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Sixty years of phototherapy for neonatal jaundice: from serendipitous observation to standardized treatment and rescue for millions

Journal of Perinatology volume 40, pages 1582–1583 (2020)Cite this article

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We appreciate Dr. Newman’s interest in the review by Hansen et al. [1], celebrating 60 years of phototherapy use for neonatal jaundice. His first concern was that we: “…didn’t mention concerns about photo-oxidative injury or damage to DNA raised in multiple studies. They also failed to cite recent studies indicating that phototherapy is associated with a small absolute increases in the risk of subsequent cancer and epilepsy”. Some UV radiation may occur with the use of fluorescent light for phototherapy, thus presenting some mutagenic risk, although likely very small and probably inconsequential in most cases. Blue light-emitting diode (LED)-based devices eliminate this risk, but still have been associated with some photo-oxidation in exposed tissues. Although the exact mechanism(s) by which LED light might interact with tissues to cause injury, especially if the skin is more translucent, is unkown, extremely low birthweight (ELBW) infants may be at increased risk. There are several recent human [2] and animal studies [3, 4], which report such concerns. Indeed, the NICHD trial reporting on the aggressive vs. conservative use of phototherapy in ELBW infants suggests an increase in mortality [5], which is the motivation for another NIH multicenter trial of cycled phototherapy, as a way of reducing the exposure. However, any recently reported associations between phototherapy, cancer risks and epilepsy need to be further validated in prospective studies before changes in current guidelines for practice might be considered. Although animal model studies are hypothesis-generating, their relevance to humans must be established in rigorous clinical studies that could include population surveillance studies. His other concern is in regard to our statement that “phototherapy has saved the lives of millions from death and disabilities…”. Although the exact number of infants who might have been spared morbidities or mortality is uncertain and debatable, it is likely that “millions” have been protected from injury caused by excessive bilirubin levels based simply on the computation of approximations to estimate the potential numbers of lives saved and disabilities prevented from the use of phototherapy.

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References

  1. Hansen TWR, Maisels MJ, Ebbesen F, et al. Sixty years of phototherapy for neonatal jaundice - from serendipitous observation to standardized treatment and rescue for millions. J Perinatol. 2020;40:180–93.

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Authors and Affiliations

  1. Division of Pediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway

    Thor Willy Ruud Hansen

  2. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Thor Willy Ruud Hansen

  3. Department of Pediatrics, Oakland University William Beaumont, School of Medicine, Beaumont Children’s Hospital, Royal Oak, MI, USA

    M. Jeffrey Maisels

  4. Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark

    Finn Ebbesen

  5. Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark

    Finn Ebbesen

  6. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

    Hendrik J. Vreman, David K. Stevenson, Ronald J. Wong & Vinod K. Bhutani

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  1. Thor Willy Ruud Hansen
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  2. M. Jeffrey Maisels
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  3. Finn Ebbesen
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  5. David K. Stevenson
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  7. Vinod K. Bhutani
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Correspondence to Vinod K. Bhutani.

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Hansen, T.W.R., Jeffrey Maisels, M., Ebbesen, F. et al. Sixty years of phototherapy for neonatal jaundice: from serendipitous observation to standardized treatment and rescue for millions. J Perinatol 40, 1582–1583 (2020). https://doi.org/10.1038/s41372-020-0712-3

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  • DOI: https://doi.org/10.1038/s41372-020-0712-3

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