Neonatal Jaundice: New Trends in Phototherapy

Hyperbilirubinemia of the neonate and the related risk of brain damage with conseguent important alterations in motor development, particularly in sick preterm babies, remains a major problem in nurseries throughout the world. Since its introduction in the 1950's phototherapy has been used for reducing serum bilirubin concentrations in the newborn with hyperbilirubinemia; however, only recently the photoprocesses invoked by light on various substrates including bilirubin have been clari­ fied in sufficient detail. Light treatment actually exemplifies the intimate relationship between the clinical and basic sciences: the better understanding of the mechanism of phototherapy as a result of investigations initiated in the laboratory has been extended to the bedside as new types of lamps or new schedules of treatment. As a consequence, phototherapy of hyperbilirubinemia has emerged as a well-established branch of photomedicine, based on molecular photo­ biology, scientific method, and creative use of physics and sophis­ ticated electrooptical capabilities. The collaboration and exchange of information between workers in different basic and clinical di­ sciplines is likely to stimulate a further optimization of photo­ therapy. The purpose of this monograph is to discuss some of the new aspects of bilirubin metabolism and phototherapeutic treatment. Bilirubin conjugation in the fetal and early neonatal life, the mechanism of bilirubin entry into the brain, the measurements of bilirubin concentration in the skin and serum bilirubin binding capacity are discussed by a number of prominent neonatologists.