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Nishio T, Kishi R, Sato K, Sato K. Blue light exposure enhances oxidative stress, causes DNA damage, and induces apoptosis signaling in B16F1 melanoma cells. MUTATION RESEARCH/GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2022; 883-884:503562. [DOI: 10.1016/j.mrgentox.2022.503562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022]
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Clarkson DM, Tshangini M, Satodia P. Preliminary observations of a system for determination of phototherapy exposure over a neonate body shape. Med Eng Phys 2021; 95:1-8. [PMID: 34479685 DOI: 10.1016/j.medengphy.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
While it is possible to determine the irradiance and spectral content for a given neonatal phototherapy device at various locations over a neonate's surface, this does not allow estimation of the total rate of energy delivery within a specific spectral range over the neonate's exposed body surface. A series of 192 blue wavelength enhanced silicon photodiodes was distributed over the surface of a commercially available newborn body shape and connected to a specially designed interface circuit. Placement of photosensors over the surface of the baby shape was determined with consideration of the surface area of twelve specific anatomical areas where each was allocated 16 individual photodiodes. Calibration of detection channels for specific wavelength intervals was undertaken using a Bentham dmc150 spectroradiometer system and also a separate hand held spectroradiometer. This made it possible to estimate the effective integrated dose rate in Watts for specific wavelength intervals such as 460 nm to 490 nm as identified by the American Academy of Pediatrics for phototherapy lamp devices. This allowed identification of dose rate contributions from specific anatomical areas. Initial observations are reported for a range of phototherapy lamp systems and the findings are discussed in terms of their predicted relative clinical effectiveness. Options are also discussed in relation to the future development of the reported measurement system.
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Affiliation(s)
- Douglas M Clarkson
- Department of Clinical Physics and Bioengineering FM Building, University Hospital Coventry, CV2 2DX, United Kingdom.
| | - Mati Tshangini
- Department of Clinical Physics and Bioengineering FM Building, University Hospital Coventry, CV2 2DX, United Kingdom
| | - Prakash Satodia
- Department of Clinical Physics and Bioengineering FM Building, University Hospital Coventry, CV2 2DX, United Kingdom
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Savedra RML, Fonseca AMT, Silva MM, Bianchi RF, Siqueira MF. White LED phototherapy as an improved treatment for neonatal jaundice. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2021; 92:064101. [PMID: 34243508 DOI: 10.1063/5.0046430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/15/2021] [Indexed: 06/13/2023]
Abstract
With the aim of improving phototherapy for neonatal jaundice (hyperbilirubinemia), this study investigates the degradation of unconjugated bilirubin under irradiance by conventional light and by white, red, green, and blue LED sources in vitro. The absorption spectra of bilirubin under these different light sources are compared. The results demonstrate that white LED phototherapy promotes more efficient bilirubin degradation than conventional blue-light therapy. This study provides a basis for the design of novel phototherapy devices for the treatment of hyperbilirubinemia.
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Affiliation(s)
- R M L Savedra
- Departamento de Física da Universidade Federal de Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - A M T Fonseca
- Departamento de Física da Universidade Federal de Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - M M Silva
- Departamento de Física da Universidade Federal de Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - R F Bianchi
- Departamento de Física da Universidade Federal de Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - M F Siqueira
- Departamento de Física da Universidade Federal de Ouro Preto, Ouro Preto, MG 35400-000, Brazil
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Abstract
Acute bilirubin encephalopathy (ABE) is still an insufficiently addressed cause of mortality and long-term morbidity in low- and middle-income countries (LMICs). This article highlights that delayed or incorrect medical advice, inaccurate bilirubin measurements as well as ineffective phototherapy are some of the relevant causes predisposing jaundiced newborns to develop extreme hyperbilirubinemia [EHB, total serum/plasma bilirubin (TB) ≥ 25 mg/dL (428 µmol/L)] and subsequent ABE. Obstacles preventing state of the art management of such infants are also discussed. Prevention of ABE cannot occur without a system-based approach tailored to suit the needs and available resources of each community. Clear set protocols, rigorous training, monitoring, and accurate documentation together with simple innovative affordable technologies that can be locally produced, are essential to observe the change desired.
