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ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 38-40

Is phototherapy stressful? A study to compare the stress of neonates in single and double-surface phototherapy


Department of Pediatrics, Christian Hospital Chhatarpur (A Unit of Emmanuel Hospital Association, New Delhi), Madhya Pradesh, India

Date of Web Publication6-Feb-2018

Correspondence Address:
Dr. Varghese Abraham
Consultant Pediatrician & In-charge SNCU, Christian Hospital Chhatarpur (A Unit of Emmanuel Hospital Association, New Delhi), Mahoba Road, Chhatarpur - 471 001, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_108_17

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  Abstract 


Objectives: The aim of this study is to compare the stress level of neonate undergoing double-surface (DS) and single-surface (SS) phototherapy. Study Design: This was a prospective observational study. Study Setting: Neonates with indirect hyperbilirubinemia on phototherapy in Special Newborn Care Unit of Christian Hospital, Chhatarpur, Madhya Pradesh, India (A Unit of Emmanuel Hospital Association, New Delhi). Materials and Methods: The stress level of neonate under DS and SS phototherapy was assessed with COMFORT-B scale. The neonate was assessed before the start of phototherapy (zero hours) and was further assessed at 2, 6, 12, and 24 h of phototherapy. Results: A total of 94 neonates were included in the study, of which 56 (59.5%) are term and 38 (40.5%) are preterm. The maximum COMFORT-B scale score was 23, and the minimum score was 7. The mean COMFORT-B score was marginally higher with DS phototherapy at all hours of phototherapy, but it is not statistically significant. Similar observations were noted among terms and preterms. Conclusion: There is no additional stress to neonates in DS phototherapy compared to SS phototherapy.

Keywords: COMFORT-B scale, Double surface, Hyperbilirubinemia, Phototherapy, Single surface


How to cite this article:
Abraham V, Johnson E, Deep K, Dip D, Yadav P, Singh M. Is phototherapy stressful? A study to compare the stress of neonates in single and double-surface phototherapy. J Clin Neonatol 2018;7:38-40

How to cite this URL:
Abraham V, Johnson E, Deep K, Dip D, Yadav P, Singh M. Is phototherapy stressful? A study to compare the stress of neonates in single and double-surface phototherapy. J Clin Neonatol [serial online] 2018 [cited 2022 May 19];7:38-40. Available from: https://www.jcnonweb.com/text.asp?2018/7/1/38/224806




  Introduction Top


Hyperbilirubinemia is a common problem encountered in neonates. Approximately 85% of all term and most of the preterm develop clinical jaundice.[1] Phototherapy is the most widely used treatment for hyperbilirubinemia in neonates.[2] As compared to traditional single-surface (SS) intensive phototherapy, double surface (DS) is effective in decreasing bilirubin,[3] and thus preventing exchange transfusion. Although DS phototherapy is very effective, it is likely to cause additional stress in the neonate because of high intensity of light and the heat generated from the source. Hays et al. at Washington in 2012 demonstrated that stress in the neonatal period can cause adverse neurodevelopmental and behavioral outcome.[4] Hence, in this study, we compared the stress level of neonates in DS and SS phototherapy using COMFORT-B scale.[5]


  Materials and Methods Top


This observational cross-sectional study was done on neonates admitted in the Special Newborn Care Unit (SNCU) of Christian Hospital, Chhatarpur, Madhya Pradesh, India. All neonates with parental consent and requiring phototherapy were enrolled in the study. These neonates were assessed with COMFORT-B scale before the start of phototherapy (zero hours) and were further assessed at 2, 6, 12, and 24 h of phototherapy. The assessment was done by a trained neonatal intensive care nurses. COMFORT-B scale was used to assess the stress in neonates. This scale includes various indicators such as alertness, calmness/agitation, crying, physical movement, tone, and facial tension. Each indicator was scored between 1 and 5 based on the behaviors exhibited by the patient.[5] Patients were observed unobtrusively for 2 min.[6] The total score was derived by adding the scores of each indicator. The higher the score on the COMFORT-B scale, the higher will be the stress to the neonate.[7] Exclusion criteria included neonates who had birth asphyxia or developed respiratory distress and were ventilated or were in shock or were on anti-epileptics or any other sedation medication. The results were entered in Microsoft Excel and compared with mean, median, and interquartile range. Normality of the data was checked by Kolmogorov–Smirnov test, and the P value was calculated by Mann–Whitney test. The phototherapy unit used in this study was Phoenix Brilliance Phototherapy unit with light-emitting diode light for both single and DS. This study was approved by the Institutional Ethics Committee of Emmanuel Hospital Association (EHA).


  Results Top


A total of 94 neonates were assessed, of which 56 (59.5%) were term and 38 (40.5%) were preterm. Out of the term neonates, 38 (67.8%) were under DS phototherapy, and the remaining 32.2% were under SS phototherapy. Of the 38 preterm neonates, 26 (68.4%) were under SS phototherapy and remaining 31.6% were under DS phototherapy. The maximum COMFORT-B scale score was 23, and the minimum score was 7.

