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Objective. To evaluate the efficacy of fiber-optic phototherapy using the standard Ohmeda Biliblanket, a large version, double standard Biliblankets, and conventional phototherapy using daylight fluorescent lamps in full-term, healthy infants with nonhemolytic hyperbilirubinemia.Methods. Full-term, healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 μmol/L or 222 μmol/L at Results. A total of 171 infants were studied; 42 were exposed to standard fiber-optic phototherapy, 43 to large fiber-optic phototherapy, 42 to double–fiber-optic phototherapy, and 44 to conventional phototherapy. Durations of exposure were 87.05 ± 6.09 (SEM), 82.57 ± 5.84, 64.85 ± 5.43, and 62.61 ± 3.74 hours, respectively; the 24-hour decline rates were 10.26% ± 1.84%, 14.50% ± 1.53%, 21.82% ± 1.71%, and 19.00% ± 1.65%, respectively; the overall decline rates over the whole exposure period were 0.47% ± 0.03%, 0.52% ± 0.04%, 0.71% ± 0.05%, and 0.75% ± 0.04% per hour, respectively. The efficacy of double–fiber-optic phototherapy and conventional phototherapy was similar and significantly better than that of the large fiber-optic mat and the standard fiber-optic mat in duration, 24-hour decline rate, and overall decline rate. The large mat was slightly better than the standard-size mat with regard to 24-hour decline rate and overall decline rate, but this difference was not significant. Failure of phototherapy occurred only in the large fiber-optic mat group (3 of 43) and the standard fiber-optic mat group (4 of 42); none occurred in the other two groups, but differences not statistically significant. The nursing personnel were more comfortable with single fiber-optic phototherapy, which caused no initial disturbance to the swaddled infants as did conventional phototherapy, but found double–fiber-optic phototherapy difficult to use.Conclusion. For efficacy of fiber-optic phototherapy in full-term infants to be comparable to that of our conventional phototherapy, the light dose of the standard mats needs to be doubled. fiber-optic phototherapy, neonatal hyperbilirubinemia, efficacy.

The effectiveness of phototherapy in the management of neonatal hyperbilirubinemia in glucose-6-phosphate dehydrogenase (G6PD)-deficient infants was studied. "Prophylactic" phototherapy for six continuous days commencing from the first day of life was effective in preventing a significant rise in bilirubin levels in 12 G6PD-deficient infants in the first three days, during which period a rapid rise was observed in a control group of G6PD-deficient infants. The hemoglobin levels on the first and eighth postnatal days were comparable in both groups. "Therapeutic" phototherapy proved equally effective in reducing bilirubin levels in 24 infants with nonhemolytic hyperbilirubinemia and an equal number of infants with hyperbilirubinemia associated with G6PD deficiency. Phototherapy was efficacious in the prevention or treatment of neonatal hyperbilirubinemia associated with G6PD deficiency; even if its use is prolonged it does not cause hemolysis in such infants.

Umbilical cord plasma α-fetoprotein (AFP) values were determined in 127 infants with hyperbilirubinemia (56 glucose-6-phosphate dehydrogenase (G-6-PD) deficient and 71 G-6-PD normal) and 136 control subjects (73 G-6-PD deficient and 63 G-6-PD normal). The mean α-fetoprotein value of 173 ± 35.2 (SD) mg/L for the group of infants with hyperbilirubinemia was significantly greater than that (122 ± 21.7 mg/L) for the control infants (P < .001). G-6-PD status and sex did not significantly affect the α-fetoprotein values. Using an α-fetoprotein level of 130 mg/L as a "cut-off" value, the incidence of false-positive results was 25.5% and the incidence of false-negative results was 11.8%. This test can be used as a screening procedure to detect infants at high risk for hyperbilirubinemia.

The effectiveness of phototherapy for nonhemolytic hyperbilirubinemia was evaluated in two groups of closely matched newborns, one group consisting of "healthy" and the other of "ill" infants. Phototherapy was equally effective in reducing bilirubin levels in both groups of infants. It would seem to be the treatment of choice in all infants with nonhemolytic hyperbilirubinemia, especially ill infants in whom its simplicity, safety, and effectiveness would make it an ideal form of therapy.

Two matched groups of Chinese infants with "idiopathic" jaundice were subjected to phototherapy, one group to "single-direction" phototherapy and the other to "double-direction" phototherapy. The total energy output on the skin of the infants was similar in both groups. The 24-hour fall in bilirubin levels was almost identical in the two groups; the number of infants in each group achieving bilirubin levels less than 11 mg/100 ml at 24, 48, and 72 hours was statistically very similar too. Where the energy output can be adjusted to supply a constant dose on the infant (by varying the energy output in inverse proportion to the skin area exposed), the effect of varying the skin area under phototherapy is minimal. However, the total area of skin exposed to phototherapy under uniform lighting conditions is important because it determines the dose of energy output acting on it, and hence the effectiveness of the procedure.

Umbilical cord plasma alpha-fetoprotein (AFP) values were determined in 127 infants with hyperbilirubinemia (56 glucose-6-phosphate dehydrogenase (G-6-PD) deficient and 71 G-6-PD normal) and 136 control subjects (73 G-6-PD deficient and 63 G-6-PD normal). The mean alpha-fetoprotein value of 173 +/- 35.2 (SD) mg/L for the group of infants with hyperbilirubinemia was significantly greater than that (122 +/- 21.7 mg/L) for the control infants (P less than .001). G-6-PD status and sex did not significantly affect the alpha-fetoprotein values. Using an alpha-fetoprotein level of 130 mg/L as a "cut-off" value, the incidence of false-positive results was 25.5% and the incidence of false-negative results was 11.8%. This test can be used as a screening procedure to detect infants at high risk for hyperbilirubinemia.

The effectiveness of phototherapy in the management of neonatal hyperbilirubinemia in glucose-6-phosphate dehydrogenase (G6PD)-deficient infants was studied. "Prophylactic" phototherapy for six continuous days commencing from the first day of life was effective in preventing a significant rise in bilirubin levels in 12 G6PD-deficient infants in the first three days, during which period a rapid rise was observed in a control group of G6PD-deficient infants. The hemoglobin levels on the first and eighth postnatal days were comparable in both groups. "Therapeutic" phototherapy proved equally effective in reducing bilirubin levels in 24 infants with nonhemolytic hyperbilirubinemia and an equal number of infnats with hyperbilirubinemia associated with G6PD deficiency. Phototherapy was efficacious in the prevention or treatment of neonatal hyperbilirubinemia associated with G6PD deficiency; even if its use is prolonged it does not cause hemolysis in such infants.