Researchers find aggressive phototherapy can improve neurodevelopmental outcomes in some preemies

October 29, 2008

Researchers at The University of Texas Medical School at Houston say the use of aggressive phototherapy reduces the odds that tiny premature infants will develop neurodevelopmental impairment such as cerebral palsy, blindness, deafness or physical or mental challenges. The study, titled "Aggressive Versus Conservative Phototherapy for Infants with Extremely Low Birth Weight," is published in the Oct. 30, 2008 issue of the New England Journal of Medicine.

The study was a multi-center clinical trial funded by the Neonatal Research Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the UT Medical School at Houston was the lead center in designing and conducting it.

"Before this study, we had very limited information from clinical research to indicate how phototherapy should be used in small premature babies. The only previous major clinical trial was performed more than 30 years ago and included only a few infants who weighed less than 1,000 grams, or 2.3 ounces. With all the advances in obstetric and neonatal care, these infants are much more likely to survive today, and we need large clinical trials like this to know how to achieve the best possible long-term outcomes," said co-author Jon E. Tyson, M.D., professor of pediatrics and obstetrics and the Michelle Bain Distinguished Professor in Medicine and Public Health at the UT Medical School at Houston.

Neonatal jaundice is a yellowing of the skin and other tissues in a newborn due to high levels of bilirubin, an indication that red blood cells are being broken down too quickly for the liver to process. The condition is caused by the newborn's overall physiologic immaturity, including immaturity of the liver. Phototherapy helps to reduce the bilirubin level and the risk of brain damage that can occur when bilirubin reaches high levels and crosses over from the blood into the brain.

The study involved nearly 2,000 infants who were born at 501 to 1,000 grams birth weight between September 2002 and April 2005 in hospitals of the Neonatal Research Network, including Children's Memorial Hermann Hospital and the Harris County Hospital District's Lyndon B. Johnson General Hospital.

Aggressive phototherapy reduced the infants' chances of having severe neurodevelopmental impairments, said Brenda Morris, M.D., former associate professor of pediatrics at the UT Medical School at Houston and principal investigator of the Neonatal Research Network study. "There was a 14 percent reduction in neurodevelopment impairment with aggressive phototherapy. This relative risk reduction was statistically significant, and we did not see any evidence of harm in the study's larger infants, those weighing 751 to 1,000 grams at birth," she said. Phototherapy was deemed aggressive when started in the first 24 hours of life and used until the bilirubin remained at very low levels.

In the smaller babies, the ones weighing 501-750 grams, Tyson said, the results suggest that the reduction in profound impairment may be offset by a trend toward a somewhat higher mortality rate. However, this increase was not statistically significant and may have simply occurred by chance. Tyson added that the Neonatal Research Network is in the planning stages of a trial which would investigate another treatment option for jaundice.
-end-
A special feature of the phototherapy trial was the use of an innovative method of statistical analysis (Bayesian analysis) used in evaluating the study results. These analyses were performed by Claudia Pedroza, Ph.D. at The University of Texas School of Public Health. Other study personnel include: Kathleen Kennedy, M.D.; Georgia McDavid, R.N., Patricia Evans, M.D.; Pamela J. Bradt, M.D.; Laura L. Whiteley, M.D.; Patty A. Cluff, R.N.; Anna E. Lis, R.N.; Claudia Y. Franco, R.N.; Maegan Currence, R.N.; Nora I. Alaniz; Patti L. Tate; Sharon L. Wright, and Esther G. Akpa, R.N.

[Print-quality digital photos of Dr. Tyson and Dr. Morris are available via e-mail by request.]

University of Texas Health Science Center at Houston

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200852.

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.