The mean COMFORT-B score was higher with DS phototherapy at all hours of phototherapy, but it is not statistically significant [Table 1]. Similar observations were noted among terms and preterms [Table 2] and [Table 3]. The normality of the data was checked with Kolmogorov–Smirnov Test, and the P value was calculated by Mann–Whitney test. Since the data were not normally distributed, the median scores were compared. The median score is marginally higher for DS phototherapy at all hours of phototherapy [Figure 1]. Surprisingly, on comparing the hours of phototherapy with the COMFORT-B score, there was a proportionate gradual decrease in the stress level of neonates as the hours of DS phototherapy progressed [Figure 1].
Table 1: Mean COMFORT-B score in neonates

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Table 2: Mean COMFORT-B score in term neonates

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Table 3: Mean COMFORT-B score in preterm neonates

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Figure 1: Median score comparison of COMFORT-B scale between double-surface and single-surface phototherapy

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  Discussion Top


This study revealed a higher mean COMFORT-B score in DS phototherapy, but it was not statistically significant. Thus, to conclude, there was no additional stress noticed in DS phototherapy compared to SS phototherapy. Similarly, the author also suggests that there was no additional stress noticed with the duration of phototherapy. Xiong et al., 2011, demonstrated various complications of phototherapy, but no previous study was done to access stress level in neonate under phototherapy.[8] There are many factors which can add onto the stress levels in neonates such as external temperature and painful procedures which is not taken into consideration in the present study.

van Dijk et al., 2000, used COMFORT-B scale to access pain in postoperative patients from 0 to 3 years.[5],[9] Ista et al., 2005, used COMFORT-B scale to access the sedation level in pediatric intensive care.[5],[7] Valkenburg et al., 2011, used COMFORT-B scale to access pain and distress in Down's Syndrome children who underwent cardiac and intestinal surgery.[10] However, this is the only study were COMFORT-B scale was used to compare stress in neonates under DS and SS phototherapy.


  Conclusion Top


On comparison of median COMFORT-B score, there were no difference in stress experienced by neonates in DS and SS phototherapy; and hence, DS phototherapy can be used more judiciously as it is more effective in decreasing the bilirubin. It was also noticed that there was no additional stress experienced by neonate with the duration of phototherapy.

Acknowledgment

The authors would like to thank Miss Meera Mehto, Miss Mahima Kumari, and Miss Monika Thapa.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lucia P, Gregory M, Martin CR, Cloherty JP. Neonatal Hyperbilirubinemia. In: Manual of Neonatal Care. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 305.  Back to cited text no. 1
    
2.
Abd Hamid IJ, M Iyen MI, Ibrahim NR, Abd Majid N, Ramli N, Van Rostenberghe H, et al. Randomised controlled trial of single phototherapy with reflecting curtains versus double phototherapy in term newborns with hyperbilirubinaemia. J Paediatr Child Health 2013;49:375-9.  Back to cited text no. 2
    
3.
Boonyarittipong P, Kriangburapa W, Booranavanich K. Effectiveness of double-surface intensive phototherapy versus single-surface intensive phototherapy for neonatal hyperbilirubinemia. J Med Assoc Thai 2008;91:50-5.  Back to cited text no. 3
[PUBMED]    
4.
Hays SL, McPherson RJ, Juul SE, Wallace G, Schindler AG, Chavkin C, et al. Long-term effects of neonatal stress on adult conditioned place preference (CPP) and hippocampal neurogenesis. Behav Brain Res 2012;227:7-11.  Back to cited text no. 4
[PUBMED]    
5.
van Dijk M, Peters JW, van Deventer P, Tibboel D. The COMFORT behavior scale: A tool for assessing pain and sedation in infants. Am J Nurs 2005;105:33-6.  Back to cited text no. 5
    
6.
Boerlage AA, Ista E, de Jong M, Tibboel D, van Dijk M. The COMFORT behavior scale: Is a shorter observation period feasible? Pediatr Crit Care Med 2012;13:e124-5.  Back to cited text no. 6
[PUBMED]    
7.
Ista E, van Dijk M, Tibboel D, de Hoog M. Assessment of sedation levels in pediatric intensive care patients can be improved by using the COMFORT “behavior” scale. Pediatr Crit Care Med 2005;6:58-63.  Back to cited text no. 7
[PUBMED]    
8.
Xiong T, Qu Y, Cambier S, Mu D. The side effects of phototherapy for neonatal jaundice: What do we know? What should we do? Eur J Pediatr 2011;170:1247-55.  Back to cited text no. 8
[PUBMED]    
9.
van Dijk M, de Boer JB, Koot HM, Tibboel D, Passchier J, Duivenvoorden HJ, et al. The reliability and validity of the COMFORT scale as a postoperative pain instrument in 0 to 3-year-old infants. Pain 2000;84:367-77.  Back to cited text no. 9
    
10.
Valkenburg AJ, Boerlage AA, Ista E, Duivenvoorden HJ, Tibboel D, van Dijk M, et al. The COMFORT-behavior scale is useful to assess pain and distress in 0- to 3-year-old children with down syndrome. Pain 2011;152:2059-64.  Back to cited text no. 10
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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