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Pu R, Wang Z, Zhu R, Jiang J, Weng TC, Huang Y, Liu W. Investigation of Ultrafast Configurational Photoisomerization of Bilirubin Using Femtosecond Stimulated Raman Spectroscopy. J Phys Chem Lett 2023; 14:809-816. [PMID: 36655842 DOI: 10.1021/acs.jpclett.2c03535] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Phototherapy is an efficient and safe way to reduce high levels of free 4Z,15Z-bilirubin (ZZ-BR) in the serum of newborns. The success of BR phototherapy lies in photoinduced configurational and structural isomerization processes that form excretable isomers. However, the physical picture of photoinduced photoisomerization of ZZ-BR is still unclear. Here, we strategically implement tunable femtosecond stimulated Raman spectroscopy and several time-resolved electronic spectroscopies, assisted by quantum chemical calculations, to dissect the detailed primary configurational isomerization dynamics of free ZZ-BR in organic solvents. The results of this study demonstrate that upon photoexcitation, ultrafast configurational isomerization proceeds by a volume-conserving "hula twist", followed by intramolecular hydrogen-bond distortion and large-scale rotation of the two dipyrrinone halves of the ZZ-BR isomer in a few picoseconds. After that, most of the population recovers back to ZZ-BR, and a very small amount is converted into stable BR isomers via structural isomerization.
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Affiliation(s)
- Ruihua Pu
- School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
- STU and SIOM Joint Laboratory for Superintense Lasers and the Applications, Shanghai 201210, China
| | - Ziyu Wang
- School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
- STU and SIOM Joint Laboratory for Superintense Lasers and the Applications, Shanghai 201210, China
| | - Ruixue Zhu
- School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Jiaming Jiang
- School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Tsu-Chien Weng
- School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Yifan Huang
- School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Weimin Liu
- School of Physical Science and Technology, ShanghaiTech University, Shanghai 201210, China
- STU and SIOM Joint Laboratory for Superintense Lasers and the Applications, Shanghai 201210, China
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Blue-Green (~480 nm) versus Blue (~460 nm) Light for Newborn Phototherapy-Safety Considerations. Int J Mol Sci 2022; 24:ijms24010461. [PMID: 36613904 PMCID: PMC9820095 DOI: 10.3390/ijms24010461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/15/2022] [Accepted: 12/03/2022] [Indexed: 12/29/2022] Open
Abstract
We have previously shown that the phototherapy of hyperbilirubinemic neonates using blue-green LED light with a peak wavelength of ~478 nm is 31% more efficient for removing unconjugated bilirubin from circulation than blue LED light with a peak wavelength of ~452 nm. Based on these results, we recommended that the phototherapy of hyperbilirubinemic newborns be practiced with light of ~480 nm. Aim: Identify and discuss the most prominent potential changes that have been observed in the health effects of phototherapy using either blue fluorescent- or blue LED light and speculate on the expected effects of changing to blue-green LED light phototherapy. Search the phototherapy literature using the terms neonate, hyperbilirubinemia, and phototherapy in the PubMed and Embase databases. Transitioning from blue fluorescent light to blue-green LED light will expose neonates to less light in the 400-450 nm spectral range, potentially leading to less photo-oxidation and geno-/cytotoxicity, reduced risk of cancer, and decreased mortality in extremely low-birthweight neonates. The riboflavin level may decline, and the increased production and retention of bronze pigments may occur in predisposed neonates due to enhanced lumirubin formation. The production of pre-inflammatory cytokines may rise. Hemodynamic responses and transepidermal water loss are less likely to occur. The risk of hyperthermia may decrease with the use of blue-green LED light and the risk of hypothermia may increase. Parent-neonate attachment and breastfeeding will be positively affected because of the shortened duration of phototherapy. The latter may also lead to a significant reduction in the cost of phototherapy procedures as well as the hospitalization process.
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Action spectrum of phototherapy in hyperbilirubinemic neonates. Pediatr Res 2022; 92:816-821. [PMID: 34789840 DOI: 10.1038/s41390-021-01743-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/16/2021] [Accepted: 08/27/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Phototherapy with blue light matching plasma absorption spectrum of the bilirubin-albumin complex with peak at 460 nm is standard treatment of neonatal hyperbilirubinemia. AIM To demonstrate clinically the action (efficacy) spectrum of phototherapy in hyperbilirubinemic neonates, through determination of the fraction of total serum bilirubin (TSB) decreased by phototherapy with peak emission wavelengths ≥478 nm (blue-green) compared with that of light of 459/452 nm (blue). METHODS TSB values were compiled from three earlier trials, in which hyperbilirubinemic neonates were randomized to receive 24 h of either blue-green light (478/490/497 nm) (intervention groups) or blue light (459/452/459 nm) (control groups) with equal irradiance and exposed body surface areas. Ratios (efficacy) between the decrease in TSB between intervention and control groups were calculated and graphed versus peak wavelengths, demonstrating the course of the action spectrum. RESULTS Calculated efficacy ratios were 1.31, 1.18, and 1.04 for light with peak wavelengths of 478, 490, and 497 nm, respectively. The action spectrum increases from 452/459 to maximum at 478 nm, from where it decreases to 1.18 and finally to 1.04. CONCLUSION For optimal phototherapeutic treatment, neonates need to be exposed to light with peak wavelength some 20 nm longer than is presently used. IMPACT The action (efficacy) spectrum of phototherapy for hyperbilirubinemic neonates has its peak wavelength at 478 nm. The peak wavelength of this action spectrum is 20 nm longer than the wavelength presently believed to be most efficient. The peak is also different from the peak found in vitro. For optimal phototherapeutic effect, neonates need to be treated with light of wavelengths some 20 nm longer than are presently used.
