Pediatrics International (2019) 61, 747
13982
Editorial
Effectiveness of green light phototherapy for neonatal
hyperbilirubinemia
Sixty years have passed since Cremer et al. reported on the
beneficial effects of phototherapy for treating neonatal hyper-
bilirubinemia.1 The mechanism of action of phototherapy is
now known to involve the photochemical reaction of bilirubin
in a tetrapyrrolic state, and qualitative and quantitative analy-
ses of these photoisomers have been performed using high-
performance liquid chromatography.2 The most important pho-
toisomer in the clinical effectiveness of phototherapy is the
structural photoisomer (EZ)-cyclobilirubin IXa.3 With this iso-
mer, in vitro evaluation of the clinical effectiveness of light
sources in phototherapy became possible, and green light pho-
totherapy was shown to be effective.4,5 Against this back-
ground, Kuboi et al. report in the Journal an investigation of
the clinical effectiveness of green light-emitting diode (LED)
phototherapy in vivo.6
Blue light contains a short visible wavelength close to that
of harmful ultraviolet light. Blue light has been shown to have
subclinical cell toxicity, as evidenced by the visual impairment
caused by blue light from liquid-crystal display monitors.7 In
recent years, the adverse effects of aggressive phototherapy in
extremely low-birthweight infants have been reported,8 and
are becoming a clinical problem. Therefore, when considering
the effectiveness and toxicity of phototherapy, green light can
be considered preferable. As such, light sources with longer
wavelengths in the blue light spectrum are being developed by
manufacturers overseas.
This problem can be resolved by phototherapy using LED
that exclude the deleterious wavelengths in the visible spec-
trum and provide stronger irradiation of monochromatic light.
Here, Kuboi et al. report a randomized comparative study
showing that the clinical effectiveness of green LED pho-
totherapy is similar to that of blue LED phototherapy.6 Japan
is one of the few countries currently using green light in the
clinical setting, and it is important to show the clinical effec-
tiveness of green LED phototherapy, which is not evaluated
based on the American Academy of Pediatrics (AAP) Guide-
lines. Along with the review paper by Itoh et al., which was
recently published in the Journal,9 we hope that the Kuboi
et al. report will be read not only by neonatologists, but by all
pediatric physicians.
Editorial Office’s Note
The editorial of Vol 61, Issue 5 “Green light-emitting diode phototherapy for neonatal hyperbilirubinemia: Randomized controlled trial”
Dr. Toru Kuboi is on this issue because of a mistake of editorial office. We sincerely apologize for the three month delay of publication.
© 2019 Japan Pediatric Society
doi: 10.1111/ped.
Disclosure
The author declares no conflict of interest.
Author contributions
T.K. wrote this paper and approved the final version.
Takashi Kusaka
Faculty of Medicine, Department of Pediatrics, Kagawa
University, Kitagun, Kagawa, Japan
E-mail: kusaka@med.kagawa-u.ac.jp
References
1 Cremer RJ, Perryman PW, Richards DH. Influence of light on
the hyperbilirubinaemia of infants. Lancet 1958; 1(7030):
1094–7.
2 Itoh S, Isobe K, Onishi S. Accurate and sensitive high-
performance liquid chromatographic method for geometric and
structural photoisomers of bilirubin IXa using the relative
molar absorptivity value. J. Chromatogr. A 1999; 848: 169–77.
3 Onishi S, Isobe K, Itoh S et al. Metabolism of bilirubin and its
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4 Itoh S, Onishi S, Isobe K, Manabe M, Yamakawa T.
Wavelength dependence of the geometric and structural
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controlled trial. Pediatr. Int. 2019; 61: 465–70.
7 Chen P, Lai Z, Yihui W et al. Retinal neuron is more sensitive
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