Phototherapy is the most effective non-invasive method of neonatal hyperbilirubinemia treatment. Application of this method can be associated with side effects including changes in the cardiovascular system. During phototherapy, the primary effects in the cardiovascular system include cutaneous vasodilation leading to skin hyperperfusion and subsequent redistribution of blood. The increased blood flow through the skin is associated with increased transepidermal water loss. Further effects include an increase in cerebral blood flow. Redistribution of blood to the cutaneous bed is compensated by hypoperfusion in the splanchnic area (mostly postprandial) and a significant reduction of the renal blood flow. Regarding closure/reopening of the ductus arteriosus, the results suggest that that phototherapy does not affect ductal patency. During phototherapy the cardiac output can be slightly reduced due to a decreased stroke volume, especially in preterm newborns. Systemic blood pressure is decreased and heart rate is elevated in both preterm and term newborns during phototherapy. The heart rate variability is slightly reduced. Symbolic dynamics analysis of the short-term HRV showed that during phototherapy the activity of the ANS regulating the heart rate is shifted towards the dominancy of the sympathetic activity. The responses in the cardiovascular system of premature/mature newborns without other pathology confirm a well physiologically functioning control of this system, even under specific conditions of phototherapy.
- MeSH
- fototerapie škodlivé účinky metody MeSH
- lidé MeSH
- minutový srdeční výdej MeSH
- novorozenec MeSH
- otevřená tepenná dučej * etiologie MeSH
- srdce * fyziologie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Fototerapia je najčastejšou terapeutickou intervenciou na novorodeneckých oddeleniach počas prvých dní života. Priaznivý vplyv svetla na zníženie hladiny sérového bilirubínu prvýkrát popísali Cremer a spol. v päťdesiatych rokoch minulého storočia. Od tých čias sa fototerapia efektívne využíva v liečbe významnej hyperbilirubinémie a dokázala takmer úplne eliminovať výmennú transfúziu. Fototerapia novorodencov je neinvazívnou metódou, no popri poklese koncentrácie bilirubínu ovplyvňuje aj niektoré ďalšie funkcie: perfúziu orgánov, najmä kože, periférnu vaskulárnu rezistenciu, distribúciu krvného prietoku, činnosť srdca, systémový tlak krvi, ako aj dýchanie. Vedľajšou zložkou aplikovaného svetla je určitý prílev tepla, ktoré ohrieva povrch tela. Vzniká tak nebezpečenstvo exogénneho prehriatia a zvýšenej straty vody kožou. V práci sme analyzovali vplyv fototerapie na tlak krvi a ďalšie parametre, ako sú frekvencia srdca, frekvencia dýchania, kyslíková saturácia, kožná a rektálna teplota. Pri porovnaní kontrolného súboru (n = 20) s pacientami s hyperbilirubinémiou a fototerapiou (n = 20) boli zistené významné zmeny sledovaných parametrov. Systolický, stredný aj diastolický tlak krvi významne klesol už po 1. hodine fototerapie (p = 0,001; p = 0,000; p = 0,001), na konci 2. hodiny fototerapie bol pokles ešte výraznejší (p = 0,002; p = 0,000; p = 0,003). Počas fototera-pie sa zvyšovala aj frekvencia akcie srdca a to už po 1. hodine, ešte výraznejšie na konci 2. hodiny fototerapie (p = 0,008; p = 0,002), taktiež stúpala aj frekvencia dýchania (p = 0,033; p = 0,015). Uvedené zmeny boli sprevádzané zvýšením kožnej i centrálnej (rektálnej) teploty. Z predkladaných výsledkov vyplýva, že počas fototerapie novorodencov dochádza k zmenám niektorých fyziologických parametrov. Dôsledné sledovanie vitálnych funkcií by preto malo byť samozrejmou súčasťou starostlivosti o novorodenca počas liečby modrým svetlom.
Phototherapy is the most frequent therapeutic intervention in neonatal wards during the first days of life. The beneficial effect of light on decreasing serum bilirubin level was first described by Cremer and colleagues in the 1950s. Since then, phototherapy has been used effectively in the treatment of severe hyperbilirubinaemia and has almost completely eliminated exchange transfusion. Phototherapy is a non-invasive method, but, in addition to decreasing bilirubin levels, it may affect some other function, e.g. organ perfusion, especially in skin, peripheral vascular resistance, blood flow distribution, heart frequency, systemic blood pressure and breathing. The next component of applied light is a certain influx of heat that warms the body surface up. There is a risk of exogenous overheating and increased water loss by skin. We analyzed the effect of phototherapy on blood pressure and other parameters such as heart rate, respiratory rate, oxygen saturation, skin and rectal temperature. Comparison of control group (n=20) with patients with hyperbilirubinaemia and phototherapy (n=20) showed significant changes in some monitored parameters. Systolic, mean and diastolic blood pressure decreased significantly after the first hour of phototherapy (p=0.001; p=0.000; p=0.001), while at the end of the 2nd hour of phototherapy the drop was even more pronounced (p=0.002; p=0.000; p=0.003). During phototherapy, heart rate increased after 1 hour, even more significantly at the end of the 2nd hour of phototherapy (p=0.008; p=0.002), the respiratory rate also increased (p=0.033; p=0.015). These changes were accompanied by increasing skin and central (rectal) temperature. Based on the results, there are changes in some physiological parameters during phototherapy in newborns. Consistent monitoring of vital signs should therefore be an obvious part of care of the newborn during the treatment with blue light.
- MeSH
- fototerapie * škodlivé účinky MeSH
- hyperbilirubinemie * terapie MeSH
- krevní tlak účinky záření MeSH
- lidé MeSH
- měření krevního tlaku MeSH
- novorozenec MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- práce podpořená grantem MeSH
