Phototherapy

PHOTOTHERAPY

Q. 1

Which mechanism in phototherapy is chiefly responsible for reduction in serum billirubin ‑

 A

Photo-oxidation

 B

Photo-isomerization

 C

Structural isomerization

 D

Conjugation

Q. 1

Which mechanism in phototherapy is chiefly responsible for reduction in serum billirubin ‑

 A

Photo-oxidation

 B

Photo-isomerization

 C

Structural isomerization

 D

Conjugation

Ans. C

Explanation:

Ans. is ‘c’ i.e., Structural isomerization

  • “Structural isomerization is the intramolecular cyclization of bilirubin to lumirubin. It is the most important pathway for the lowering of serum bilirubin levels.” – Manual of Neonatal Care

Phototherapy for unconjugated hvperbilirubinemia

  • Phototherapy has emerged as the most widely used form of treatment for unconjugated hyperbilirubinemia.
  • Phototherapy converts unconjugated bilirubin into isomers that are able to bypass the conjugating system of liver and are excreted in the bile or urine.

o Three types of photochemical reactions occur; in decreasing order of importance

1. Structural isomerization

 Bilirubin is converted into lumirubin, which is excreted in the bile and urine.

2. Photoisomerization

Less toxic, polar isomers are formed which are excreted in bile.

But, the photoisomer can revert back to unconjugated bilirubin and get reabsorbed from the gut if the baby is not having stools.

3. Photo-oxidation

It converts bilirubin into small polar products that are excreted in urine.

o Also know :

o “The most effective lights for phototherapy are those with high energy output near the maximum absorption peak of bilirubin (450 to 460 nm). Special blue lamps with a peak output of 425 to 475 nm are the most efficient for phototherapy.” – Manual of Neonatal


Q. 2

Bronze baby syndrome is due to –

 A

Phototherapy

 B

Wilson disease

 C

Chloramphenicol toxicity

 D

Hemochromatosis

Q. 2

Bronze baby syndrome is due to –

 A

Phototherapy

 B

Wilson disease

 C

Chloramphenicol toxicity

 D

Hemochromatosis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Phototherapy

Bronze baby syndrome ‑

It refers to dark grayish brown discoloration of the skin in infants undergoing phototherapy. Almost all infants observed with this syndrome have had a mixed type of hyperbilirubinemia with significant elevation of direct reacting bilirubin and often with other evidence of obstructive liver disease.

Other complications of phototherapy

  • Loose stool                                                              o Erythematous macular rash
  • Purpurich rash associated with transient porphyrinemia.      o Retinal damage.
  • Increase in environment and body temperature

Q. 3

A full term, 80 hrs old new born baby develops jaundice what should be the minimum level of serum bilirubin to start phototherapy –

 A

20mg%

 B

12.5mg%

 C

18mg%

 D

15mg%

Q. 3

A full term, 80 hrs old new born baby develops jaundice what should be the minimum level of serum bilirubin to start phototherapy –

 A

20mg%

 B

12.5mg%

 C

18mg%

 D

15mg%

Ans. A

Explanation:

Ans. is ‘a’ i.e., 20mg%


Q. 4

Infants receiving phototherapy –

 A

May develop diaorrhea

 B

Generally develop a bronze discolouration of skin

 C

Should have their eyes patched during therapy

 D

All

Q. 4

Infants receiving phototherapy –

 A

May develop diaorrhea

 B

Generally develop a bronze discolouration of skin

 C

Should have their eyes patched during therapy

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., Have increased insensible water loss; ‘b’ i.e., Generally develop a bronze discolouration of skin & ‘c’ i.e., Should have their eyes patched during therapy

o Phototherapy causes insensible water loss especially in premature infants -3 Increase in body temprature.

o Stools tend to be more frequent and watery (Diarrhea).

o Phototherapy can cause retinal damage. Therefore, it is essential that the eyes of all newborns exposed to phototherapy should be covered.

o Skin, urine and serum become brownish black after several days of phototherapy —> Bronze baby syndrome.


