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PHOTOTHERAPY-A REVIEW

PHOTOTHERAPY-A REVIEW. Srichakra Scientifics Pvt. Ltd. OUTLINE. HISTORICAL NOTES MECHANISM-HOW IT WORKS EFFICACY DATA SIDE EFFECTS LONG TERM OUTCOME. HISTORICAL NOTE.

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PHOTOTHERAPY-A REVIEW

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  1. PHOTOTHERAPY-A REVIEW Srichakra Scientifics Pvt. Ltd.

  2. OUTLINE • HISTORICAL NOTES • MECHANISM-HOW IT WORKS • EFFICACY DATA • SIDE EFFECTS • LONG TERM OUTCOME

  3. HISTORICAL NOTE FIRST PAPER ON PHOTOTHERAPY PUBLISHED IN 1958 (CREMER,LANCET) BASED ON THEIR IN VITRO OBSERVATION OF FALLING VALUES OF BILIRUBIN WHEN SERUM SAMPLES WERE EXPOSED TO LIGHT

  4. HISTORICAL NOTES-CONT’D • SEVERAL CLINICAL TRIALS IN THE ’60s CONFIRMED THE EFFICACY OF PHOTOTHERAPY LEADING TO ITS USE AS STANDARD CARETRIALS ALSO SHOWED MORE EFFICACY AMONG LOW BIRTH WEIGHT INFANTS

  5. MECHANISM • BILIRUBIN ABSORS PHOTON FROM LIGHT AT 450 nm ( IN VITRO) • PHOTOCHEMICAL REACTIONS • FORMATION OF THREE MAJOR PRODUCTS THAT ENHANCES ELIMINATION

  6. ABSORPTION SPECTRUM OF BILIRUBIN

  7. ABSORPTION OF LIGHT BY BILIRUBIN IN VIVO • BECAUSE BILIRUBIN IN VIVO IS BOUND TO ALBUMIN ,SPECTRUM OF MAXIMUM ABSORPTION IS SHIFTED TO THE RIGHT ( 450 TO 475 nm) • THIS EXPLAINS THE VARIABLE EFFICACY OF LIGHT USED IN CLINICAL SETTING

  8. PHOTOCHEMICAL REACTIONS LIGHTBILIRUBIN ABSORBS PHOTON ‘ EXCITED’ BILIRUBIN ↓ ↓ ↓ ↓ PHOTO-OXIDATION ↓ STRUCTURAL ISOMEZARATION (LUMIRUBIN) ↓ CONFIGURATIONAL ISOMERIZATION ( 4E,15Z,4Z,15E AND 4E,15E PHOTOISOMERES)

  9. PHOTO-OXIDATION • SINCE CREMER’S REPORT(1958), IT HAS BEEN ASSUMED THAT PHOTO-OXIDATION IS THE MECHANISM FOR  BILIRUBIN EXCRETION • 1984, ISOMERE FORMATION FOUND TO BE THE MAJOR MECHNISM

  10. CONFIGURATIONAL ISOMERIZATION (4Z,15E)

  11. STRUCTURAL ISOMERIZATION (LUMIRUBIN)

  12. PHYSICAL PROPERTY OF BILIRUBIN AND ITS PRODUCT • NATIVE BILIRUBIN ( 4Z,15Z) HYDROPHOBIC AND LIPOPHYLIC • BILIRUBIN ISOMERES ARE LESS LIPOPHYLIC AND HYDROPHOBIC • ENHANCE ELIMINATION VIA BILE AND URINE

  13. RATE OF FORMATION & ELIMINATION OF BILIRUBIN • RATE OF FORMATION:4Z,15E ISOMERES > LUMIRUBIN > PHOTO-OXIDATION PRODUCTS • RATE OF EXCRETION:LUMRUBIN >4Z,15E > PHOTOOXIDATION PRODUCTS • LUMIRUBIN APPEARS TO BE THE MAJOR FORM OF ELIMIATION

  14. PHOTO-CHEMICAL REACTION & ELIMINATION OF BILIRUBIN

  15. FACTORS AFFECTING EFFICACY OF PHOTOTHERY • DEPENDENT ON • TYPE OF LIGHT USED • LIGHT INTENSITY • SURFACE AREA OF SKIN EXPOSED TO LIGHT • DISTANCE FROM LIGHT TO BABY

  16. TYPES OF PHOTOTHERAPY DEVICE • FLUORESCENT TUBES • DAYLIGHT(WHITE) • BLUE • GREEN • HALOGEN LAMPS • FIBEROPTIC SYSTEM • GALLIUM NITRIDE LIGHT EMITTING DIODES (L.E.D)

  17. COMPARISON OF DIFFERENT LIGHTS % REDUCTION IN SERUM BILIRUBIN P<0.05 TAN KL ET AL: PEDIATRICS,114:132,1989

  18. CONCLUSION (TAN) • PREFERABLE TO USE EITHER DAYLIGHT( PROVIDES ENHANCED CLINICAL OBSERVATION AND ADEQUATE EFFICACY) OR BLUE LIGHT (BETTER EFFICACY) • NOT GREEN LIGHT WHICH PROVIDES NEITHER

  19. HALOGEN LAMPS • MORE COMPACT THAN FLORESCENT LAMP • CAN NOT BE BROUGHT TOO CLOSE TO INFANT ( RISK OF BURN)

  20. FIBEROPTIC SYSTEM (WALLABY) • ADVANTAGES • NO EYE PATCH NECESSARY • MORE PORTABLE • CONVENIENT FOR MOTHER AND HOME THERAPY • DISADVANTAGE • LOW SPECTRAL POWER

  21. FIBEROPTIC VS. CONVENTIONAL DECLINE IN SERUM BILIRUBIN (M/L/HR) N.S. P<0.05 FIBER CONV.

  22. LIGHT EMITTING DIODES • NARROW BAND OF LIGHT SPECTRUM( BLUE-GREEN) • POWER EFFICIENT AND LOW HEAT EMISSION • SOMEWHAT EYE-IRRITATING TO THE STAFF

  23. LIGHT SPECTRUM OF LED

  24. RCT FOR LED VS HALOGEN LAMP SERUM BILIRUBIN (µM/L) ENTRY DURING (N=34)(N=35) SEDMAN, DS ET AL J PEDTRIC136:771,2000

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