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Lahmann JM, Faase RA, Leu HY, Jacques SL, Scottoline B, Schilke KF, Baio JE, Higgins AZ. Microfluidic photoreactor to treat neonatal jaundice. BIOMICROFLUIDICS 2021; 15:064104. [PMID: 34853627 PMCID: PMC8616629 DOI: 10.1063/5.0066073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/09/2021] [Indexed: 06/13/2023]
Abstract
While in most cases, jaundice can be effectively treated using phototherapy, severe cases require exchange transfusion, a relatively risky procedure in which the neonate's bilirubin-rich blood is replaced with donor blood. Here, we examine extracorporeal blood treatment in a microfluidic photoreactor as an alternative to exchange transfusion. This new treatment approach relies on the same principle as phototherapy but leverages microfluidics to speed up bilirubin removal. Our results demonstrate that high-intensity light at 470 nm can be used to rapidly reduce bilirubin levels without causing appreciable damage to DNA in blood cells. Light at 470 nm was more effective than light at 505 nm. Studies in Gunn rats show that photoreactor treatment for 4 h significantly reduces bilirubin levels, similar to the bilirubin reduction observed for exchange transfusion and on a similar time scale. Predictions for human neonates demonstrate that this new treatment approach is expected to exceed the performance of exchange transfusion using a low blood flow rate and priming volume, which will facilitate vascular access and improve safety.
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Affiliation(s)
- John M. Lahmann
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Ryan A. Faase
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Hsuan Yu Leu
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Steven L. Jacques
- Department of Bioengineering, University of Washington, Seattle, Washington 98105, USA
| | - Brian Scottoline
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon 97239, USA
| | - Kate F. Schilke
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Joe E. Baio
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
| | - Adam Z. Higgins
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon 97331, USA
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Characteristics of bilirubin photochemical changes under green light-emitting diodes in humans compared with animal species. Sci Rep 2021; 11:6391. [PMID: 33737608 PMCID: PMC7973762 DOI: 10.1038/s41598-021-85632-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/03/2021] [Indexed: 11/08/2022] Open
Abstract
Phototherapy using light-emitting diodes (LEDs) centered on the green spectrum, which has a high cyclobilirubin production rate, was as effective as that centered on the blue spectrum for neonatal hyperbilirubinemia. There are no reports of species differences in bilirubin photochemical changes in this spectrum, and the characteristics of bilirubin photochemical changes in humans must be elucidated to proceed with the development of new light sources that include these spectra. This report describes the characteristic photochemical kinetics of bilirubin under green-spectrum LEDs in human, rat, rabbit, dog, pig, sheep, bovine and chicken serum albumin and rhesus monkey serum. These albumin-bilirubin complex solutions were irradiated by green LEDs, and the time-course changes in bilirubin photoisomers were measured by high-performance liquid chromatography. The cyclobilirubin production rates in humans, pigs, and monkeys were significantly higher than those in other species. The rate constant of (EZ)-cyclobilirubin production from (EZ)-bilirubin 'k' was significantly higher in humans and monkeys than in other species. In conclusion, bilirubin photochemical kinetics under green spectrum LEDs in humans were characterized by a high cyclobilirubin production rate at a low substrate concentration. The bilirubin photochemical kinetics in monkeys were similar to those in humans.
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Effect of blue LED phototherapy centered at 478 nm versus 459 nm in hyperbilirubinemic neonates: a randomized study. Pediatr Res 2021; 89:598-603. [PMID: 32335581 DOI: 10.1038/s41390-020-0911-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/16/2020] [Accepted: 04/07/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Treatment of choice for hyperbilirubinemic neonates is blue light matching the absorption spectrum of bilirubin-albumin in vitro with maximum absorption at 459 nm. Blue LED light centered at 478 nm was hypothesized as being more efficient than that centered at 459 nm. This study compares the bilirubin-reducing effect of the two light qualities with equal irradiance in a randomized nonblinded clinical trial. METHODS Inclusion criteria were healthy hyperbilirubinemic neonates with gestational age ≥33 weeks. Forty-nine neonates included in each group received phototherapy from above for 24 h. Mean irradiances were 9.2 × 1015 and 9.0 × 1015 photons/cm2/s for the 478 and 459 nm groups, respectively. RESULTS Mean [95% CI] decreases in total serum bilirubin were 150 [141, 158] and 120 [111, 130] µmol/L for the 478 and 459 nm groups, respectively; mean difference was 29 [17, 42] µmol/L. Mean [95% CI] percentage decreases in bilirubin were 54.8% [52.5, 57.0] and 41.8% [39.3, 44.3]; mean difference was 12.9 [9.6, 16.3] percentage points. After adjustment this difference was 13.4 [10.2, 16.7] percentage points. All differences were highly statistically significant (P < 0.001). CONCLUSION Blue LED light centered at 478 nm had a greater bilirubin-reducing effect than that centered at 459 nm with equal irradiance quantified as photon fluence rate. IMPACT Blue LED light centered at 478 nm had a greater in vivo bilirubin-reducing effect than blue LED light centered at 459 nm with equal irradiance quantified as photon fluence rate in the treatment of hyperbilirubinemic late preterm or term neonates. LED light centered at 478 nm might reduce the duration of phototherapy compared to LED light centered at 459 nm as the same effect can be obtained while exposing the infants to fewer photons. Blue light matching the absorption spectrum of the bilirubin-albumin complex in vitro with peak absorption at 459 nm is used worldwide as it is considered to be the most effective light for phototherapy of jaundiced neonates. This study showed that blue LED light centered at 478 nm had a greater bilirubin-reducing effect than blue LED light centered at 459 nm. Therefore, blue LED light centered at 478 nm should be used instead of blue light centered at 459 nm. By this, the risk of potential side effects might be minimized, and the duration of phototherapy potentially reduced.
