The last decade or so has seen the development of improved phototherapy, some powerful light systems that can make the jaundice go away even faster. Such systems have been accepted pretty readily into neonatal practice. When the alternative to phototherapy is the possible need for an exchange transfusion - where we replace the baby's blood over about an hour's time with a couple of units from the blood bank - we're happy to have effective phototherapy to use.
I read with interest, then, a Medscape news blurb about a recent study that claims that neonatal phototherapy increases the risk of a child developing nevi, those little brownish things on our skin that are commonly called moles. In a study in the December Archives of Dermatology, French investigators reported that 8 to 9 year old kids who had received phototherapy as newborns had more nevi sized 2 to 5 millimeters than kids who did not receive phototherapy. The significance of this is that nevi can turn into melanoma, a deadly skin cancer. The more nevi one has, perhaps the greater risk of melanoma.
This study, however, did not show that phototherapy increased the risk of melanoma, just the risk of more nevi. A couple of other studies in the past have not demonstrated an increased risk of melanoma with phototherapy, either. Also, this study was pretty small, including only 18 phototherapy exposed kids, and it did not show a dose response relationship. That is, kids who got more phototherapy did not get more nevi than kids who got lesser amounts of phototherapy, which I would expect if the phototherapy were really causing the nevi.
Will phototherapy be one of those neonatal therapies that historically neonatologists thought were safe, like oxygen, chloramphenacol, benzoyl alcohol, phenobarbital for prevention of brain bleeding, and steroids for BPD treatment, that subsequently turned out to be harmful? I don't really think so. We've used it for so long that by now we probably would have discovered any harmful effects that occur frequently. Also, phototherapy is better than the alternatives: exchange transfusions or no treatment, which can lead to brain damage, so I'm still going to light up the babies. The study won't change my practice. It will just make me worry more when I give phototherapy. Great....
P.S. While surfing the web yesterday, I discovered that I have been nominated for a 2006 Medical Weblog Award in the Best Health Policies/Ethics Weblog category. I'm flattered as all get out to be nominated and would like to thank ex utero for nominating me. (Apparently it only takes one person to nominate you. Maybe it's not as great an honor as I thought!) The voting ends today, January 14, so there's no sense in putting one of those Weblog Award Nominee pictures in my sidebar (as if I could figure out how to do it.) Forgive me for tooting my own horn here, but I just couldn't not tell you. Onward and upward!