PHOTOTHERAPY

फोटोथेरेपी

(ADVANCED LED PHOTOTHERAPY)

लगभग 70% बच्चों को पहले हफ्ते में पीलापन दिखता है। यह ज़्यादातर बच्चों में लिवर के एंज़ाइमों की अपरिपक्वता एवं रक्त में लाल रक्त कोशिकाओं की ज्यादा मात्रा होने के कारण होता है। सामान्यतः यह पहले सात दिन में ही ठीक भी हो जाता है।

इनमें से केवल 5% से 10% बच्चों को फोटोथेरेपी के इलाज (नवजात शिशुओं में होने वाले पीलिया का इलाज फोटोथेरेपी द्वारा होता है) की जरूरत पड़ती है।

असल में पीलिया की शिकायत वाले सभी बच्चों को पीलिया से नुकसान नहीं होता है, पर इनमें से कुछ बच्चों को पीलिया ज्यादा होने के कारण दिमाग पर पीलिया का नुकसान हो सकता है। चूंकि वह कौन से बच्चे हैं जिनको ज्यादा पीलिया से कोई नुकसान नहीं होगा और किसका पीलिया इतना ज्यादा बड़ जायेगा की दिमाग पर नुकसान हो जाये, यह पता करना काफी कठिन होता है। इसीलिए एक सीमा से ज्यादा पीलिया होने पर (यह बच्चे की उम्र, उसकी गर्भावधि उम्र, और कुछ रिस्क फ़ैक्टर्स जैसे संक्रमण आदि पर निर्भर करता है) बच्चों को फोटोथेरेपी के इलाज की सलाह दी जाती है।

फोटोथेरेपी इलाज में बच्चे के कपड़े निकाल के उसे रेडियंट वार्मर बेड पर लिटाया जाता है, उसकी आँखें कवर करके सारे शरीर पर फोटोथेरेपी का प्रकाश डाला जाता है। यह इलाज सामान्यतः लगातार दिया जाता है और इसकी अवधि आमतौर पर दो से चार दिन होती है। इस इलाज में किसी प्रकार के इंजेक्शन, एंटीबायोटिक या आइ.वी. फ्लुइड की आवश्यकता नहीं होती है। इस दौरान डॉक्टर जितना संभव हो माँ का दूध जारी रखने की सलाह देते हैं। आधुनिक फोटोथेरेपी मशीन के साथ ज़्यादातर (~95%) बच्चों को इस इलाज से किसी प्रकार के खराब असर की शिकायत नहीं होती है।

नियो चिल्ड्रन हॉस्पिटल में उच्च कोटि की आधुनिक LED फोटोथेरेपी से नवजात शिशुओं के पीलिया का इलाज किया जाता है।

Neonatal Jaundice: Do we know enough?

Neonatal jaundice is yellowish discoloration of the skin and other tissues of a newborn infant due to excess amount of yellow pigment called bilirubin in the body. A bilirubin level of more than 5 mg/dL manifests clinical jaundice in neonates. Jaundice in the neonate appears first in the face and upper body and with increasing serum bilirubin levels it progresses downward toward the hands and feet. Premature infants are more likely to develop jaundice than full-term infants.

Neonatal jaundice is a common phenomenon and nearly 70% of term and 80% of preterm infants develop jaundice in early neonatal period. Although, unlike adults or children, jaundice in neonates is usually non-pathological and usually do not warrant any treatment; up to 10% of these neonates require treatment to prevent adverse effects due to very high serum bilirubin levels.

Being such a common phenomena neonatal jaundice really need general public awareness. There are lots of issues related to neonatal jaundice which are unclear to many of us. In this article I have answered some common queries on neonatal jaundice in a rational way on the basis of current scientific evidences.

1. What is the usual time course of neonatal jaundice?

Neonatal jaundice is usually a transient phenomena occurring due to excessive production and inadequate removal of serum bilirubin in neonates. In most of the neonate jaundice appear on second day of age, increase in severity till day three to four of age and then start decreasing to eventually disappear by day seven of age.

2. Do all neonates with jaundice require treatment?

NO, because neonatal jaundice is usually a physiological event, not all neonates with jaundice require treatment. Only 8% - 10% of all neonates require treatment for jaundice.

3. Do neonates with jaundice require special care?

No, except for treatment of jaundice (required in few babies) jaundiced neonates do not require any special care. There is absolutely no need to place any dietary restriction to the mother of a jaundiced neonate.

4. Does breast feeding affect neonatal jaundice?

Inadequate breast feeding increases entero-hepatic circulation of bilirubin (inadequate removal of serum bilirubin via gut) and can increase serum bilirubin levels in a jaundiced neonate.

5. How to decide which neonates would require treatment?

Treatment of neonatal jaundice is based on serum bilirubin levels, baby’s gestational age, postnatal age, and presence of any risk factors for jaundice. Based on above mentioned factors, cutoff bilirubin levels for treatment are decided with the help of internationally accepted charts on Management of Neonatal Hyperbilirubinemia, prepared by a subcommittee of American Academy of Pediatrics (AAP 2004) headed by an Indo-American doctor, Dr Vinod K Bhutani.

6. What is neonatal hyperbilirubinemia?

When serum bilirubin levels increased to pathological range in a neonate it is termed as neonatal hyperbilirubinemia.

7. What are the additional risk factors for neonatal hyperbilirubinemia?

Most common and modifiable risk factor for neonatal hyperbilirubinemia is inadequate /infrequent breast feeding. Prematurity (gestation less than 37 weeks), blood group incompatibility, and birth trauma are other common risk factors.

8. Can we use sunlight as a treatment for neonatal hyperbilirubinemia?

Based on available evidences treatment for neonatal jaundice is an all or none phenomenon. Because treatment for jaundice in a particular infant is started at bilirubin levels which are in unsafe range or may progress to unsafe range, treatment is intensive phototherapy delivered by artificially made special blue tube lights or special compact fluorescent lamps which deliver light in particular wavelengths. Sun rays definitely incorporate 425 to 475 nm wavelengths, spectrum of light used to treat neonatal jaundice; however, as sun rays include vast spectrum of visible and invisible light, irradiance of sun rays in medically useful spectrum is very limited. In addition, ultraviolet part of sun rays can damage fragile neonatal skin and there are always risk of hyper- or hypothermia to exposed infant. So, as of now based on available evidences, use of sunlight for treatment of neonatal jaundice is not recommended.

9. What is the treatment for neonatal hyperbilirubinemia?

Treatment for neonatal jaundice is usually a non-invasive and simple procedure called phototherapy. Neonates are placed under special tube lights or compact fluorescent lamps. Treatment generally last for 24 to 72 hours. One should continue breast feeding during the treatment. However, as phototherapy is a simple and relatively risk free procedure, it should not be overdone.

It should be remembered that in few neonates, with very high serum bilirubin levels for baby’s postnatal age and gestation, exchange transfusion (blood of the baby is exchanged with blood born disease free and cross matched blood from a certified blood bank) may be required to rapidly decrease the serum bilirubin levels.

10. What are the adverse effects of neonatal hyperbilirubinemia?

Significantly high serum bilirubin levels in a neonate, if not treated promptly, can cause bilirubin induced brain damage (kernicterus). Kernicterus is a dangerous and potentially lethal complication leading to permanent brain damage if not treated in early stages.