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The effectiveness of phototherapy using blue-green light for neonatal hyperbilirubinemia - Danish clinical trials. Semin Perinatol 2021; 45:151358. [PMID: 33358025 DOI: 10.1016/j.semperi.2020.151358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The effectiveness of phototherapy for neonatal hyperbilirubinemia based on Danish clinical trials is presented. Randomized controlled trials on the quality of light showed that blue-green fluorescent light (peak emission at 490 nm) was more efficient than blue fluorescent light (peak emission at 452 nm); blue-green light-emitting diode (LED) light (peak emission at 478 nm) was more efficient than blue LED light (peak emission at 459 nm); and blue-green LED light (peak emission at 497 nm) was equivalent to blue LED light (peak emission at 459 nm). Bilirubin-reducing effects correlated with irradiance, dependent on hemoglobin concentration, and independent of rotating infants. Phototherapy from both above and below was more efficient than therapy applied only from above at high levels of irradiance. In conclusion, we estimate and recommend the use of blue-green LED light (peak emission at 480 nm) rather than blue light (peak emission at 460 nm) for treating of neonatal hyperbilirubinemia.
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Madea D, Mahvidi S, Chalupa D, Mujawar T, Dvořák A, Muchová L, Janoš J, Slavíček P, Švenda J, Vítek L, Klán P. Wavelength-Dependent Photochemistry and Biological Relevance of a Bilirubin Dipyrrinone Subunit. J Org Chem 2020; 85:13015-13028. [DOI: 10.1021/acs.joc.0c01673] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Dominik Madea
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Sadegh Mahvidi
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - David Chalupa
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Taufiqueahmed Mujawar
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Aleš Dvořák
- Institute of Medical Biochemistry and Laboratory Diagnostics, 4th Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Na Bojišti 3, 121 08 Prague 2, Czech Republic
| | - Lucie Muchová
- Institute of Medical Biochemistry and Laboratory Diagnostics, 4th Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Na Bojišti 3, 121 08 Prague 2, Czech Republic
| | - Jiří Janoš
- Department of Physical Chemistry, University of Chemistry and Technology, Technická 5, 16628 Prague 6, Czech Republic
| | - Petr Slavíček
- Department of Physical Chemistry, University of Chemistry and Technology, Technická 5, 16628 Prague 6, Czech Republic
| | - Jakub Švenda
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Libor Vítek
- Institute of Medical Biochemistry and Laboratory Diagnostics, 4th Department of Internal Medicine, Faculty General Hospital and 1st Faculty of Medicine, Charles University, Na Bojišti 3, 121 08 Prague 2, Czech Republic
| | - Petr Klán
- Department of Chemistry, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- RECETOX, Faculty of Science, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
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9
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Hansen TWR, Maisels MJ, Ebbesen F, Vreman HJ, Stevenson DK, Wong RJ, Bhutani VK. Sixty years of phototherapy for neonatal jaundice - from serendipitous observation to standardized treatment and rescue for millions. J Perinatol 2020; 40:180-193. [PMID: 31420582 DOI: 10.1038/s41372-019-0439-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/04/2019] [Accepted: 05/23/2019] [Indexed: 11/09/2022]
Abstract
A breakthrough discovery 60 years ago by Cremer et al. has since changed the way we treat infants with hyperbilirubinemia and saved the lives of millions from death and disabilities. "Photobiology" has evolved by inquiry of diverse light sources: fluorescent tubes (wavelength range of 400-520 nm; halogen spotlights that emit circular footprints of light; fiberoptic pads/blankets (mostly, 400-550 nm range) that can be placed in direct contact with skin; and the current narrow-band blue light-emitting diode (LED) light (450-470 nm), which overlaps the peak absorption wavelength (458 nm) for bilirubin photoisomerization. Excessive bombardment with photons has raised concerns for oxidative stress in very low birthweight versus term infants treated aggressively with phototherapy. Increased emphasis on prescribing phototherapy as a "drug" that is dosed cautiously and judiciously is needed. In this historical review, we chronicled the basic to the neurotoxic components of severe neonatal hyperbilirubinemia and the use of standardized interventions.
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Affiliation(s)
- Thor Willy Ruud Hansen
- Division of Paediatric and Adolescent Medicine, Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Jeffrey Maisels
- Department of Pediatrics, Oakland University William Beaumont School of Medicine, Beaumont Children's Hospital, Royal Oak, MI, USA
| | - Finn Ebbesen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.,Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Hendrik J Vreman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Vinod K Bhutani
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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Vreman HJ, Kourula S, Jašprová J, Ludvíková L, Klán P, Muchová L, Vítek L, Cline BK, Wong RJ, Stevenson DK. The effect of light wavelength on in vitro bilirubin photodegradation and photoisomer production. Pediatr Res 2019; 85:865-873. [PMID: 30710116 DOI: 10.1038/s41390-019-0310-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The action spectrum for bilirubin photodegradation has been intensively studied. However, questions still remain regarding which light wavelength most efficiently photodegrades bilirubin. In this study, we determined the in vitro effects of different irradiation wavelength ranges on bilirubin photodegradation. METHODS In our in vitro method, normalized absolute irradiance levels of 4.2 × 1015 photons/cm2/s from light-emitting diodes (ranging from 390-530 nm) and 10-nm band-pass filters were used to irradiate bilirubin solutions (25 mg/dL in 4% human serum albumin). Bilirubin and its major photoisomer concentrations were determined; the half-life time of bilirubin (t1/2) was calculated for each wavelength range, and the spectral characteristics for bilirubin photodegradation products were obtained for key wavelengths. RESULTS The in vitro photodegradation of bilirubin at 37 °C decreased linearly as the wavelength was increased from 390 to 500 nm with t1/2 decreasing from 63 to 17 min, respectively. At 460 ± 10 nm, a significantly lower rate of photodegradation and thus higher t1/2 (31 min) than that at 500 nm (17 min) was demonstrated. CONCLUSION In our system, the optimum bilirubin photodegradation and lumirubin production rates occurred between 490 and 500 nm. Spectra shapes were remarkably similar, suggesting that lumirubin production was the major process of bilirubin photodegradation.
