Levels to Light: Phototherapy Irradiance in Term and Late Preterm Infants with Indirect Hyperbilirubinemia

Publication Number: 1636.659

Jeremiah O. Olabiyi, Children's Hospital of Michigan, Melvindale, MI, United States; Sanjay Chawla, Children's Hospital of Michigan, TROY, MI, United States; Kriti Damodaran, Children's hospital of Michigan, Detroit, MI, United States; Hannah J. Sampath, Central Michigan University College of Medicine, Royal Oak, MI, United States; Ronald Thomas, Central Michigan University College of Medicine, Detroit, MI, United States; Narin Thanaputkaiporn, Los angeles medical center, LOS ANGELES, CA, United States

Background: Neonatal jaundice is common in term and late preterm infants, with over 80% experiencing elevated bilirubin levels in the first few days of age. The American Academy of Pediatrics (AAP) recommends intensive phototherapy when the bilirubin concentration crosses a certain value based on age and risk factor. Intensive phototherapy refers to treatment using light with an irradiance of 30 µW/cm²/nm or higher. No upper limit for irradiance is specified. This study investigates the real-world use of irradiance levels in clinical practice.

Objective: To describe the real-world usage of phototherapy irradiance range in term and late preterm infants with indirect hyperbilirubinemia and to compare it to the recommended level by the AAP.

Design/Methods: This was a prospective observational study conducted at a level III and a level IV NICU. Neonates born at or after 35 weeks of gestation who developed indirect hyperbilirubinemia and needed overhead phototherapy were included. Measurements of irradiance were taken at the level of the infants' trunk. Three sets of measurements were recorded at the center of the light source. For each infant, the mean irradiance from these three measurements was determined. Data were collected on baseline bilirubin levels, irradiance intensity, and phototherapy duration.

Results: The study included 48 newborns diagnosed with indirect hyperbilirubinemia. The median gestational age was 38.0 weeks (IQR 37.0–39.0; range 35–40 weeks). The median birth weight was 3160 g (IQR 3010–3300; range 1790–4010 g). Median postnatal age at phototherapy initiation was 42.9 hours (IQR 34.1–63.0; range 6–234 hours), and the median irradiance used was 62.1 µW/cm²/nm (IQR 56.4–67.7; range 19.1–106.0 µW/cm²/nm). Adverse effects were rare, with hyperthermia in 13%, rash in 8%, and 17% having loose stools. Two infants (4.2%) received phototherapy at less than the recommended irradiance, indicating that adherence to proper phototherapy guidelines could still be improved.

Conclusion(s): This study highlights the frequent use of very high level of irradiance for the treatment of indirect hyperbilirubinemia in neonates. Further investigation is required to determine whether these very high irradiance levels are safe and effective, especially when considering possible long-term impacts on newborns. It remains to be investigated whether a dose-response relationship exists at irradiance levels above a certain threshold.