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Affiliation(s)
- Iman Iskander
- Departments of Pediatrics and Neonatology, Cairo University Medical School, 1 Aly Ibrahim Street, El Sayedah Zeinab, Cairo 11799, Eqypt.
| | - Rasha Gamaleldin
- Departments of Pediatrics and Neonatology, Cairo University Medical School, 1 Aly Ibrahim Street, El Sayedah Zeinab, Cairo 11799, Eqypt
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Siddappa AM, Prekker FL, Slusher TM. Improving Effectiveness of Phototherapy in an Academic Center: A Quality Improvement Project. Glob Pediatr Health 2020; 7:2333794X20969275. [PMID: 33195747 PMCID: PMC7605035 DOI: 10.1177/2333794x20969275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/02/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
Neonatal hyperbilirubinemia is a common cause of delayed discharge and readmissions in our institution. As previously published, the irradiance our phototherapy (PT) units provided was below the irradiance recommended by the AAP for intensive phototherapy (>30 µW/cm2/nm). We measured irradiance delivered by our PT units (Drager 4000) using a standardized footprint grid. By varying number of blue and white fluorescent PT lights, height of PT unit above the neonate and type of bed used (open bassinet versus isolette), we determined the optimal PT arrangement needed to deliver intensive PT (30 µW/cm2/nm). We then developed a standardized, multidisciplinary protocol specifying light arrangement and distance required needed to achieve the desired irradiance level. We were able to show improved irradiance following above changes. Onsite measurement of irradiance provided by local phototherapy units and development of a multidisciplinary, standardized protocol are necessary to assure delivery of recommended levels PT for neonates with hyperbilirubinemia.
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Affiliation(s)
- Ashajyothi M Siddappa
- Hennepin Healthcare, Minneapolis, MN, USA.,University of Minnesota, Minnesota, MN, USA
| | - Frances L Prekker
- Hennepin Healthcare, Minneapolis, MN, USA.,University of Minnesota, Minnesota, MN, USA
| | - Tina M Slusher
- Hennepin Healthcare, Minneapolis, MN, USA.,University of Minnesota, Minnesota, MN, USA
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Sampurna MT, Etika R, Utomo MT, Rani SA, Irzaldy A, Irawan ZS, Ratnasari KA, Bos AF. An evaluation of phototherapy device performance in a tertiary health facility. Heliyon 2020; 6:e04950. [PMID: 32995629 PMCID: PMC7502345 DOI: 10.1016/j.heliyon.2020.e04950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/18/2020] [Accepted: 09/11/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION A range of phototherapy devices are commercially available. The American Academy of Pediatrics (2004) recommends routine intensity measurement of phototherapy devices to ensure that babies affected by hyperbilirubinemia receive effective phototherapy. OBJECTIVE The aims of this study were to calculate the irradiance decay velocity of phototherapy devices used in a tertiary care hospital to evaluate whether current maintenance procedures for phototherapy devices are effective, and to contribute to the improvement of a standardized maintenance procedure in daily practice, thus helping to ensure that all babies affected by hyperbilirubinemia receive prompt treatment. METHODS This research represents a prospective observational study conducted at Dr. Soetomo Academic Teaching Hospital in Surabaya, Indonesia from February 2019-July 2019. The intensities of 11 phototherapy devices were measured at specific times using a Bili Blanket Meter II. We calculated the Δ irradiance differences in μW/cm2/nm and calculated them as velocity μW/cm2/nm/hour of use. RESULTS Among the 11 phototherapy devices included in this study, nine were fluorescent and two were light-emitting diode (LED) machines. The mean (standard deviation) irradiance decay velocity of the fluorescent lamps was 0.02 (±0.03) μW/cm2/nm/hour of use, while that of the LED lamps was 0.015 (±0.007) μW/cm2/nm/hour of use. The fastest irradiance decay velocity was 0.08 μW/cm2/nm/hour of use, while the slowest irradiance decay velocity was <0.01 μW/cm2/nm/hour of use, both of which were from fluorescent-based devices. There was one fluorescent-based device that provided an intensity lower than the therapeutic level. CONCLUSION Irradiance decay occurred in all phototherapy device lamps. It is important to perform routinely intensity measurements, regardless of manufacturer recommendations, to avoid ineffective phototherapy resulting from intensities lower than the required therapeutic levels.