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Affiliation(s)
- Hendrik J Vreman
- Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Room S214, Stanford, CA, 94305, USA.
| | - Stephanie Kourula
- Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Room S214, Stanford, CA, 94305, USA
| | - Jana Jašprová
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, Kateřinská 32, 120 00, Prague, Czech Republic
| | - Lucie Ludvíková
- Department of Chemistry and RECETOX, Faculty of Science, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Petr Klán
- Department of Chemistry and RECETOX, Faculty of Science, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
| | - Lucie Muchová
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, Kateřinská 32, 120 00, Prague, Czech Republic
| | - Libor Vítek
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, Kateřinská 32, 120 00, Prague, Czech Republic.
| | - Benjamin K Cline
- Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Room S214, Stanford, CA, 94305, USA
| | - Ronald J Wong
- Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Room S214, Stanford, CA, 94305, USA
| | - David K Stevenson
- Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Room S214, Stanford, CA, 94305, USA
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11
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Boswell M, Boswell W, Lu Y, Savage M, Mazurek Z, Chang J, Muster J, Walter R. The transcriptional response of skin to fluorescent light exposure in viviparous (Xiphophorus) and oviparous (Danio, Oryzias) fishes. Comp Biochem Physiol C Toxicol Pharmacol 2018; 208:77-86. [PMID: 29017858 PMCID: PMC5889750 DOI: 10.1016/j.cbpc.2017.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/26/2017] [Accepted: 10/04/2017] [Indexed: 01/14/2023]
Abstract
Differences in light sources are common in animal facilities and potentially can impact experimental results. Here, the potential impact of lighting differences on skin transcriptomes has been tested in three aquatic animal models commonly utilized in biomedical research, (Xiphophorus maculatus (platyfish), Oryzias latipes (medaka) and Danio rerio (zebrafish). Analysis of replicate comparative RNA-Seq data showed the transcriptional response to commonly utilized 4100K or "cool white" fluorescent light (FL) is much greater in platyfish and medaka than in zebrafish. FL induces genes associated with inflammatory and immune responses in both medaka and zebrafish; however, the platyfish exhibit suppression of genes involved with immune/inflammation, as well as genes associated with cell cycle progression. Furthermore, comparative analyses of gene expression data from platyfish UVB exposures, with medaka and zebrafish after exposure to 4100K FL, show comparable effects on the same stress pathways. We suggest the response to light is conserved, but that long-term adaptation to species specific environmental niches has resulted in a shifting of the wavelengths required to incite similar "genetic" responses in skin. We forward the hypothesis that the "genetic perception" of light may have evolved differently than ocular perception and suggest that light type (i.e., wavelengths emitted) is an important parameter to consider in experimental design.
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Affiliation(s)
- Mikki Boswell
- The Xiphophorus Genetic Stock Center, Department of Chemistry and Biochemistry, 419 Centennial Hall, Texas State University, San Marcos, TX 78666, USA.
| | - William Boswell
- The Xiphophorus Genetic Stock Center, Department of Chemistry and Biochemistry, 419 Centennial Hall, Texas State University, San Marcos, TX 78666, USA.
| | - Yuan Lu
- The Xiphophorus Genetic Stock Center, Department of Chemistry and Biochemistry, 419 Centennial Hall, Texas State University, San Marcos, TX 78666, USA.
| | - Markita Savage
- The Xiphophorus Genetic Stock Center, Department of Chemistry and Biochemistry, 419 Centennial Hall, Texas State University, San Marcos, TX 78666, USA.
| | - Zachary Mazurek
- The Xiphophorus Genetic Stock Center, Department of Chemistry and Biochemistry, 419 Centennial Hall, Texas State University, San Marcos, TX 78666, USA.
| | - Jordan Chang
- The Xiphophorus Genetic Stock Center, Department of Chemistry and Biochemistry, 419 Centennial Hall, Texas State University, San Marcos, TX 78666, USA.
| | - Jeanot Muster
- Howard Hughes Medical Institute, University of Washington, 850 Republican Street, Seattle, WA 98109, USA.
| | - Ronald Walter
- The Xiphophorus Genetic Stock Center, Department of Chemistry and Biochemistry, 419 Centennial Hall, Texas State University, San Marcos, TX 78666, USA.
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12
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Ebbesen F, Madsen PH, Vandborg PK, Jakobsen LH, Trydal T, Vreman HJ. Bilirubin isomer distribution in jaundiced neonates during phototherapy with LED light centered at 497 nm (turquoise) vs. 459 nm (blue). Pediatr Res 2016; 80:511-5. [PMID: 27331354 DOI: 10.1038/pr.2016.115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 04/02/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Phototherapy using blue light is the treatment of choice worldwide for neonatal hyperbilirubinemia. However, treatment with turquoise light may be a desirable alternative. Therefore, the aim of this randomized, controlled study was to compare the bilirubin isomer distribution in serum of jaundiced neonates after 24 h of therapy with narrow-band (LED) light centered at 497 nm (turquoise) vs. 459 nm (blue), of essentially equal irradiance. MATERIALS Eighty-three neonates (≥33 wk gestational age) with uncomplicated hyperbilirubinemia were included in the study. Forty neonates were exposed to light centered at 497 nm and 43 infants with light centered at 459 nm. Irradiances were 5.2 × 10(15) and 5.1 × 10(15) photons/cm(2)/s, respectively. RESULTS After 24 h of treatment no significant differences in serum concentrations of total bilirubin isomers and Z,Z-bilirubin were observed between the 2 groups. Interestingly, concentrations of Z,E-bilirubin, and thus also total bilirubin isomers formed during therapy, were highest for infants receiving light centered at 459 nm, while the concentration of E,Z-bilirubin was highest for those receiving light centered at 497 nm. No significant difference was found between concentrations of E,Z-lumirubin. CONCLUSION Therapy with LED light centered at 497 nm vs. 459 nm, applied with equal irradiance on the infants, resulted in a different distribution of bilirubin isomers in serum.
