Abstract Blue light has been widely used for the treatment of neonatal hyperbilirubinemia since the 1950s. Neonatal phototherapy can decrease plasma unconjugated bilirubin level, thus preventing bilirubin encephalopathy, and greatly reduces the exchange transfusion rate. Generally, it is accepted that the side effects of neonatal phototherapy are not serious and seem to be well controlled, however recent research has provided new evidence. The short-term side effects of phototherapy include interference with maternal-infant interaction, imbalance of thermal environment and water loss, electrolyte disturbance, bronze baby syndrome and circadian rhythm disorder. In addition, phototherapy may be associated with some long-term side effects such as melanocytic nevi and skin cancer, allergic diseases, patent ductus arteriosus and retinal damage. Therefore, it is necessary to develop evidence-based guidelines, new light devices and alternative agents, as well as individualized treatments, to minimize the side effects of phototherapy.
[2]Morris BH, Oh W, Tyson JE, Stevenson DK, Phelps DL, O'Shea TM, et al. Aggressive vs. conservative phototherapy for infants with extremely low birth weight[J]. N Engl J Med, 2008, 359(18): 1885-1896.
[3]Usatin D, Liljestrand P, Kuzniewicz MW, Escobar GJ, Newman TB. Effect of neonatal jaundice and phototherapy on the frequency of first-year outpatient visits[J]. Pediatrics, 2010, 125(4): 729-734.
[4]Kumar P, Murki S, Malik GK, Chawla D, Deorari AK, Karthi N, et al. Light emitting diodes versus compact fluorescent tubes for phototherapy in neonatal jaundice: a multi center randomized controlled trial[J]. Indian Pediatr, 2010, 47(2): 131-137.
[5]Mehta S, Kumar P, Narang A. A randomized controlled trial of fluid supplementation in term neonates with severe hyperbilirubinemia[J]. J Pediatr, 2005, 147(6): 781-785.
[6]Hooman N, Honarpisheh A. The effect of phototherapy on urinary calcium excretion in newborns[J]. Pediatr Nephrol, 2005, 20(9): 1363-1364.
[7]Chen A, Du L, Xu Y, Chen L, Wu Y. The effect of blue light exposure on the expression of circadian genes: bmal1 and cryptochrome 1 in peripheral blood mononuclear cells of jaundiced neonates[J]. Pediatr Res, 2005, 58(6): 1180-1184.
[8]De Luca D, Picone S, Fabiano A, Paolillo P. Images in neonatal medicine. Bronze baby syndrome: pictorial description of a rare condition[J]. Arch Dis Child Fetal Neonatal Ed, 2010, 95(5): F325.
[9]McDonagh AF. Bilirubin, copper-porphyrins, and the bronze-baby syndrome[J]. J Pediatr, 2011, 158(1): 160-164.
[10]Bertini G, Dani C, Fonda C, Zorzi C, Rubaltelli FF. Bronze baby syndrome and the risk of kernicterus[J]. Acta Paediatr, 2005, 94(7): 968-971.
[11]Matichard E, Le Henanff A, Sanders A, Leguyadec J, Crickx B, Descamps V. Effect of neonatal phototherapy on melanocytic nevus count in children[J]. Arch Dermatol, 2006, 142(12): 1599-1604.
[12]Tatli MM, Minnet C, Kocyigit A, Karadag A. Phototherapy increases DNA damage in lymphocytes of hyperbilirubinemic neonates[J]. Mutat Res, 2008, 654(1): 93-95.
[13]Karadag A, Yesilyurt A, Unal S, Keskin I, Demirin H, Uras N, et al. A chromosomal-effect study of intensive phototherapy versus conventional phototherapy in newborns with jaundice[J]. Mutat Res, 2009, 676(1-2): 17-20.
[14]Csoma Z, Hencz P, Orvos H, Kemeny L, Dobozy A, Dosa-Racz E, et al. Neonatal blue-light phototherapy could increase the risk of dysplastic nevus development[J]. Pediatrics, 2007, 119(6): 1269.
[15]Csoma Z, Hencz P, Orvos H, Kemeny L, Dobozy A, Dosa-Racz E, et al. Neonatal blue-light phototherapy could increase the risk of dysplastic nevus development[J]. Pediatrics, 2007, 119(5): 1036-1037.
[16]Csoma Z, Kemeny L, Olah J. Phototherapy for neonatal jaundice[J]. N Engl J Med, 2008, 358(23): 2523-2524.
[17]Berg P, Lindelof B. Is phototherapy in neonates a risk factor for malignant melanoma development?[J]. Arch Pediatr Adolesc Med, 1997, 151(12): 1185-1187.
