Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Effect of chest shielding during phototherapy for hyperbilirubinemia on symptomatic patent ductus arteriosus – a double-blind randomized placebo-controlled trial

Pediatric Research (2024)Cite this article

Abstract

Background

Meta-analysis of randomized trials suggests that phototherapy is associated with patent ductus arteriosus (PDA). We hypothesized that chest shielding during phototherapy would decrease the incidence of symptomatic PDA (sPDA) compared to sham shielding.

Methods

A single center, double-blind, randomized, placebo-controlled trial was performed to evaluate the effect of chest shielding during phototherapy on sPDA in infants ≤ 29 weeks gestational age (GA) or with birth weight (BW) ≤ 1000 g. Infants were randomized to either chest shield (with aluminum foil, intervention group) or sham shield (without aluminum foil, control group) during phototherapy. The primary outcome was sPDA during the period 24 h after phototherapy initiation until 3 days after phototherapy cessation.

Results

160 infants were randomized with 10 infants withdrawn from each group due to shield placement after phototherapy initiation. Of 140 infants analyzed, the mean GA and BW was 26.6 weeks and 872 g, respectively. There was no difference in the incidence of sPDA between the intervention (n = 70) and control group (n = 70) (10% vs 11%, respectively, adjusted odds ratio 0.78, 95% CI:0.33–1.82; p = 0.57).

Conclusions

Chest shielding during phototherapy had no effect on sPDA in infants ≤ 29 weeks GA or with BW ≤ 1000 g.

Trial registration

http://clinicaltrials.gov, Identifier: NCT02552927.

Impact

  • Meta-analysis of randomized clinical trials suggests that chest shielding during phototherapy used for hyperbilirubinemia may decrease the incidence of patent ductus arteriosus.

  • The effect of chest shielding during phototherapy on symptomatic patent ductus arteriosus has not been evaluated in a double-blind randomized trial.

  • In this double-blind, randomized, placebo-controlled trial, chest shielding during phototherapy was not associated with a decreased incidence of symptomatic patent ductus arteriosus in premature infants.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: CONSORT flow diagram.

Similar content being viewed by others

Data availability

Following the article publication, a de-identified dataset generated and analyzed during the current study is available from the authors upon reasonable request.

References

  1. Clyman, R. I., Couto, J. & Murphy, G. M. Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all? Semin. Perinatol. 36, 123–129 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Weber, S. C. et al. Natural history of patent ductus arteriosus in very low birth weight infants after discharge. J. Pediatr. 167, 1149–1151 (2015).

    Article  PubMed  Google Scholar 

  3. Hamrick, S. E. G. et al. Patent ductus arteriosus of the preterm infant. Pediatrics 146 https://doi.org/10.1542/peds.2020-1209 (2020).

  4. McNamara, P. J. & Sehgal, A. Towards rational management of the patent ductus arteriosus: the need for disease staging. Arch. Dis. Child Fetal Neonatal Ed. 92, F424–F427 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dice, J. E. & Bhatia, J. Patent ductus arteriosus: an overview. J. Pediatr. Pharmacol. Ther. 12, 138–146 (2007).

    PubMed  PubMed Central  Google Scholar 

  6. Ergenekon, E. et al. Nitric oxide production in newborns under phototherapy. Nitric Oxide 6, 69–72 (2002).

    Article  CAS  PubMed  Google Scholar 

  7. Furchgott, R. F., Ehrreich, S. J. & Greenblatt, E. The photoactivated relaxation of smooth muscle of rabbit aorta. J. Gen. Physiol. 44, 499–519 (1961).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Liu, G. S. et al. Effect of phototherapy on blood endothelin and nitric oxide levels: clinical significance in preterm infants. World J. Pediatr. 4, 31–35 (2008).

    Article  PubMed  Google Scholar 

  9. Benders, M. J., Van Bel, F. & Van de Bor, M. Cardiac output and ductal reopening during phototherapy in preterm infants. Acta Paediatr. 88, 1014–1019 (1999).

    Article  CAS  PubMed  Google Scholar 

  10. Barefield, E. S., Dwyer, M. D. & Cassady, G. Association of patent ductus arteriosus and phototherapy in infants weighing less than 1000 grams. J. Perinatol. 13, 376–380 (1993).

    CAS  PubMed  Google Scholar 

  11. Maisels, M. J. et al. An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation. J. Perinatol. 32, 660–664 (2012).

    Article  CAS  PubMed  Google Scholar 

  12. Rosenfeld, W. et al. Phototherapy effect on the incidence of patent ductus arteriosus in premature infants: prevention with chest shielding. Pediatrics 78, 10–14 (1986).