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Affiliation(s)
- Finn Ebbesen
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul H Madsen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lasse H Jakobsen
- Department of Statistics, Aalborg University Hospital, Aalborg, Denmark
| | - Torleif Trydal
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Hendrik J Vreman
- Neonatal and Developmental Medicine Laboratory, Division of Neonatology, Department of Pediatrics, Stanford University Medical Center, Stanford, California
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13
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Ebbesen F, Vandborg PK, Madsen PH, Trydal T, Jakobsen LH, Vreman HJ. Effect of phototherapy with turquoise vs. blue LED light of equal irradiance in jaundiced neonates. Pediatr Res 2016; 79:308-12. [PMID: 26484622 DOI: 10.1038/pr.2015.209] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/27/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Blue light with peak emission around 460 nm is the preferred treatment of neonatal hyperbilirubinemia. However, studies using fluorescent light tubes have suggested that turquoise light with peak emission at 490 nm may be more efficient. At present, the predominant light source for phototherapy is light emitting diodes (LEDs). Hence, the aim of this study was to compare the bilirubin-reducing effect in jaundiced neonates treated either with turquoise or with blue LED light with peak emission at 497 or 459 nm, respectively, with equal irradiance on the infants. METHODS Infants with gestational age ≥33 wk and uncomplicated hyperbilirubinemia were randomized to either turquoise or blue LED light and were treated for 24 h. The mean irradiance footprint at skin level was 5.2 × 10(15) and 5.1 × 10(15) photons/cm(2)/s, respectively. RESULTS Forty-six infants received turquoise light and 45 received blue light. The median (95% confidence interval) decrease of total serum bilirubin was 35.3% (32.5; 37.3) and 33.1% (27.1; 36.8) for infants treated with turquoise and blue lights, respectively. The difference was nonsignificant (P = 0.53). The decrease was positively correlated to postnatal age and negatively to birth weight. CONCLUSION Using LED light of equal irradiance, turquoise and blue lights had equal bilirubin-reducing effect on hyperbilirubinemia of neonates.
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Affiliation(s)
- Finn Ebbesen
- Department of Paediatrics, Aalborg University Hospital, Aalborg, Denmark.,Clinical Institute, Aalborg University, Aalborg, Denmark
| | | | - Poul H Madsen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Torleif Trydal
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Lasse H Jakobsen
- Department of Statistics, Aalborg University Hospital, Aalborg, Denmark
| | - Hendrik J Vreman
- Neonatal and Development Medicine Laboratory, Division of Neonatology, Department of Pediatrics, Stanford University Medical Center, Stanford, California
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Lamola AA, Bhutani VK, Wong RJ, Stevenson DK, McDonagh AF. The effect of hematocrit on the efficacy of phototherapy for neonatal jaundice. Pediatr Res 2013; 74:54-60. [PMID: 23604171 DOI: 10.1038/pr.2013.67] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 01/08/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND The therapeutic phototherapy action spectrum ranges from 420 to 500 nm. However, a recent report of improved efficacy of fluorescent "turquoise" light (~490 nm) as compared with blue light (~450 nm) underscores the need to define an optimal action spectrum for precision-targeted phototherapy using very narrow wavelength ranges. METHODS We used a current semi-empirical model of the optical properties of skin for robust calculations of the fraction of light absorbed by bilirubin at various wavelengths that could be confounded by hemoglobin (Hb), melanin, and skin thickness. Applying assumptions regarding the wavelength dependence of bilirubin photochemistry, "action spectra" were assembled from the calculated values. RESULTS All the calculated action spectra displayed a peak between 472 and 480 nm (most at 476 nm), which is a significant shift from the well-reported 460 nm absorption peak of bilirubin. Of note, the relative amplitudes of the action spectra showed an inverse relationship with hematocrit (Hct). CONCLUSION We speculate that a narrow range of light at 476 nm would be 60% more effective than blue (broadband) fluorescent lamps. Because Hb serves as a major competitor of bilirubin for light absorption, the calculations also predict that the efficacy of phototherapy is dependent on the Hct. A high Hct could reduce therapeutic efficiency.
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Affiliation(s)
- Angelo A Lamola
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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15
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Zhou Y, Zhang C, Yao DK, Wang LV. Photoacoustic microscopy of bilirubin in tissue phantoms. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:126019. [PMID: 23235894 PMCID: PMC3521055 DOI: 10.1117/1.jbo.17.12.126019] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Determining both bilirubin's concentration and its spatial distribution are important in disease diagnosis. Here, for the first time, we applied quantitative multiwavelength photoacoustic microscopy (PAM) to detect bilirubin concentration and distribution simultaneously. By measuring tissue-mimicking phantoms with different bilirubin concentrations, we showed that the root-mean-square error of prediction has reached 0.52 and 0.83 mg/dL for pure bilirubin and for blood-mixed bilirubin detection (with 100% oxygen saturation), respectively. We further demonstrated the capability of the PAM system to image bilirubin distribution both with and without blood. Finally, by underlaying bilirubin phantoms with mouse skins, we showed that bilirubin can be imaged with consistent accuracy down to >400 μm in depth. Our results show that PAM has potential for noninvasive bilirubin monitoring in vivo, as well as for further clinical applications.
