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Efficacy of phototherapy of neonatal jaundice – light wavelength matters

Pediatric Research (2024)Cite this article

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Since its discovery in 50´s of the last century,1 phototherapy of neonatal jaundice has become the golden standard in the treatment of severe neonatal jaundice.2 Exposure of the newborn to the light of a specific wavelength (blue or blue-green light) leads to photisomerization and photooxidation of unconjugated bilirubin (UCB), the products of which are more polar and excretable through the kidneys into the urine and the liver into the bile. In the last seven decades, phototherapy has become a modern, evidence-based therapeutic tool, with the development of treatment protocols to maximize its efficacy. Among the factors most importantly affecting the efficacy of phototherapy are irradiance intensity (depending on the skin area exposed), distance of the light source (various sources have been developed, from fluorescence tubes, halogen spotlights, fiberoptic pads/blankets, to light-emitting diodes), the exposed skin, intermittence/continuance of phototherapy, and the spectrum of light.2 Blue light, such as that emitted from blue light-emitting diodes (LED´s) within the narrow range of 450–470 nm, has long been believed to be the most efficient,3 based on the fact that the absorption maximum of UCB in aqueous media is around 440 nm.4 However, recent data suggest that wavelengths longer than those reflecting the absorption maximum of UCB are even more effective in lowering serum UCB concentrations in newborns suffering from severe neonatal jaundice.

The first experimental study on efficient bilirubin oxidation with blue-green/turquoise green light was reported as early as 19815 followed by several clinical studies proving the efficacy of green light. 6,7,8,9,10,11,12,13,14 In the recent study, Ebbesen and colleagues confirmed a significantly higher efficacy in reducing UCB of blue-green LED light phototherapy with a peak emission of 478 nm compared to standard blue LED light with a peak emission of 459 nm,15 which was supported by quantifying the production of the main individual bilirubin photooxidation products.

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Acknowledgements

Supported by a grant MH CZ-DRO-VFN64165 from the Czech Ministry of Health (LV) and by a grant of the Fondazione Italiana Fegato (CT).

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  1. 4th Department of Internal Medicine and Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic

    Libor Vítek

  2. Italian Liver Foundation, Trieste, Italy

    Claudio Tiribelli

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  1. Libor Vítek
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  2. Claudio Tiribelli
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Correspondence to Libor Vítek or Claudio Tiribelli.

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Vítek, L., Tiribelli, C. Efficacy of phototherapy of neonatal jaundice – light wavelength matters. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03750-y

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