Over the past few years, we have published studies looking at possible adverse effects of one of the mainstays of treatment for hyperbilirubinemia—phototherapy. One such set of studies by Newman et al. (10.1542/peds.2015-1353) found a small increased risk of developing certain types of cancer within a large patient database in California. This work underscores the need to be judicious in the use of phototherapy, which for many children is both effective and necessary.
This week, we release a study again using a large database of Kaiser Permanente patients by Newman et al. (10.1542/peds.2018-0648), addressing whether phototherapy is associated with an increased risk of childhood seizures. The authors looked at 37,683 infants who received phototherapy and were followed for a mean of 8 years from a database of 499,642 babies born at ≥35 weeks’ gestation. The study found an overall 10-year excess risk of seizures of 2.4 per 1000 person, with boys having a greater risk than boys (3.7 vs. 0.8). After adjusting for confounders like bilirubin level, the increased risk persisted for boys but not girls.
To better understand on how much we should be concerned, we asked Seattle Children’s pediatrician and clinical researcher Dr. James Taylor to review the findings and comment on whether or not they meet epidemiologic principles to ensure the findings are valid (10.1542/peds.2018-2241). One important point raised by Dr. Taylor is the lack of information on the dose of phototherapy received. The mechanism that phototherapy might lead to seizures is also unclear. While this study should not deter you from ordering phototherapy for your patients with elevated bilirubin levels who warrant it perhaps, as Dr. Taylor points out, we need to reassess the threshold by which we implement such treatments, especially for low-risk full-term babies. This study shines some light on recognizing that any procedure that seems safe may not be totally and encourages us to be good stewards of phototherapy.