الفهرس 
Neonatal JaundiceOnly 14 pages are availabe for public view
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Abstract
Neonatal jaundice is one of the most common conditions. Phototherapy has been accepted as the standard treatment for neonatal jaundice and the decline in the number of exchange transfusions in recent years is, at least in part, likely a direct reflection of the effectiveness of phototherapy at treating hyper-bilirubinemia. However, this treatment modality also has some complications. One possible harmful consequence is potential immunotoxic effects by affection of lymphocytes subtypes which can affect the immune system functions in infants.
The current study was performed to compare the effect of both conventional and tunnel phototherapy on lymphocytes subsets in term neonates (≥37weeks) with unconjugated hyperbilirubinemia.
In this prospective study, 60 term neonates (≥37weeks) 40 of them with unconjugated hyperbilirubinemia were admitted to NICUs in Ain-Shams university hospital. They were randomly assigned to 3 groups: 20 patients were exposed to conventional phototherapy and 20 patients were exposed to tunnel phototherapy and the other 20 healthy full term were assigned as control group.
Total serum bilirubin (TSB), direct serum bilirubin (DSB), CBC, CD4 and CD8 percentages and absolute count were measured before and 48 h after phototherapy in the phototherapy groups. Baseline lab was done in the control group at once.
Upon comparing the effect of both types of phototherapy on bilirubin level, we found significant decrease in total and direct bilirubin post-phototherapy in both phototherapy groups proved that tunnel phototherapy is as effective as conventional phototherapy as both provided rapid decrease in bilirubin levels.
As regards the effect of phototherapy on lymphocytic count, we found that lymphocytic count significantly decreased post-phototherapy in both phototherapy groups.
As regards the effect of phototherapy on CD4+ and CD8+ percentages, we found that CD4+ % significantly decreased post-phototherapy in conventional phototherapy group. Moreover, when we measured CD4+ and CD8+ absolute counts, we found that CD4+ and CD8+ absolute counts significantly decreased post-phototherapy in both phototherapy groups.
In the view of the effect of phototherapy on CD4/CD8 ratio, we found that the ratio significantly increased in tunnel phototherapy group.
In conclusion, we observed that conventional and tunnel phototherapy which are used in the treatment of neonatal hyperbilirubinemia, affects the function of the immune system in newborns via alterations in CD4+ and CD8+ absolute counts.
Conclusions
from this study, we conclude that:
Tunnel phototherapy is as effective as conventional in the management of indirect hyperbilirubinemia in healthy term neonates.
Both types of phototherapy decreased lymphocytic count 48 hours after phototherapy.
Both types of phototherapy decreased CD4+ and CD8+ absolute counts after 48 hours of phototherapy.
Conventional phototherapy decreased CD4% after 48 hours of phototherapy initiation.
Tunnel phototherapy increased CD4/CD8 ratio 48 hours after initiation of phototherapy.
No difference between conventional and tunnel phototherapy regarding percentage of DROP of CD4+ and CD8+ absolute counts.
Recommendations
In the view of the present study, we recommend the following:
Decreasing the duration of phototherapy to the least possible duration to avoid possible adverse effects on immune system.
Further studies are needed to define the safe time period for phototherapy.
Long term follow-up of neonates who receive phototherapy is needed to determine long term effects on the immune system in infancy and childhood.