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Affiliation(s)
- Mahendra T.A. Sampurna
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Risa Etika
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Martono T. Utomo
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Siti A.D. Rani
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Abyan Irzaldy
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Zahra S. Irawan
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Kinanti Ayu Ratnasari
- Department of Pediatrics, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Arend F. Bos
- Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
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Hansen TWR, Wong RJ, Stevenson DK. Molecular Physiology and Pathophysiology of Bilirubin Handling by the Blood, Liver, Intestine, and Brain in the Newborn. Physiol Rev 2020; 100:1291-1346. [PMID: 32401177 DOI: 10.1152/physrev.00004.2019] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Bilirubin is the end product of heme catabolism formed during a process that involves oxidation-reduction reactions and conserves iron body stores. Unconjugated hyperbilirubinemia is common in newborn infants, but rare later in life. The basic physiology of bilirubin metabolism, such as production, transport, and excretion, has been well described. However, in the neonate, numerous variables related to nutrition, ethnicity, and genetic variants at several metabolic steps may be superimposed on the normal physiological hyperbilirubinemia that occurs in the first week of life and results in bilirubin levels that may be toxic to the brain. Bilirubin exists in several isomeric forms that differ in their polarities and is considered a physiologically important antioxidant. Here we review the chemistry of the bilirubin molecule and its metabolism in the body with a particular focus on the processes that impact the newborn infant, and how differences relative to older children and adults contribute to the risk of developing both acute and long-term neurological sequelae in the newborn infant. The final section deals with the interplay between the brain and bilirubin and its entry, clearance, and accumulation. We conclude with a discussion of the current state of knowledge regarding the mechanism(s) of bilirubin neurotoxicity.
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Affiliation(s)
- Thor W R Hansen
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ronald J Wong
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David K Stevenson
- Division of Paediatric and Adolescent Medicine, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; and Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Amadi HO, Abdullahi RA, Mokuolu OA, Ezeanosike OB, Adesina CT, Mohammed IL, Olateju EK, Abubakar AL, Bello MA, Eneh AU, Onwe Ogah E, Eziechila BC, Chapp-Jumbo AU, Jimoh A, Udo JJ. Comparative outcome of overhead and total body phototherapy for treatment of severe neonatal jaundice in Nigeria. Paediatr Int Child Health 2020; 40:16-24. [PMID: 31142230 DOI: 10.1080/20469047.2019.1610607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: In Nigeria, neonatal jaundice is commonly treated by overhead phototherapy with neonates lying supine, often with effective exposure of less than one half of the body surface. Total body exposure in phototherapy has been in use for less than 2 years in Nigeria, but is available in only five neonatal centres.Aim: To compare the effectiveness of total body exposure (TBPE) with the conventional partial exposure (COPT) for treatment of hyperbilirubinaemia.Methods: Eleven datasets from 10 neonatal units across Nigeria were retrieved. They included neonates with severe hyperbilirubinaemia treated with TBPE using the Firefly® device (MTTS Asia) as a test group. The remainder of the patients, the controls, were treated with COPT. Any requirement for exchange blood transfusion (EBT) in either group was documented. Total serum bilirubin (TSB) >213.8 μmol/L (12.5 mg/dL) was treated as severe hyperbilirubinaemia. The efficiency of the intervention was determined according to the time taken for a severe case to be downgraded to mild at ≤213.8 μmol/L.Results: A total of 486 patients were studied, 343 controls and 143 cases. Mean (SD) postnatal age was 6 days (0.7) for cases and 5 (0.9) for controls, for gestational age (GA) in completed weeks was 36 (0.5) for cases and 37 (0.7) for controls and for birthweight was 2.7 kg (0.25) for cases and 2.7 (0.22) for controls. Mean (SD) pre-intervention TSB was 299.3 (35.7) μmol/L for cases and 327.3 (13.9) for controls. Severity downgrade day was Day 2 (0.4) for cases and Day 5 (1.1) for controls. Overall relative EBT rate was 6% for cases and 55% for controls (p= 0.0001), and early preterm relative EBT rate was 0% for cases and 68% for controls (p < 0.01).Conclusion: TBPE was quicker and safer for reduction of hyperbilirubinaemia and patients rarely required EBT. TBPE is recommended for rapid reduction of serum bilirubin levels and the reduction of treatment costs, morbidity and mortality in low- and middle-income countries.Abbreviations: EBT, exchange blood transfusion; TBPE, total body exposure technique; COPT, conventional partial exposure; TSB, total serum bilirubin; SB, serum bilirubin; NNJ, neonatal jaundice; SCNU, special care neonatal unit; LMIC, low- and middle-income countries; HIC, high-income countries; LED, light-emitting diode.