[18]Brewster DH, Tucker JS, Fleming M, Morris C, Stockton DL, Lloyd DJ, et al. Risk of skin cancer after neonatal phototherapy: retrospective cohort study[J]. Arch Dis Child, 2010, 95(10): 826-831
[19]McGeady SJ. Immunocompetence and allergy[J]. Pediatrics, 2004, 113(4 Suppl): 1107-1113.
[20]Kurt A, Aygun AD, Kurt AN, Godekmerdan A, Akarsu S, Yilmaz E. Use of phototherapy for neonatal hyperbilirubinemia affects cytokine production and lymphocyte subsets[J]. Neonatology, 2009, 95(3): 262-266.
[21]Aycicek A, Kocyigit A, Erel O, Senturk H. Phototherapy causes DNA damage in peripheral mononuclear leukocytes in term infants[J]. J Pediatr (Rio J), 2008, 84(2): 141-146.
[22]Gloria-Bottini F, Bottini E. Is there a role of early neonatal events in susceptibility to allergy?[J]. Int J Biomed Sci, 2010, 6(1): 8-12.
[23]Aspberg S, Dahlquist G, Kahan T, Kallen B. Is neonatal phototherapy associated with an increased risk for hospitalized childhood bronchial asthma?[J]. Pediatr Allergy Immunol, 2007, 18(4): 313-319.
[24]Aspberg S, Dahlquist G, Kahan T, Kallen B. Confirmed association between neonatal phototherapy or neonatal icterus and risk of childhood asthma[J]. Pediatr Allergy Immunol, 2010, 21(4 Pt 2): e733-e739.
[25]Batenburg WW, Kappers MH, Eikmann MJ, Ramzan SN, de Vries R, Danser AH. Light-induced vs. bradykinin-induced relaxation of coronary arteries: do S-nitrosothiols act as endothelium-derived hyperpolarizing factors?[J]. J Hypertens, 2009, 27(8): 1631-1640.
[26]Weissman A, Berkowitz E, Smolkin T, Blazer S. Effect of phototherapy on neonatal heart rate variability and complexity[J]. Neonatology, 2009, 95(1): 41-46.
[27]Barefield ES, Dwyer MD, Cassady G. Association of patent ductus arteriosus and phototherapy in infants weighing less than 1000 grams[J]. J Perinatol, 1993, 13(5): 376-380.
[28]Benders MJ, Van Bel F, Van de Bor M. Cardiac output and ductal reopening during phototherapy in preterm infants[J]. Acta Paediatr, 1999, 88(9): 1014-1019.
[29]Grimm C, Wenzel A, Williams T, Rol P, Hafezi F, Reme C. Rhodopsin-mediated blue-light damage to the rat retina: effect of photoreversal of bleaching[J]. Invest Ophthalmol Vis Sci, 2001, 42(2): 497-505.
[30]Baba L, McGrath JM. Oxygen free radicals: effects in the newborn period[J]. Adv Neonatal Care, 2008, 8(5): 256-264.
[31]Aycicek A, Erel O. Total oxidant/antioxidant status in jaundiced newborns before and after phototherapy[J]. J Pediatr (Rio J), 2007, 83(4): 319-322.
[32]Yeo KL, Perlman M, Hao Y, Mullaney P. Outcomes of extremely premature infants related to their peak serum bilirubin concentrations and exposure to phototherapy[J]. Pediatrics, 1998, 102(6): 1426-1431.
[33]Khatami SF, Yousefi A, Bayat GF, Mamuri G. Retinopathy of prematurity among 1000-2000 gram birth weight newborn infants[J]. Iran J Pediatr, 2008, 18(2): 137-142.
[34]Ebrahim M, Ahmad RS, Mohammad M. Incidence and risk factors of retinopathy of prematurity in Babol, North of Iran[J]. Ophthalmic Epidemiol, 2010, 17(3): 166-170.
[35]Cetinkursun S, Demirbag S, Cincik M, Baykal B, Gunal A. Effects of phototherapy on newborn rat testicles[J]. Arch Androl, 2006, 52(1): 61-70.
[37]Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice[J]. New Engl J Med, 2008, 358(9): 920-928.
[38]Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation[J]. Pediatrics, 2004, 114(1): 297-316.
[39]Stevenson DK, Wong RJ. Metalloporphyrins in the management of neonatal hyperbilirubinemia[J]. Semin Fetal Neonatal Med, 2010, 15(3): 164-168.
[40]Sharafi R, Mortazavi Z, Sharafi S, Parashkouh R. The effect of clofibrate on decreasing serum bilirubin in healthy term neonates under home phototherapy[J]. Iran J Pediatr, 2010, 20(1): 48-52.
[41]Whitelaw A, Odd D. Postnatal phenobarbital for the prevention of intraventricular hemorrhage in preterm infants[J]. Cochrane Database Syst Rev, 2007(4): CD001691.