Cardio Pulmonary Monitoring during Phototherapy in near term neonates: current practice among NICUs and PICUs in Switzerland

Introduction: Despite updated recommendation by the Swiss Soc of Neonatology, the evidence for cardiopulmonary monitoring (CPM) during Phototehrapy (PT) in near-term neonates is unclear. With limited NICU beds, the need for CPM has to be evaluated. At first, we conducted a Switzerland-wide survey of current practice. Method: All 31 swiss NICU and PICUs received a questionnaire. Results: 22 were returned (71%). All had PT guidelines, 91% the updated version. 68% expected side effects in <5% of the babies (top 4 were: 54.5% hyperthermia, 45.5% irritability, 41% weight gain decrease and 36.5% feeding intolerance). Cardiopulmonary (CP) symptoms were less frequent: tachy-, bradycardia (22.5%, 13.5%), tachy- and apnea (32%, 13.5%). CPM by oxygen saturation (SpO2): 32% yes, 50% no, 18% depending on circumstances; by ECG monitoring: 9% yes, 59% no, 32% circumstance dependant. SpO2+ECG: 13.5% yes (similarly to non jaundiced babies). Discussion: Despite evidence for CP side effects, 63.5% of the units didnrsquor;t apply any CPM during PT. Bader showed statistically significant lower respiratory rate and higher heart rate (HR) during certain sleep states while SpO2, apneas or periodic breathing were unchanged. Yao reported a decreased systolic BP and a HR increase, which is consistent with cutaneous vasodilation (Jahnukainen). Benders showed a decreased left ventricular outpout. It remains unclear whether these changes have any biological impact and whether the used CPM is justified. Conclusion: Despite reported CP changes during PT, current CPM in Switzerland is inhomogeneous and the question whether a near-term neonate has to be admitted to a nursery for CPM during PT needs urgently to be answered.

Literatur: Bader D, Kugelman A, Blum DE, et al. Effect of phototherapy on cardiorespiratory activity during sleep in neonates with physiologic jaundice. Isr Med Assoc J. 2006 Jan;8(1):12-6. Benders MJ, Van Bel F, Van de Bor M. Cardiac output and ductal reopening during phototherapy in preterm infants. Acta Paediatr. 1999 Sep;88(9):1014-9. Jahnukainen T, Lindqvist A, Jalonen J, et al. Responsiveness of cutaneous vasculature to thermal stimulation during phototherapy in neonatal jaundice. Eur J Pediatr. 1999 Sep;158(9):757-60.

Cardio Pulmonary Monitoring - Near Term Newborn - Phototherapy