Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
On Sep 2018




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On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : SC01 - SC05 Full Version

Effects of Different Types of Phototherapy Units on Neonatal Jaundice: A Cross-sectional Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55618.16417
Sathyamoorthy Mani, Karthikeyan Panneerselvam, Suresh Rangaraj, Balaji Ramraj, Subash Sundar

1. Associate Professor, Department of Paediatrics, SRM Medical college Hospital and Research Centre, Kattankulathur, Tamil Nadu, India. 2. Professor, Department of Paediatrics, SRM Medical college Hospital and Research Centre, Kattankulathur, Tamil Nadu, India. 3. Assistant Professor, Department of Paediatrics, SRM Medical college Hospital and Research Centre, Kattankulathur, Tamil Nadu, India. 4. Scientist-E (Medical), ICMR-National Institute of Research in Tuberculosis, Chennai, Tamil Nadu, India. 5. Professor, Department of Paediatrics, SRM Medical college Hospital and Research Centre, Kattankulathur, Tamil Nadu, India.

Correspondence Address :
Dr. Karthikeyan Panneerselvam,
Professor, Department of Paediatrics, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India.
E-mail: karthik.dch@gmail.com

Abstract

Introduction: Phototherapy is the mainstay of treatment of neonates who develop significant jaundice. Light-emitting diode and compact florescent lamp phototherapy units are the newer devices in the management of neonatal hyperbilirubinaemia. The advantage of light-emitting diode phototherapy includes portability, energy efficiency, less heat production, and durability. Blue and white phototherapy devices are more economical but generate more heat leading to hyperthermia and dehydration more often.

Aim: To determine the efficacy and side effects of three modes of phototherapy units viz conventional blue and white light phototherapy, Compact Fluorescent Lamp (CFL) phototherapy, and Light-emitting Diode (LED) phototherapy on neonates having jaundice.

Materials and Methods: This cross-sectional study was conducted in Department of Paediatrics at SRM Medical college Hospital and Research Centre (tertiary care teaching hospital), Kattankulathur, Tamil Nadu, India, from February 2021 to January 2022. A total of 150 neonates with hyperbilirubinaemia in the phototherapy range, American Academy of Paediatrics (AAP), were included in this study. Study subjects were divided into three groups of 50 neonates each to receive phototherapy using one of the three phototherapy devices, i.e., Blue and white light, CFL, LED phototherapy groups. Data of serum bilirubin levels were recorded at the beginning and end of phototherapy. The number of babies who required exchange transfusion and other clinical side effects among the study groups was recorded. Descriptive statistics were reported as Mean±SD for continuous variables, frequencies (percentage) for categorical variables. The One-way Analysis of Variance (ANOVA) test was used to determine the statistically significant differences between the means of three independent groups.

Results: All the three type of phototherapy units generated statistically non significant mean flux (p-value=0.754). Mean difference (from the baseline bilirubin) at end of phototherapy for blue and white light group was 5.77±1.72 mg%, for CFL group was 5.48±1.32 mg%, and for LED group was 6.34±1.48 mg%. The difference was statistically significant in all three groups (p-value=<0.001). The reduction in serum bilirubin at the end of phototherapy was lesser in CFL group compared to blue and white light group and LED group.

Conclusion: Light-emitting diode and blue and white light phototherapy units are more effective than compact fluorescent lamp phototherapy in treating neonatal hyperbilirubinaemia.

Keywords

Blue and white, Compact fluorescent lamp phototherapy devices, Efficacy, Light-emitting diode, Side effects

Unconjugated hyperbilirubinaemia occurs as a result of increased bilirubin production from excessive lysis of Red Blood Cells (RBC) during the 1st week of neonatal life and also because of the inability of the neonatal liver to clear bilirubin rapidly enough from the blood. In India, various researchers report an overall neonatal jaundice rate ranging from 54.6-77%. About 4-8% of neonates develop pathological jaundice (1). In a study by Dutta D et al., neonatal jaundice constituted 15.3% of Neonatal Intensive Care Unit (NICU) admissions (2). Many of them suffer from unconjugated hyperbilirubinaemia.

Babies with jaundice need to be monitored closely, as higher serum bilirubin is potentially toxic to the central nervous system which can lead to bilirubin encephalopathy and subsequently kernicterus, with devastating permanent neurodevelopmental handicap (3). Consequently, treatment should be expedited as soon as possible. Phototherapy is a widely used treatment modality for neonatal jaundice.