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Affiliation(s)
- Yong Zhou
- Washington University in St. Louis, Department of Biomedical Engineering, Optical Imaging Laboratory, One Brookings Drive, St. Louis, Missouri 63130
| | - Chi Zhang
- Washington University in St. Louis, Department of Biomedical Engineering, Optical Imaging Laboratory, One Brookings Drive, St. Louis, Missouri 63130
| | - Da-Kang Yao
- Washington University in St. Louis, Department of Biomedical Engineering, Optical Imaging Laboratory, One Brookings Drive, St. Louis, Missouri 63130
| | - Lihong V. Wang
- Washington University in St. Louis, Department of Biomedical Engineering, Optical Imaging Laboratory, One Brookings Drive, St. Louis, Missouri 63130
- Address all correspondence to: Lihong V. Wang, Washington University in St. Louis, Department of Biomedical Engineering, Optical Imaging Laboratory, One Brookings Drive, St. Louis, Missouri 63130. Tel: 314-935-9586; Fax: 314-935-7448; E-mail:
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16
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Nwose EU, Richards RS, Bwititi P, Butkowski E. Serum bilirubin and lipoprotein-a: how are these associated with whole blood viscosity? Redox Rep 2012; 17:8-13. [PMID: 22340510 DOI: 10.1179/1351000211y.0000000017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND It has been demonstrated that oxidative stress can induce red blood cell rigidity and haemolysis, which in turn can cause hyperviscosity and hyperbilirubinaemia, respectively. However, haemolysis may be associated with a low level of haemoglobin, which reduces whole blood viscosity (WBV). Bilirubin can behave as antioxidant or oxidant, and one uncharted course for diagnostic pathology is how or whether bilirubinaemia and viscosity are associated. Further, oxidative stress is now being assessed using lipoprotein-a (Lp(a)), among other things but whether it is associated with blood viscosity has not been established. AIM This study investigates the association and correlation of haemoglobin level and WBV with serum Lp(a) and bilirubin levels in a general population of patients. MATERIALS AND METHODS Sixty-eight cases that were tested for Lp(a), concomitantly with full blood count and liver function, in our archived clinical pathology database were used in this study. WBV levels were determined using a validated formula. Multivariate and univariate analyses as well as correlation were performed. RESULTS WBV was found to be significantly associated with bilirubin (P<0.02), but not with Lp(a). Haemoglobin concentration was inversely correlated with Lp(a) (P<0.04), but not with bilirubinaemia. CONCLUSION This pilot study suggests that hyperbilirubinaemia and hyperviscosity are associated and positively correlated. Consideration of whether serum bilirubin (as an indirect index of oxidative stress) can be used in combination with WBV (as index of macrovascular effect of oxidative stress) to assess oxidative damage is recommended.
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Affiliation(s)
- E U Nwose
- School of Community Health, Charles Sturt University, Albury, NSW, Australia.
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17
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Bosschaart N, Kok JH, Newsum AM, Ouweneel DM, Mentink R, van Leeuwen TG, Aalders MCG. Limitations and opportunities of transcutaneous bilirubin measurements. Pediatrics 2012; 129:689-94. [PMID: 22430456 DOI: 10.1542/peds.2011-2586] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Although transcutaneous bilirubinometers have existed for over 30 years, the clinical utility of the technique is limited to a screening method for hyperbilirubinemia, rather than a replacement for invasive blood sampling. In this study, we investigate the reason for this limited clinical value and address possibilities for improvement. METHODS To obtain better insight into the physiology of bilirubin measurements, we evaluated a transcutaneous bilirubinometer that determines not only the cutaneous bilirubin concentration (TcB) but also the blood volume fraction (BVF) in the investigated skin volume. For 49 neonates (gestational age 30 ± 3.1 weeks, postnatal age 6 [4-10] days) at our NICU, we performed 124 TcB and 55 BVF measurements. RESULTS The TcB correlated well with the total serum bilirubin concentration (TSB) (r = 0.88) with an uncertainty of 55 µmol/L. The BVF in the measured skin volume ranged between 0.1% and 0.75%. CONCLUSIONS The performance of our bilirubinometer is comparable to existing transcutaneous devices. The limited clinical value of current bilirubinometers can be explained by the low BVF in the skin volume that is probed by these devices. Because the TcB depends for over 99% on the contribution of extravascular bilirubin, it is a physiologically different parameter from the TSB. Hence, the standard method of evaluation that compares the TcB to the TSB is insufficient to fully investigate the clinical value of transcutaneous bilirubinometers, ie, their predictive value for kernicterus. We suggest that the clinical value may be improved considerably by changing either the method of evaluation or the technological design of transcutaneous bilirubinometers.
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Affiliation(s)
- Nienke Bosschaart
- Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
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Shortland DB, Hussey M, Dey Chowdhury A. Understanding neonatal jaundice: UK practice and international profile. ACTA ACUST UNITED AC 2008; 128:202-6. [DOI: 10.1177/1466424008092229] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the last 25 years there have been considerable advances in the treatment and technologies used in the care of newborn infants. Most of these advances are related to the care of the premature infants and there have been few changes in the management of conditions commonly seen in term infants. Neonatal jaundice is one of the commonest neonatal disorders and has been recognized since early history. Early neonatal jaundice is usually caused by the physiological destruction of red blood cells in the infant and its importance lies in the ability of the bilirubin pigment so produced to cross the blood brain barrier resulting in neurotoxicity. Prolonged neonatal jaundice (after 14 days of age) may be an indication of an underlying liver disorder. The approach to neonatal jaundice has remained largely unchanged over the last two to three decades. We continue to rely on visual inspection to assess the severity of early neonatal jaundice. We have technology that is effective in reducing the level of bilirubinaemia but in the UK there is no clear consensus as to the level at which jaundice should be treated. We do not have a standardized approach to the management of prolonged jaundice and there is potential for infants with significant liver problems to be diagnosed at a relatively late stage. Some countries (for example the US) have professional bodies who have introduced guidelines to ensure a standardized approach to the jaundice infant. We have little information about neonatal jaundice treatment in other parts of the developing world.
