Effectiveness of Double-surface Intensive Phototherapy in Neonatal Hyperbilirubinemia with G6PD Deficiency

Abstract

Effectiveness of Double-surface Intensive Phototherapy in Neonatal Hyperbilirubinemia with G6PD Deficiency

Payon Boonyarittipong MD

Panida Horharin MD

Kannikar Booranavanich MD

Manutham Manawathongchai MD

Department of Pediatrics, BMA Medical College and Vajira Hospital, Bangkok

Objective: To evaluate the effectiveness and adverse effects of double-surface intensive phototherapy (DsIPT) in comparison with single-surface intensive phototherapy (SsIPT) in the treatment of term jaundiced infants with G6PD deficiency.

Study design: Prospective randomized controlled trial.

Subjects: Fourty-five infants born in BMA Medical College and Vajira Hospital between November 2006 to June 2007 were enrolled. All subjects were healthy term infants with gestational age 37-42 weeks, birth weight > 2,500 g. They had no evidence of birth asphyxia, the APGAR score at 1 and 5 minutes were more than 6. All of them had hyperbilirubinemia (bilirubin 13.0 - 19.9 mg/dl) with G6PD deficiency, but without blood group incompatibility and congenital spherocytosis.

Methods: All subjects were allocated into two groups by simple randomization. Twenty-three infants were in the control group and received SsIPT, 22 infants were in the study group and received DsIPT. Serum bilirubin was measured at 12, 24, 36 and 48 hours after phototherapy. Body weight, mean body temperature and number of defecation were recorded at 24 and 48 hours after phototherapy.

Main outcome measures: The decrease in total serum bilirubin and adverse effects in terms of body temperature, weight loss and number of defecation after treatment 12, 24, 36 and 48 hours.

Results: Demographic characteristics of the infants such as birth weight, APGAR score, hematocrit and reticulocyte count in both groups were not significantly different, except mean age at start phototherapy in the control group was significantly earlier than in the study group (53.7 + 16.7 vs 62.7 + 9.8 hours). Initial mean serum bilirubin in the study group was significantly higher than in the control group (16.3 + 2.0 vs 15.1 + 1.7 mg/dl). After 12, 24, 36 and 48 hours of phototherapy, mean serum bilirubin in the study group declined significantly more than in the control group. (2.9 + 1.3, 5.4 + 1.6, 7.1 + 1.8, 7.5 + 1.8 mg/dl or 17.8 + 6.9%, 33.0 + 8.3%, 43.0 + 7.8%, 45.7 + 6.9% in the study group compared with 1.2 + 0.8, 2.5 + 1.5, 3.7 + 1.6, 4.9 + 1.5 mg/dl or 8.1 + 4.9%, 16.4 + 8.4%, 24.4 + 9.9%, 32.4 + 9.7% in the control group. Mean body temperature after 24 hours of phototherapy in the study group was significantly higher than in the control group but without clinical significance (37.1 + 0.1 vs 37.0 + 0.2 ^oC). Mean body weight loss in the control group was significantly more than in the study group after 24 hours of phototherapy (2.4 + 1.7% vs 1.6 + 0.4%), but the number of defecation in both groups were not statistically significant different.

Conclusion: DsIPT was significantly more effective in reducing serum bilirubin than SsIPT in term jaundiced infants with G6PD deficiency after 12, 24, 36 and 48 hours of treatment.

Keywords: unconjugated hyperbilirubinemia, G6PD deficiency, single-surface intensive phototherapy (SsIPT), double-surface intensive phototherapy (DsIPT)

Vajira Med J 2010 ; 54 : 123-133