650 - High-Irradiance Phototherapy to Prevent Kernicterus without Exchange Transfusion

Publication Number: 1627.650

Yo Shimizu, Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Shin Kato, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan; Osuke Iwata, nagoya city university, Nagoya, Aichi, Japan

Background: Severe neonatal hyperbilirubinemia causes bilirubin encephalopathy and kernicterus. Phototherapy is an efficient first-line treatment for jaundice; however, exchange transfusion is still preferred for the most severe cases to prevent kernicterus.

Objective: Previous studies have shown a linear dose-response between irradiance and bilirubin reduction up to 55 μW/cm²/nm. Recent devices provide even higher irradiance, the efficacy and safety of which remain unclear.

Design/Methods: We performed a single-center retrospective study of 92 neonates with severe jaundice admitted to a tertiary neonatal intensive care unit between 2017 and 2024. Severe jaundice was defined as total serum bilirubin levels above or within 2.5 mg/dL of the exchange transfusion threshold. Phototherapy was administered with NeoBlue or Bililux in single- or double-directional modes. Estimated irradiance ranged from 35 to 148 μW/cm²/nm. The dependence of bilirubin reduction rate on the estimated irradiance and other clinical variables was evaluated.

Results: The mean (standard deviation) gestational age and birth weight were 37.7 (2.5) weeks and 2704 (620) g, respectively. Only one neonate required an exchange transfusion. In multivariable analysis, the bilirubin reduction rate was associated with the irradiance (B, 0.22; 95% CI, 0.12-0.32; p < 0.001) and total serum bilirubin at the commencement of phototherapy (B, 0.04; 95% CI, 0.029-0.051; p < 0.001). The bilirubin reduction rate was dose-dependent up to 148 μW/cm²/nm, regardless of the device. Short-term adverse events were transient hyperthermia (12%).

Conclusion(s): High-irradiance phototherapy achieved dose-dependent bilirubin reduction up to 148 μW/cm²/nm, with limited short-term events. Intensive phototherapy may efficiently prevent kernicterus without the need for exchange transfusion, ultimately sparing the healthcare burden.

Characteristics of the study population
Values were expressed as the number (%), mean ±medians (95% confidence interval), or median (quartile ranges). Abbreviation: T-24, the day before PT; T0, the commencement of PT; T+24, the day after PT; CI, confidence interval; TSB, total serum bilirubin; PT, Phototherapy.

Crude dependence of the bilirubin reduction rate on clinical variables
Abbreviation: T-24, the day before PT; T0, the commencement of PT; T+24; the day after PT; CI, confidence interval; TSB, total serum bilirubin; PT, Phototherapy; ET, exchange transfusion.

Findings of multivariable analysis on the bilirubin reduction rate
Abbreviation: CI, confidence interval; TSB, total serum bilirubin PT, Phototherapy.