INSTITUTE OF NURSING EDUCATION

CHILD HEALTH NURSING DEPARTMENT

REVIEW LITERATURE
JOURNAL
TOPIC:- NEONATAL JAUNDICE AND PHOTOTHERAPY

SUBMITED TO

 RESP. MADAM SONAVANE M.B.

PROFESSOR, PRINCIPAL,

HOD OF CHILD HEALTH NURSING

INE MUNBAI

 RESP. MADAM MANE GRACE

CLINICAL INSTRUCTER
INE MUMBAI

SUBMITED BY

SMT. NAGARGOJE ANITA D.

MSc. NURSING IInd YEAR

INE MUMBAI
Objectives of journal presentation:

At the end of journal presentation students will be able to…

1. Understand Author of the journal.

2. Know various journal publications.

3. Describe method and material used by Author in his/her

Research.

4. Explain the research design used in the study.

5. Describe the data analysis method used by research.

6. Explain the ethical consideration of research study.

7. Able to write research report.

8. Able to discuss research findings.

 1. JOURNAL

• Name of author:
Hakam Yaseen MD, CES, DUN (France), FRCPCH (UK),
Mona Khalaf MRCP, Najat Rashid PhD and Maha Darwich MD, CES

• Title:
does prophylactic phototherapy prevent hyperbilirubinemia in neonates with
abo incompatibility and positive coombs' test?

• Journal name:
Journal of Perinatology (2005) 25, 590–594. doi:10.1038/sj.jp.7211356;
published online 21 July 2005

• OBJECTIVE:
The objective of the study was to determine whether initiation of early
phototherapy in positive direct Coombs' test (DCT) with ABO-incompatible
newborns would prevent severe jaundice.

• STUDY DESIGN:
A prospective controlled study was performed at Al Qassimi Hospital.
Infants born at term and weighing >2000 g with ABO incompatibility and a
positive DCT were included in the study. Within their first 4 hours of life
and after parental consent, infants were enrolled into one of two groups:
prophylactic phototherapy group, which received phototherapy during the
first 24 hours of life (group I), or no prophylactic phototherapy, which
represents the control group (group II). Selection of infants to either group
was by 2-week alternative strategy.
Blood group, complete blood count (CBC), reticulocyte count, blood
smears, total serum bilirubin (TSB) and DCT were performed on cord blood
 of all neonates born to mothers with O-positive blood group. CBC,
reticulocytes and TSB level were obtained in all enrolled infants at 12, 24,
48, 72, and 96 hours of life.

• RESULTS:
During the study period, 242 newborns with positive DCT were enrolled. A
total of 102 infants were allocated to the prophylactic phototherapy arm and
140 as controls. Prophylactic phototherapy was associated with a significant
decrease in the TSB at 24 hours (p=0.002) and at 48 hours (p=0.003) but not
later on. The total number of patients who had hyperbilirubinemia at any
time during the first 96 hours was significantly less in the prophylactic group
(17 vs 45 — p=0.006). Prolonged hospital stay because of phototherapy was
more frequent in the control group (p=0.03).

• CONCLUSION:
Prophylactic phototherapy was associated with a significant reduction of
TSB in the first 48 hours of life but not later on. Clinical benefits of this
strategy could not be proven.
2. Journal-

 Name of author:
Sarici SU, Alpay F, Dündaröz MR, Ozcan O, Gökçay EDepartment of
Pediatrics, Gülhane Military Medical Academy, Ankara, Turkey.
 Title: The efficacy and wavelengths of fiberoptic phototherapy and
conventional daylight phototherapy
 Journal name:- The Turkish Journal of Pediatrics [2001, 43(4):280-285]
Type: Clinical Trial, Journal Article, Randomized Controlled Trial