    Article  CAS  PubMed  Google Scholar 

  13. Travadi, J. et al. Patent ductus arteriosus in extremely preterm infants receiving phototherapy: does shielding the chest make a difference? A randomized, controlled trial. Acta Paediatr. 95, 1418–1423 (2006).

    Article  PubMed  Google Scholar 

  14. Mannan, J. & Amin, S. B. Meta-analysis of the effect of chest shielding on preventing patent ductus arteriosus in premature infants. Am. J. Perinatol. 34, 359–363 (2017).

    Article  PubMed  Google Scholar 

  15. American Academy of Pediatrics Subcommittee on, H. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 114, 297–316 (2004).

    Article  Google Scholar 

  16. Kemper, A. R. et al. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 150. https://doi.org/10.1542/peds.2022-058859 (2022).

  17. Hegyi, T., Brantley, V. & Hiatt, I. M. The effects of shielding the hepatic area on the clinical response to phototherapy. Eur. J. Pediatr. 137, 303–305 (1981).

    Article  CAS  PubMed  Google Scholar 

  18. Koch, J. et al. Prevalence of spontaneous closure of the ductus arteriosus in neonates at a birth weight of 1000 grams or less. Pediatrics 117, 1113–1121 (2006).

    Article  PubMed  Google Scholar 

  19. Bhola, K., Foster, J. P. & Osborn, D. A. Chest shielding for prevention of a haemodynamically significant patent ductus arteriosus in preterm infants receiving phototherapy. Cochrane Database Syst. Rev. 2015, CD009816 (2015).

    PubMed  PubMed Central  Google Scholar 

  20. Furchgott, R. F. Endothelium-dependent relaxation, endothelium-derived relaxing factor and photorelaxation of blood vessels. Semin. Perinatol. 15, 11–15 (1991).

    CAS  PubMed  Google Scholar 

  21. Furchgott, R. F. & Jothianandan, D. Endothelium-dependent and -independent vasodilation involving cyclic GMP: relaxation induced by nitric oxide, carbon monoxide and light. Blood Vessels 28, 52–61 (1991).

    CAS  PubMed  Google Scholar 

  22. Visscher, M. & Narendran, V. The ontogeny of skin. Adv. Wound Care 3, 291–303 (2014).

    Article  Google Scholar 

  23. Kapoor, S. et al. Chest shielding in preterm neonates under phototherapy-a randomised control trial. Eur. J. Pediatr. 180, 767–773 (2021).

    Article  PubMed  Google Scholar 

  24. Semberova J. et al. Spontaneous closure of patent ductus arteriosus in infants </=1500 g. Pediatrics 140 https://doi.org/10.1542/peds.2016-4258 (2017).

  25. Slaughter, J. L. et al. Nonsteroidal anti-inflammatory administration and patent ductus arteriosus ligation, a survey of practice preferences at US children’s hospitals. Eur. J. Pediatr. 175, 775–783 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Amin, S. B., Handley, C. & Carter-Pokras, O. Indomethacin use for the management of patent ductus arteriosus in preterms: a web-based survey of practice attitudes among neonatal fellowship program directors in the United States. Pediatr. Cardiol. 28, 193–200 (2007).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Amin, S. B., Smith, T. & Timler, G. Developmental influence of unconjugated hyperbilirubinemia and neurobehavioral disorders. Pediatr. Res. 85, 191–197 (2019).

    Article  PubMed  Google Scholar 

  28. Liguori, M. B. et al. Patent ductus arteriosus in premature infants: clinical trials and equipoise. J. Pediatr. 261, 113532 (2023).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Dr. Roger Vermilion, pediatric cardiologist, who analyzed the echocardiograms and Dr. Hongyue Wang, Ph.D, biostatistician, who performed sample size calculation and statistical analyses. We would also like to thank the NICU nurses and echocardiographers who helped us perform this trial.

Funding

This work was supported by Gerber Grant 4156. Javed Mannan and Sanjiv Amin received research support from Gerber Foundation, USA. The study was partly supported by NIH R21 HD078744 to Sanjiv Amin. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Massachusetts Memorial Medical Center, Worcester, MA, USA

    Javed Mannan

  2. Department of Pediatrics, Children’s Hospital of Michigan, Central Michigan University, Detroit, MI, USA

    Sanjiv B. Amin

Authors
  1. Javed Mannan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sanjiv B. Amin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and interpretation of data were performed by all authors. The first draft of the manuscript was written by Javed Mannan. Sanjiv Amin revised it critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sanjiv B. Amin.

Ethics declarations

Competing interests

The authors declare no competing interests.

Informed consent

Written informed consent was obtained from the parents.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mannan, J., Amin, S.B. Effect of chest shielding during phototherapy for hyperbilirubinemia on symptomatic patent ductus arteriosus – a double-blind randomized placebo-controlled trial. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03310-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41390-024-03310-4

Search

Advanced search

Quick links