Description
Springer Neonatal Jaundice New Trends in Phototherapy 1st Editon 2014 Softbound by Firmino F. Rubaltelli
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. Bilirubin Metabolism.- Bilirubin metabolism in the newborn: its mechanisms and relationship to kernicterus.- Serum bilirubin mono- and diconjugates in human newborns.- Mechanism of bilirubin entry into the brain in an animal model.- The importance of serum binding and the blood-brain barrier in the development of acute bilirubin neurotoxicity.- Distribution of bilirubin between serum and cerebrospinal fluid in newborn infants.- Assessment of the Risk of Bilirubin Toxicity.- The chemical nature of fetal albumin.- Estimation of reserve albumin equivalent concentration for binding of bilirubin.- Postnatal changes in the ability of plasma albumin to bind bilirubin.- Interactions of bilirubin and drugs.- Estimation and clinical significance of bilirubin binding status.- Factors affecting the transcutaneous measurement of bilirubin: influence of race, gestational age, phototherapy and albumin binding capacity.- Chemistry and Photochemistry of Bilirubin.- Recent advances in the chemistry of bile pigments.- Solution conformations, photophysics and photochemistry of Bilirubin and biliverdin dimethyl esters.- Photophysical properties of bile pigments.- In vitro and in vivo bilirubin-sensitized photoeffects at the molecular and cellular levels.- Photooxygenation products of bilirubin in the urine of jaundiced phototherapy neonates.- Phototherapy of Neonatal Jaundice.- Molecular mechanisms of phototherapy of neonatal jaundice.- Mechanisms of action of phototherapy: new concepts.- Laser-oriented search of the optimum light for phototherapy.- A mathematical description of the phototherapy-effect: an investigation of the dose-response relationship under high irradiances.- The Gunn rat: a model for phototherapy.- Light dose-response relationship in phototherapy.- Prediction of the effect of phototherapy in newborns.- Reducing the duration of phototherapy for neonatal jaundice by cholestyramine administration.- Bronze baby syndrome: new insights on bilirubin-photosensitization of copper-porphyrins.- Effect of light and various concentrations of oxygen on the retina of the newborn pig.- Effect of phototherapy on hepatic microsomal drug metabolism in heterozygous and homozygous Gunn rats.- Long term outcome of phototherapy; selected aspects of the NICHHD cooperative phototherapy study.