Q. 5

Ideal treatment of B/L retinoblastoma:

 A

Enucleation

 B

Radiotherapy

 C

Chemotherapy

 D

Phototherapy

Q. 5

Ideal treatment of B/L retinoblastoma:

 A

Enucleation

 B

Radiotherapy

 C

Chemotherapy

 D

Phototherapy

Ans. A

Explanation:

Ans. Enucleation


Q. 6

A 32 weeks premature, healthy infant weighing less than 1 kg is having jaundice with serum bilirubin level of 5 mg%. Ideal management in such a case would be:   

September 2006

 A

Observation

 B

Phototherapy

 C

Medical management

 D

Exchange transfusion

Q. 6

A 32 weeks premature, healthy infant weighing less than 1 kg is having jaundice with serum bilirubin level of 5 mg%. Ideal management in such a case would be:   

September 2006

 A

Observation

 B

Phototherapy

 C

Medical management

 D

Exchange transfusion

Ans. B

Explanation:

Ans. B: Phototherapy

Phototherapy is the primary treatment in neonates with unconjugated hyperbilirubinemia. The photoisomers of bilirubin are excreted in bile and, to some extent, in urine. Phototherapy acts by several ways:

  • Configurational isomerization
  • Structural isomerization
  • Photo-oxidation

Indications:

Premature infants (less than 35 weeks gestational age):

The following total bilirubin levels are suggested for premature infants.

BirthWeight (g)— —Total Bilirubin (mg/dl)

  1. 2000-2499— — — — —11 to 14
  2. 1501-1999 ————— -8 to 12
  3. Less than 1500— — —5 to 8

Use the lower levels for:

  1. Babies with risk factors
  2. Bilirubin levels measured within 72 hours of birth

“Risk factors” include the following:

  1. Hemolysis Sepsis
  2. Asphyxia (5 minute Apgar of 3 or less)
  3. Temperature instability
  4. Acidosis (pH < 7.20 for more than 1 hour)
  5. ifypoalbuminemia (< 2.5 mg/dl)
  6. CNS signs (e.g. lethargy)

Q. 7

A full term 80 hours old new born baby develops jaundice. What should be the minimum level of serum bilirubin to start phototherapy:    

March 2013

 A

20 mg%

 B

12.5 gm%

 C

18 mg%

 D

15 mg%

Q. 7

A full term 80 hours old new born baby develops jaundice. What should be the minimum level of serum bilirubin to start phototherapy:    

March 2013

 A

20 mg%

 B

12.5 gm%

 C

18 mg%

 D

15 mg%

Ans. A

Explanation:

Ans. A i.e. 20 mg%

Jaundice

  • Causes of unconjugated hyperbilirubinemia:

– Criggler Najjar syndrome I & II,

– Physiological jaundice,

– Gilbert syndrome

– Breast milk jaundice etc.

  • Causes of conjugated hyperbilirubinemia: Biliary atresia (extrahepatic/ intrahepatic),
  • MC cause of conjugated bilirubinemia in newborn: Idiopathic infantile hepatitis
  • Physiological jaundice appears on: 3rd day (lasts upto 7th day)
  • MC cause of jaundice within 24 hours after birth: Erythroblastosis fetalis
  • Breast milk jaundice is due to: Pregnandiole
  • Kernicterus: Unconjugated bilirubin, in basal ganglia
  • Rise in level of bilirubin in physiological jaundice: Less than 5 mg/ dl/ day

Q. 8

Identify the apparatus use in ICU as shown in the picture below ? 

 A

Resuscitation.

 B

Radiant warming.

 C

Cooling blanket.

 D

Phototherapy.

Q. 8

Identify the apparatus use in ICU as shown in the picture below ? 

 A

Resuscitation.

 B

Radiant warming.

 C

Cooling blanket.

 D

Phototherapy.

Ans. D

Explanation:

Phototherapy is the most common treatment for reducing high bilirubin levels that cause jaundice in a newborn. In the standard form of phototherapy, baby lies in a bassinet or enclosed plastic crib (incubator) and is exposed to a type of fluorescent light that is absorbed by baby’s skin.


Q. 9

ldentify the apparatus used in paediatrics as shown in photograph below ? 

 A

Incubator.

 B

Resuscitator.

 C

Heart rate & respiration monitor.

 D

Fluorescent light Phototherapy unit.

Q. 9

ldentify the apparatus used in paediatrics as shown in photograph below ? 

 A

Incubator.

 B

Resuscitator.

 C

Heart rate & respiration monitor.

 D

Fluorescent light Phototherapy unit.

Ans. D

Explanation:

 The apparatus used in paediatrics as shown in photograph above represents fluorescent light phototherapy unit.



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