The impact of hemoglobin on the efficacy of phototherapy in hyperbilirubinemic infants

BACKGROUND: Phototherapy is the routine treatment for neonatal hyperbilirubinemia. Absorption of light in the skin transforms the native Z, Z-bilirubin to photobilirubins. This study investigates whether the hemoglobin concentration has an impact on efficacy of phototherapy, expressed by the decline of total serum bilirubin concentration (TsB). METHODS: A trial was conducted on 93 infants, gestational age >= 33 weeks, with uncomplicated hyperbilirubinemia. The infants were treated with conventional phototherapy using LED light for 24 h. The median light irradiance was 66.8 mu W/cm(2)/nm. RESULTS: The median decrease in TsB after 24 h was 121 (57-199) mu mol/l; the median hemoglobin was 12.0 (7.0-14.7) mmol/l. There was a significant effect of hemoglobin concentration on the decrease in TsB of - 3.61 mu mol/mmol hemoglobin (P = 0.022), after adjusting for initial TsB and postnatal age. That is, assuming the same initial TsB and postnatal age, for each mmol/l increase in hemoglobin, the decrease in TsB was 3.61 mu mol/l smaller. In our hemoglobin range, the decrease in TsB is reduced by 28 mu mol/l (23%). CONCLUSION: Increasing hemoglobin levels led to a decrease in the efficacy of phototherapy. Our data provide additional support for the conclusion that the transformation of bilirubin to photobilirubins takes place mainly in the superficial capillaries of the skin.