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Affiliation(s)
- David B Shortland
- Department of Paediatrics and Child Health, Poole Hospital NHS Trust, Longfleet Road, Poole, Dorset BH15 2JB,
| | - Martin Hussey
- Department of Paediatrics and Child Health, Poole Hospital NHS Trust, Longfleet Road, Poole, Dorset BH15 2JB
| | - Ashoka Dey Chowdhury
- Department of Paediatrics and Child Health, Poole Hospital NHS Trust, Longfleet Road, Poole, Dorset BH15 2JB
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Zietz B, Gillbro T. Initial photochemistry of bilirubin probed by femtosecond spectroscopy. J Phys Chem B 2007; 111:11997-2003. [PMID: 17927274 DOI: 10.1021/jp073421c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Bilirubin is a breakdown product from heme catabolism, and reduced excretion of bilirubin can lead to jaundice. Phototherapy is the most common treatment for neonatal jaundice, a condition frequently encountered in newborn infants. Knowledge of the photochemistry of bilirubin, which is dominated by (ultra)fast components, is necessary for the profound understanding of the processes in phototherapy. Here, we report results from femtosecond fluorescence upconversion measurements on bilirubin and half-bilirubin model compounds, as well as pump-probe absorption measurements on bilirubin. A fast component of ca. 120 fs in the multiexponential fluorescence decay, being only visible in the bilirubin molecule, is interpreted as exciton localization within the molecular halves. The slower components of several hundreds of femtoseconds and a few picoseconds, occurring in bilirubin and the half-bilirubin model, are interpreted as relaxation to a (twisted) intermediate, which decays further with ca. 15 ps to the ground state.
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Affiliation(s)
- Burkhard Zietz
- Department of Chemistry, Biophysical Chemistry, Umeå University, SE-90187, Umeå, Sweden.
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Ebbesen F, Madsen P, Støvring S, Hundborg H, Agati G. Therapeutic effect of turquoise versus blue light with equal irradiance in preterm infants with jaundice. Acta Paediatr 2007; 96:837-41. [PMID: 17537011 DOI: 10.1111/j.1651-2227.2007.00261.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To compare the efficiency of turquoise light with that of TL52 blue in treatment of preterm infants with jaundice at the same level of body irradiance. METHODS Infants with gestational age 28-37 weeks and non-haemolytic hyperbilirubinemia were treated for 24 h with either turquoise light (OSRAM L18W/860 fluorescent lamps) or blue light (Philips TL20W/52 fluorescent lamps). The concentrations of serum total bilirubin and bilirubin isomers were measured by the Vitros routine method and by HPLC, respectively. RESULTS The decrease in serum concentrations of total bilirubin, total bilirubin isomers and the toxic Z,Z-bilirubin was greatest for infants treated with turquoise light. Further, the increase in Z,E-bilirubin was smaller and there was a trend towards a higher rise in E,Z-bilirubin. CONCLUSIONS Turquoise light has a greater bilirubin reducing effect than TL52 blue light with equal irradiance, expressed both by serum total bilirubin, total bilirubin isomers and Z,Z-bilirubin, i.e. the turquoise spectral range is more efficient than the blue. This is in accordance with deeper penetration into the skin, lower production of the Z,E-bilirubin and greater production of E,Z-bilirubin and lumirubin, in infants under turquoise light. This suggests, given equal irradiances, that light in the turquoise spectral range is preferable to the TL52 blue in treatment of newborn jaundiced infants.
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Affiliation(s)
- Finn Ebbesen
- Department of Pediatrics, University Hospital of Aalborg, Aalborg, Denmark.
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21
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Chowdhury AD, Hussey MH, Shortland DB. Critical overview of the management of neonatal jaundice in the UK. Public Health 2007; 121:137-43. [PMID: 17217973 DOI: 10.1016/j.puhe.2006.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 02/07/2006] [Accepted: 07/21/2006] [Indexed: 11/24/2022]
Abstract
AIM To determine the current management of early neonatal jaundice in the UK and to evaluate whether the current practices are evidence based. METHODS A questionnaire survey was carried out among identified lead paediatricians of neonatal intensive care units. RESULTS The survey found markedly differing practices for the recognition, investigation and treatment of neonatal jaundice. This applies particularly to confirmation of the clinical suspicion of jaundice; use of invasive and non-invasive technologies for diagnosis; preferred wavelength and intensity of light used for treatment; and whether birth weight, gestational age and postnatal age should influence treatment. CONCLUSION The study found a lack of consistency in the management of jaundiced infants in the UK. The evidence-based practice currently available does not appear to have been incorporated into treatment protocols.
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Affiliation(s)
- Ashoka D Chowdhury
- Department of Paediatrics and Child Health, Poole Hospital NHS Trust, Poole BH15 2JB, UK
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22
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Abstract
UNLABELLED Despite its popularity and widespread use, there remains much more to be learned about phototherapy. CONCLUSION There is continued debate on whether intermittent phototherapy is more effective than continuous phototherapy; if light of a longer wavelength is more effective than blue light phototherapy; and if phototherapy in the presence of bilirubin is toxic to normal or abnormal red blood cells. Three in vitro studies in this issue of the journal provide answers to some of these questions.
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Affiliation(s)
- Ashima Madan
- Stanford University School of Medicine, Palo Alto, CA 94304, USA.