The efficacy and wavelengths of fiberoptic phototherapy and conventional

daylight phototherapy were compared in a relatively larger series of term
newborns with non-hemolytic and significant hyperbilirubinemia than
reported in previous studies. One hundred and nine term newborns were
randomly assigned to receive either fiberoptic phototherapy on a fiberoptic
phototherapy pad or overhead conventional phototherapy consisting of five
daylight fluorescent lamps. Although the average spectral irradiance
measured during the study period was significantly greater in the fiberoptic
phototherapy group (9.2+/-1.2 microW/cm2/nm vs 7.1+/-1.1
microW/cm2/mm, p < 0.05), conventional phototherapy was significantly
more effective in decreasing bilirubin levels: the duration of exposure to
phototherapy was significantly shorter (49.4+/-14.4 hours vs 61+/-13.1
hours, p < 0.05), and overallbilirubin decline rate as mg/dl/h and percent/h
was significantly greater in the conventional phototherapy group (0.15+/-
0.06 mg/dl/h vs 0.11+/-0.05 mg/dl/h, and 0.81+/-0.34 percent/h vs 0.60+/-
0.28 percent/h, p < 0.05). There were four failures of phototherapy in the
fiberoptic phototherapy group whereas no phototherapy failure was observed
in the conventional phototherapy group (p < 0.05). The emission spectrum
of the daylight fluorescent lamp revealed a broad emission between the
violet and red spectra with tiny narrow peak emission bands in 405 nm, 436
nm, 546 nm and 577 nm, while a broad emission through the blue and green
wavelengths (mainly in the green spectrum) without any peak emissions was
detected in the tungsten-halogen lamp of the fiberoptic phototherapy system.
Conventional phototherapy with daylight fluorescent lamps should be
preferred to fiberoptic phototherapy administered with fiberoptic
phototherapy and in the treatment of term newborns with
nonhemolytic hyperbilirubinemia
3 JOURNAL
 TITAL:-
efficacy of phototherapy for neonatal laundice is increased by the use of
low-cost white reflecting curtains
 AUTHER :-
Djokomuljanto, S.; Quah, B. S.; Surini, Y.; Noraida, R.; Ismail, N. Z. N.;
Hansen, I. W. R.; Rostenberghe, H. VanATE
 NAME OF JOURNAL :-
November 2009 Archives of Disease in Childhood -- Fetal & Neonatal
Edition;Nov2009, Vol. 91 Issue 6, pF439 Academic Journal artical
 OBJECTIVE:
To determine whether the addition of low-cost reflecting curtains to a
standard phototherapy unit could increase effectiveness of phototherapy for
neonatal jaundice.
 DESIGN:
Randomised controlled clinical trial. Setting: Level-one nursery of the
Hospital Universiti Sains Malaysia, Kelantan, Malayasia. Patients: Term
newborns with uncomp3_licated neonatal jaundice presenting in the first
week of life.
 INTERVENTIONS:
Phototherapy with white curtains hanging from the sides of the
phototherapy unit (study group, n = 50) was compared with single
phototherapy without curtains (control group, n = 47). Main outcome
measures: The primary outcome was the mean difference in total serum
bilirubin measured at baseline and after 4 h of phototherapy. The secondary
outcome was the duration of phototherapy.
 RESULTS:
The mean (standard deviation) decrease in total serum bilirubin levels after
4 h of phototherapy was significantly (p<0.001) higher in the study group
(27.62 (25.24) mol/l) than in the control group (4.04 (24.27) mol/l). Cox
proportional hazards regression analysis indicated that the median duration
of phototherapy was significantly shorter in the study group (12 h) than in
the control group (34 h; ? change 45.2; p<0.001; hazards ratio 0.20; 95%
confidence interval 0.12 to 0.32). No difference in adverse events was noted
in terms of hyperthermia or hypothermia, weight loss, rash, loose stools or
feeding intolerance.
 CONCLUSION:
Hanging white curtains around phototherapy units significantly increases
efficacy of phototherapy in the treatment of neonatal jaundice without
evidence of increased adverse effects.
 4. JOURNAL
 TITAL: -
Randomized control trial between single phototherapy plus low-cost white
curtain and conventional phototherapy
 AUTHER :-
Djokomuljanto, S.; B. S., Quah; Y., Surini; R., Noraida; A. N. I., Nik
Zainal; Hansen, T. W. R.; Van Rostenberghe, H.
 NAME OF JOURNAL :-
January 2008, Malaysian Journal of Medical Sciences;Jan2008 Supplement,
Vol. 13, p46 Academic Journal Article
 PURPOSE :
To determine whether the addition of low-cost reflecting curtains to a
standard phototherapy unit could increase effectiveness of phototherapy for
neonatal jaundice.
 METHODS :
This is a randomised controlled clinical trial, performed in the level one
nursery of a tertiary University Hospital in Malaysia. The subjects were
term newborns with uncomplicated neonatal jaundice presenting in the first
week of life. Phototherapy with white curtains hanging from the sides of the
phototherapy unit (study group) was compared to single phototherapy
without curtains (control group). The primary outcome measure was the
mean difference in total serum bilirubin measured at baseline and after four
hours of phototherapy. The secondary outcome was the duration of
phototherapy.
 RESULTS :
There were 50 babies in the study group and 47 babies in the control group.
 The mean decrease in total serum bilirubin levels after 4 hours of
phototherapy was significantly (p<0.001) greater in the study group (27.62
mol/L, SD 25.24) compared to that of the control group (4.04 mol/L, SD
24.27). Cox proportional hazards regression analysis indicated that the
median duration of phototherapy was significantly shorter in the study
group (10 hours) than in the control group (34 hours) (chi-square-change =
38.93; p<0.001; hazards ratio: 0.21; 95% confidence interval, 0.13 to 0.35).
No difference in adverse events was noted in terms of hyper- or
hypothermia, weight loss, skin rash, loose stools, or feeding intolerance.
 CONCLUSION :
Hanging white curtains around phototherapy units significantly increases its
efficacy in the treatment of neonatal jaundice without evidence of increased
adverse effect.
5. JOURNAL

 TITAL :-
effect of clofibrate in jaundiced term newborns
 NAME OF JOURNAL :-
February 2005, Volume 72, Issue 2, pp 123-126 academic journal pediatric
 AUTHER :-
A. Mohammadzadeh, A. Sh. Farhat, R. Iranpour
 OBJECTIVE: 
Clofibrate is a glucuronosyl transferase inducer that has been proposed to
increase the elimination of bilirubin in neonates with hyperbilirubinemia.
The aim of this study was to characterize the therapeutic effect of clofibrate
in neonates born at full term and present with non-hemolytic jaundice
 METHODS: 
A clinical controlled study was performed in two groups of healthy full term
neonates. Thirty neonates were treated with a single oral dose of clofibrate
(100 mg/kg) plus phototherapy (clofibrate-treated group) while another 30
neonates (control group) received only phototherapy.
 RESULT: 
The mean plasma total bilirubin levels of 12th, 24th and 48th hours were
significantly lower in the clofibrate-treated group as compared with the
control group (P<0.0001, P<0.0001 and P=0.004, respectively). Treatment
with clofibrate also resulted in a shorter duration of jaundice and a
decreased use of phototherapy (P<0.0001). No side effects were observed.
 CONCLUSION:
Although other pharmacological agents such as metalloporphyrins and Sn-
mesoporphyrin also seem to be effective in decreasing bilirubin production,
these products are not available for routine use and cannot be used because
the safety of these drugs has to be confirmed prior to their widespread use.
Therefore, clofibrate is now the only available pharmacological treatment of
neonatal jaundice.