Hyperbilirubinemia, neonatal treatment

The forms of phototherapy in common use include (i) the phototherapy of jaundice (neonatal hyperbilirubinemia) in the newborn, and especially in the prematurely born 5 (ii) the treatment of psoriasis using light in the UV-A range (320 100 nm) and an administered photosensitizer, such as 8-methoxypsoralen 6 (iii) the treatment of the wet form of age-related macular degeneration with a photosensitizer such as a benzoporphyrin derivative (VISUDYNE ), and a laser light source 7 and (iv) the treatment of certain cancers with a photosensitizer such as a porphyrin derivative, and red light.8... 

For many years, phototherapy has been the standard treatment of neonatal hyperbilirubinemia. The effectiveness of this form of therapy is based on the ability of photons of the appropriate wavelength to convert the intramolecularly H-bonded bilirubin IXa with its low solubility into photoisomers of bilirubin in which the normal Z,Z stereochemistry at the 4- and 15-positions is changed, resulting in photoisomers that are more water soluble. In addition, bilirubin can be converted into the cyclic lumirubin, which is soluble and can be excreted in the urine (Fig. 22-2). Photoproducts can also be excreted through the liver pathway without... 

Caglayan, S., Candemir, H., Aksit, S., Kansov, S., Asik, S., Yapiak, I. Superiority of oral agar and phototherapy combination in the treatment of neonatal hyperbilirubinemia. Pediatrics 1993 92 86-89... 

Sulfonamides should not be given to pregnant women in the third trimester of pregnancy. They can displace bilirubin from plasma albumin and cause kernicterus (bilirubin encephalopathy) (205-208). For the same reason, the administration of sulfonamides to lactating women or premature infants should be avoided. Successful treatment of neonatal hyperbilirubinemia with higher bilirubin concentrations has been established using exchange transfusion and phototherapy. 

Indomethacin is FDA approved for closure of persistent patent ductus arteriosus. Successful closure is obtained in >70% of neonates treated with the drug. Such therapy is indicated primarily in premature infants who weigh between 500 and 1750 g, who have a hemodynamically significant patent ductus arteriosus, and in whom other supportive maneuvers have been attempted. Unexpectedly, treatment with indomethacin also may decrease the incidence and severity of intraventricular hemorrhage in low-birth-weight neonates. The principal limitation of treating neonates is renal toxicity, and therapy is stopped if urine output falls to <0.6 mL/kg/h. Renal failure, enterocolitis, thrombocytopenia, or hyperbilirubinemia are contraindications to the use of indomethacin. 

Once these causes of jaundice have been excluded, neonatal hepatitis, biliary atresia (BA) or duct paucity syndromes will account for more than two thirds of the remaining cases of conjugated hyperbilirubinemia in the neonate. In conjunction with nuclear medicine, US is the primary imaging modality for differentiating among these diseases and differentiation is important, as surgery is the treatment for BA but not for the other entities (Kelly 1999 Mortele et al. 2006 Gazelle et al. 1998). 

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