121 - Intensive phototherapy using multiple LED phototherapy devices to avoid exchange transfusion in Asian newborns with severe hyperbilirubinemia

Asian newborns are at increased risk of developing severe hyperbilirubinemia due in part to relatively higher frequency of UGT1A1 mutations. To prevent the development of kernicterus and cerebral palsy, exchange transfusions (ETs) are considered when the effect of phototherapy(PT) is insufficient. While the safety and simplicity of PT are well established, procedures of ETs are complex and work-force-consuming, and may cause a range of complications. Consequently, ETs are performed only in limited NICUs . After the introduction of the blue LED PT devices, delivery of high dose light energy with optimized wavelengths in lowering total serum bilirubin (TSB) levels has become available. Intensive PT using multiple LED devices may reduce the opportunity of performing ETs.

Objective:

To investigate whether intensive PT in newborns, who met the criteria of ETs and were waiting for the preparation of the reconstituted blood, can ultimately reduce the requirement for ETs.

Design/Methods:

Among 547 newborns admitted to our tertiary NICU between February 2021 and August 2022, we retrospectively evaluated the late preterm and term patients, who were referred to the NICU after meeting the criteria of ETs (established for east Asian newborns by Nakamura, Table 1). While waiting for the delivery of the reconstituted blood, newborns were treated with PT with the distance of approximately 30 cm from the chest wall, with irradiance of 1.5 to 2 times higher than standard intensive PT suggested by American Academy of Pediatrics. Patient background, etiology of hyperbilirubinemia, TSB level before and after PT, and avoidance rate of ETs were examined.

Results:

Twelve patients were included in the analysis, with a gestational week of 38.1 [36.7-39.9], a birth weight of 2874 g [2482-3798], and a treatment start date of 3 days [0-12] (median [range], Figure1, Table 2). Nine cases were idiopathic, two had alloimmune hemolytic disease, and one had Gilbert's syndrome. The reduction rate of TSB was 0.5 mg/dL/h, which resulted in the TSB levels below the threshold for ETs in eleven newborns by the time the reconstituted blood became available at about six hours of admission. The avoidance rate for ETs was 92%.

Conclusion(s):

Intensive phototherapy with high dose light energy helped to reduce the requirement for ETs in newborns with severe hyperbilirubinemia. Intensive phototherapy may contribute to reduce complications of ETs. Large scale studies are needed to assess unexpected complications of the intensive phototherapy with high dose light energy using multiple LED phototherapy devices.