Halogen or compact fluorescent lamps are commonly used in conventional phototherapy. The advantages of Light-emitting diode phototherapy are their less power consumption, durability, compact size of the device, and minimal heat production (4). Researchers Gutta S et al., (5) and Karagol BS et al., (6) found that the total serum bilirubin levels decreased significantly when phototherapy was given using light-emitting diodes.

According to reports by Mohammadizadeh M et al., (7), Takci S et al., (8), there is no significant difference between the light-emitting diode and conventional phototherapy groups regarding serum bilirubin reduction. Another study by Ngerncham S et al., concluded that special blue fluorescent tubes phototherapy is more effective than Light-emitting diode phototherapy in reducing serum bilirubin level (9). In contrast, the Cochrane review in 2011 concluded that phototherapy with either light-emitting diode or conventional light sources reduced serum total bilirubin levels equally (10).

Bilirubin molecules on exposure to phototherapy light, undergo photochemical reactions viz configurational isomerization, structural isomerization, and photo-oxidation to form nontoxic, excretable water-soluble isomers which can be excreted from the liver into the bile without undergoing conjugation or requiring special transport for their excretion.

Light-emitting diode and compact fluorescent lamp phototherapy units are the newer devices in the management of neonatal hyperbilirubinaemia. The advantages of light-emitting diode phototherapy include portability, energy efficiency, less heat production, and durability, but these are more expensive. Blue and white light phototherapy devices are more economical but generate more heat leading to hyperthermia and dehydration often.

Hence, this study was conducted in a tertiary care centre to compare the effects of these three phototherapy devices viz blue and white, compact fluorescent lamp, light-emitting diode on neonates having jaundice.

Material and Methods

This cross-sectional study was conducted in Department of Paediatrics at SRM Medical college Hospital and Research Centre (tertiary care teaching hospital), Kattankulathur, Tamil Nadu, India, from February 2021 to January 2022. This study was approved by the Institutional Ethical Committee prior to its commencement (SRM Medical College Hospital and Research centre Ethics Clearance No: 2366/IEC/2021).

Inclusion criteria: Neonates with

a) Indirect hyperbilirubinaemia in phototherapy range requiring phototherapy as per AAP guidelines (11), and gestational age more than 35 weeks,
b) Birth weight more than 2000 grams.
c) Exclusively breastfed and healthy were considered to be included in the study.

Exclusion criteria: Sick babies on intravenous fluids/medications like antibiotics, birth injuries (cephalhematoma) and babies with direct hyperbilirubinaemia , serum conjugated bilirubin level of more than 20 % of total bilirubin were excluded from the study.

Sample size calculation: Power analysis for a one-way ANOVA fixer effect with three groups was conducted in G*Power to determine a sufficient sample size using an alpha of 0.05, a power of 0.80, and large effect size (f = 0.40). Based on the aforementioned assumptions, the desired sample size is 40 per group. The total sample size was calculated as 150 including 20% attrition rate of 50 per group.

Procedure

Total 150 neonates having jaundice in the phototherapy criteria were divided into three groups of 50 neonates each, and were subjected to one of the phototherapy units viz. Blue and white light phototherapy (B&W), Compact Fluorescent Lamp (CFL) phototherapy or Light-Emitting Diode (LED) (Table/Fig 1). After obtaining informed agreement from the parents, the newborns appearing icteric on clinical examination were subjected to estimation of baseline serum bilirubin levels. Relevant history and complete physical examination were recorded for all the neonates.

The irradiance of the blue and white light phototherapy unit was increased using aluminium foils as reflectors (Table/Fig 2).

The babies were positioned 30 centimeters from the top and bottom surfaces of all phototherapy units (Table/Fig 3).

The irradiance delivered in all three phototherapy devices was between 25 to 32 μW/cm2/nm. The mean irradiance delivered in all three phototherapy devices was 27 μW/cm2/nm which was closer to intensive phototherapy. The interrupted time during phototherapy like feeding time, blood sampling time, diaper change time etc were calculated and deducted, to get the actual duration of phototherapy in hours.