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Affiliation(s)
- Hippolite O Amadi
- Department of Bioengineering, Imperial College London, London, UK.,Neonatal Unit, Jummai Babangida Maternal and Neonatal Hospital, Minna, Nigeria
| | - Ruqayya A Abdullahi
- Neonatal Unit, Jummai Babangida Maternal and Neonatal Hospital, Minna, Nigeria
| | - Olugbenga A Mokuolu
- Department of Paediatrics, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Christiana T Adesina
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | - Eyinade K Olateju
- Department of Paediatrics, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Amina L Abubakar
- Neonatal Unit, Jummai Babangida Maternal and Neonatal Hospital, Minna, Nigeria
| | - Mustapha A Bello
- Department of Paediatrics, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Augusta U Eneh
- Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Emeka Onwe Ogah
- Department of Paediatrics, Federal Teaching Hospital, Abakaliki, Nigeria
| | | | | | - Abdulrasheed Jimoh
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Jacob J Udo
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
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Wall AC, Gius JP, Buglewicz DJ, Banks AB, Kato TA. Oxidative stress and endoreduplication induced by blue light exposure to CHO cells. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2019; 841:31-35. [PMID: 31138408 DOI: 10.1016/j.mrgentox.2019.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
Blue light is commonly used for the treatment of Neonatal Jaundice and as a photodynamic therapy for cancer. In comparison to ultraviolet light, blue light has a lower toxicity due to the differences in photon energies. However, blue light can still be mutagenic to cells. The proposed mechanism suggests blue light exposure induces reactive oxygen species inducing oxidative stress. In this study, we examined how blue light exposure caused genotoxic effects utilizing Chinese hamster ovary (CHO) cells and UV135 cells when exposed to fluorescent blue light. Cytotoxic effects of blue light exposure were quantified through cellular oxidative stress analysis, cell survival assay, and in cell cycle arrest experiments. Genotoxicity was studied in sister chromatid exchange (SCE) only, and endoreduplication formation. Following blue light exposure, an increase of cell cycle arrest, oxidative stress, and cytotoxicity was observed. Blue light treatment also produced an increased amount of SCE, and more importantly, induced endoreduplicated chromosomes. In conclusion, exposure to blue light resulted in significant genotoxicity of the treated cells.
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Affiliation(s)
- Alexa C Wall
- Department of Environmental & Radiological Health Sciences, Colorado State University, Colorado 80523, USA.
| | - Jeffrey P Gius
- Department of Environmental & Radiological Health Sciences, Colorado State University, Colorado 80523, USA.
| | - Dylan J Buglewicz
- Department of Environmental & Radiological Health Sciences, Colorado State University, Colorado 80523, USA.
| | - Austin B Banks
- Department of Environmental & Radiological Health Sciences, Colorado State University, Colorado 80523, USA.
| | - Takamitsu A Kato
- Department of Environmental & Radiological Health Sciences, Colorado State University, Colorado 80523, USA.
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