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Roll EB, Christensen T. Formation of photoproducts and cytotoxicity of bilirubin irradiated with turquoise and blue phototherapy light. Acta Paediatr 2005; 94:1448-54. [PMID: 16263632 DOI: 10.1111/j.1651-2227.2005.tb01819.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To compare a new turquoise ("green") fluorescent phototherapy lamp (490 nm) with a conventional blue phototherapy lamp (450 nm) with respect to cytotoxicity and photochemical effects of bilirubin. METHODS Mouse lymphoma cells (L5178Y-R) in the presence of bilirubin solutions were exposed to phototherapy light. Occurrence of necrosis and apoptosis, reduction of mitotic index and inhibited cell growth was assayed by appropriate methods. The presence of bilirubin and its photoisomers was measured by high-pressure liquid chromatography analysis and absorption spectroscopy. RESULTS At constant and equal light irradiances, the cytotoxic effects in the presence of bilirubin bound to human serum albumin showed that the green lamp caused significantly less necrosis (n = 4, p < 0.05) and less inhibition of cell multiplication (n = 3, p < 0.05) than the blue lamp. A slightly lower apoptotic fraction, although not statistically significant, was observed in cells exposed to the blue lamp. Photo-oxidation of bilirubin was more prominent with blue light irradiation. The photoequilibria between geometric isomers of bilirubin were different for the two lamps; more geometric photoisomers were formed by blue irradiation (n = 6, p < 0.05). The amounts of the most water-soluble isomers (presumably mainly lumirubin) were rather similar for the two lamps. CONCLUSION The two lamps were similar in the formation of therapeutically relevant photoproducts, but the blue lamp showed potential in forming more photo-oxidation products and in causing more severe cellular damage in the presence of bilirubin.
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25
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Abstract
Preterm jaundiced infants were treated by phototherapy with a new turquoise fluorescent lamp. This was more effective in reducing plasma total bilirubin in relation to light irradiance than the ubiquitously used blue fluorescent lamp.
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Affiliation(s)
- F Ebbesen
- Department of Pediatrics, University Hospital of Aalborg, Denmark. Institute of Applied Physics-CNR, Sezione INFM di Firenze, Florence, Italy.
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Dicken P, Grant LJ, Jones S. An evaluation of the characteristics and performance of neonatal phototherapy equipment. Physiol Meas 2000; 21:493-503. [PMID: 11110247 DOI: 10.1088/0967-3334/21/4/306] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper reviews the current state of knowledge and practice in neonatal phototherapy, and assesses methods of evaluating the characteristics and performance of different equipment. Artificial lighting (usually fluorescent) has been used for the past 30 years in the treatment of neonatal jaundice. Widely differing light outputs and spectra are used, making comparison and evaluation difficult for clinicians. Manufacturers of neonatal phototherapy equipment have no standard for assessing the performance of their equipment, and information that is supplied is at best confusing or deceptive to the users. Best practice is usually based on empirical data from equipment in use, but there is wide agreement that present phototherapy is sub-optimal, i.e. does not achieve maximum rate of bilirubin clearance for minimum therapeutic dose. Several studies in the last ten years have emphasized the importance of both the wavelength and intensity of light for optimal phototherapy. These are discussed and a technique is proposed for normalizing the output of different systems to make comparison easier and to enable optimal treatments to be designed.
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Affiliation(s)
- P Dicken
- Department of Medical Physics, Royal United Hospital, Bath, UK.
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Agati G, Fusi F, Pratesi S, Galvan P, Donzelli GP. Bilirubin photoisomerization products in serum and urine from a Crigler-Najjar type I patient treated by phototherapy. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 1998; 47:181-9. [PMID: 10093917 DOI: 10.1016/s1011-1344(98)00221-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The relative compositions of the photoisomers of bilirubin-1X alpha (4Z, 15Z-bilirubin) in serum and urine of a patient with Crigler-Najjar type I syndrome treated by phototherapy are reported. High-performance liquid chromatography analysis reveals the presence of high serum levels of the configurational bilirubin photoisomer (4Z,15E-bilirubin) before the beginning of phototherapy (between 12 and 16% of the total bilirubin). The configurational photoisomer value increases during phototherapy with blue fluorescent lamps up to a photoequilibrium of about 25%, similar to that obtained in a bilirubin solution in vitro irradiated by the same lamps. This evidence suggests an inefficient serum excretion of the 4Z,15E-bilirubin. Indeed, its average half-life in serum of the Crigler-Najjar patient is found to be about 8 h. No detectable traces of the bilirubin structural isomer, lumirubin, are found in the serum. On the other hand, lumirubin represents the dominant bilirubin isomer excreted in the urine, as both 15Z and 15E configurations. Smaller amounts of 4Z,15E-bilirubin, 4E,15Z-bilirubin and native 4Z,15Z-bilirubin are observed in urine. The presence in urine of 4Z,15Z-bilirubin is probably due to a fast reversion of the configurational photoisomers to their native form. The half-life of the configurational photoisomers in urine kept at 38 degrees C is found to be of the order of a few minutes. Our study indicates that in Crigler-Najjar type I patients, mechanisms exist to excrete all bilirubin photoisomers. The lumirubin pathway seems to contribute markedly to bilirubin excretion in the urine, as occurs in jaundiced babies under phototherapy. However, the contribution of configurational isomers cannot be neglected.
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Affiliation(s)
- G Agati
- Istituto di Elettronica Quantistica-CNR, Sezione INFM di Firenze, Florence, Italy.
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Donzelli GP, Pratesi S, Rapisardi G, Agati G, Fusi F, Pratesi R. 1-day phototherapy of neonatal jaundice with blue-green lamp. Lancet 1995; 346:184-5. [PMID: 7603251 DOI: 10.1016/s0140-6736(95)91244-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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