Serum bilirubin levels were checked at the initiation of phototherapy, at 24 hours, and end of phototherapy using the 2,5-dichlorophenyldiazonium tetrafuoroborate (DPD)/Jendrassik-Groff method. Non invasive Transcutaneous Bilirubin (TcB) was carried out at 24 hrs after initiating phototherapy for monitoring the effect of phototherapy. Non-invasive TcB measurement was done over the forehead and sternum and the average value was recorded (Table/Fig 4).

Data Collection

Baseline characteristics of study groups (birth weight, gestational age, gender, hemoglobin and age (in hours of life) at the initiation of phototherapy, and mean flux delivered were recorded. Serum bilirubin levels were measured in the laboratory (Lab) at the start and completion of phototherapy. Because the results of non invasive TcB cannot be trusted after the skin surface has been exposed to irradiance for a few hours, a laboratory serum bilirubin level was measured at the end of phototherapy. A flux meter was used to measure irradiance (Table/Fig 5).

A five-point measurement of flux was taken from all four corners and the centre of the phototherapy unit bed [where the baby was positioned for phototherapy] and the average of these five readings was taken for calculating flux. In accordance with the AAP chart (4), the decision to stop phototherapy was based on a reduction in serum bilirubin to below the phototherapy range.

Outcome measures: Efficacy of the phototherapy was judged by the following outcome measures:

Primary outcome: Need for exchange transfusion

Secondary outcomes: Mean serum bilirubin value at the point of decision to stop /end of phototherapy, and side effect profile.

Statistical Analysis

The obtained data was entered in Microsoft excel. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 19.0. One-way Analysis of Variance (ANOVA) was used for the comparison of mean total serum bilirubin between the groups for variables such as birth weight, gestational age, haemoglobin, age in hours at the start of phototherapy. Qualitative variables such as gender and adverse events were analysed using the Chi-square test. Significance was taken as p-value < 0.05.

Results

At the start of phototherapy, there was no significant difference between the three groups of neonates in terms of birth weight, gestational age, gender distribution, or haemoglobin (one-way ANOVA, p-value >0.05) (Table/Fig 6).

The three groups did not differ significantly in age criteria (hours of life) at the start of phototherapy (one-way ANOVA, p-value >0.05). The duration of phototherapy was similarly not significantly different across the groups (one-way ANOVA, p-value >0.05). There was no statistical difference between the mean fluxes delivered between the groups.

When the mean bilirubin values of the three groups were compared at the start of phototherapy, no significant differences were found. This holds true for Transcutaneous bilirubinometer (TcB) measurement as well. The mean total bilirubin levels, recorded after 24 hours, did not differ significantly between the three groups (one-way ANOVA, p-value >0.05) (Table/Fig 7).

Mean difference from the baseline bilirubin at end of phototherapy Laboratory value (mg%) (Mean±SD) for blue and white light group was 5.77±1.72, for CFL group was 5.48±1.32, and for LED group was 6.34±1.48. The difference was statistically significant in all three groups (Table/Fig 8). The reduction in serum bilirubin at the end of phototherapy was greater in blue and white and LED group when compared to CFL group.

None of the babies in the three groups required exchange transfusion (Table/Fig 7) and all the babies were successfully treated with one of these devices and discharged.

All three phototherapy units generated statistically negligible mean flux (p-value >0.05). Overall, the side effects like rashes and loose stools noted among all the three groups were minor and transient and did not necessitate stopping of therapy. Out of six babies who developed mild dehydration, four were in blue and white light group and one each in CFL and LED group (Table/Fig 9).

They did not require any intervention, as it was mild and was managed with frequent timely feeding by the mothers.

Discussion

In routine clinical practice, a variety of phototherapy light sources are employed, with different manufacturers suggesting that newer lights, such as CFLs and LEDs, have a higher efficacy (12).

For newborns with substantial hyperbilirubinaemia, the most effective light source with the fewest side effects would be preferred if the phototherapy device availability is not an issue. In light of this, the current study was designed to compare the efficacy and side effects of various phototherapy units, Viz., blue and white, CFL and LED. The mean irradiance delivered by all three phototherapy units was 27 μW/cm2/nm which was closer to the intensive phototherapy range (Irradiance level for intensive phototherapy is >30 μW/cm2/nm as per AAP) (11). The American Academy of Paediatrics currently recommends special blue fluorescent lamps or LED lights as these are effective in various clinical studies (11). Chang, et al (12) found that using a high-intensity LED device was far more effective than using traditional phototherapy. However, LED devices were not shown to be more effective than other modalities of phototherapy in a Cochrane review published in 2011 that compared six trials (10). Another study by Jain PK et al., showed LED phototherapy is superior to CFL phototherapy in the management of neonatal hyperbilirubinaemia in terms of efficacy and side effects. The irradiance of LED group was 49 μW/cm2/nm and that of CFL group was 40 μW/cm2/nm (13). In the present study, there was no difference in terms of efficacy between blue and white light and LED groups which is similar to a Cochrane review published by Kumar P et al., (10).

Adhikari KM et al. (14) compared the efficacy of three different phototherapy units (blue and white, CFL and LED phototherapy devices) with a mean irradiance of 45 to 55 μW/cm2/nm. They found that the mean total serum bilirubin level at the end of phototherapy did not show any statistical significance between these three groups.

In the present study, with a mean irradiance of 27 μW/cm2/nm, it was found that LED phototherapy and blue and white light phototherapy were more effective than CFL phototherapy.

Gutta S et al., (7) compared conventional blue and white light phototherapy with LED phototherapy. In his study 166 neonates, (83 in each mode of phototherapy) were placed 30 to 40 cm away from the light source with an irradiance of 8 to 12 μW/cm2/nm for blue and white and 30 to 40 μW/cm2/nm for LED phototherapy unit. The study concluded that LED phototherapy was more effective in decreasing total serum bilirubin than blue and white light phototherapy. In the current study, the baby was positioned at 30 cm from the light source and irradiance of blue and white was enhanced with aluminium foils to achieve a spectral irradiance closer to Intensive phototherapy range similar to LED phototherapy. Higher irradiance of LED phototherapy group could have contributed to the superiority of this device in the above study.

Efficacy of LED phototherapy and conventional phototherapy in decreasing serum bilirubin was not significantly different between the groups according to reports by Mohammadizadeh M et al., (7), Takci S et al., (8), which is similar to the index study. As per a study by Ngerncham S et al., (9) special blue Fluorescent tubes phototherapy, is more effective than LED phototherapy in reducing serum bilirubin level. In this study the irradiance of special blue fluorescent tubes phototherapy was twice higher than that of light-emitting diode phototherapy.

In our study, the reduction in serum bilirubin was lesser in CFL phototherapy group when compared to the B&W light phototherapy group and LED group. In all three study groups, none of them required Exchange transfusion. The adverse effects noted in the study subjects were dehydration, weight loss, loose stools and rashes, which were comparable among the groups. In a study by Jain PK et al., (13), fever was the most common adverse effect due to phototherapy. In the present study, dehydration and rashes were the predominant adverse effect, which is similar to a study by Adhikari KM et al., (14). All rashes were self-limiting and disappeared on their own. Periodic reinforcement to mothers by staff about the necessity of regular temperature monitoring and timely feeding of babies while on phototherapy reduced the incidence of both hyperthermia and dehydration. Since the study excluded babies with birth weight <2000 gm and sick babies, it was possible to ensure exclusive breastfeeding of all the neonates in the study group.

Limitation(s)

The mean irradiance delivered in all the phototherapy devices was less than the intensive phototherapy range, and babies were positioned 30 cm away from the phototherapy light source. Irradiance could have been increased by positioning the babies even closer to the light source. Serial measurements of the rate of fall of serum bilirubin levels could have strengthened the comparison of these three different phototherapy devices.

Conclusion

Light-emitting diode and blue and white phototherapy units are more effective than compact fluorescent lamp phototherapy in treating neonatal hyperbilirubinaemia.

If effective irradiance, adequate feeding, and constant monitoring were maintained, all three phototherapy devices could treat hyperbilirubinaemia effectively and safely. Larger multicentric trials are required for establishing the superiority of blue and white light or LED phototherapy for effectively treating neonatal hyperbilirubinaemia.

Acknowledgement

The authors are grateful to all the faculty members of the Department of Biochemistry, for their encouragement and support.

References

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DOI and Others

DOI: 10.7860/JCDR/2022/55618.16417

Date of Submission: Feb 18, 2022
Date of Peer Review: Mar 12, 2022
Date of Acceptance: Apr 08, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 21, 2022
• Manual Googling: Apr 18, 2022
• iThenticate Software: Apr 21, 2022 (20%)

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