日本新生児成育医学会雑誌　38(2)：267-273；2026　

日本新生児成育医学会雑誌　第38巻　第2号　75 ～ 81頁（2026年）

受付日：2025．05．15

受理日：2026．01．13

新生児の重症黄疸に対する高用量の光線療法により交換輸血を回避できるか ─単施設における後方視的検討─

Efficacy of High-intensity Phototherapy in Avoiding Exchange Transfusion for Severe Neonatal Hyperbilirubinemia：A Single-center Retrospective Study

名古屋市立大学大学院　医学研究科　新生児・小児医学分野

Depatment of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences

原　佑太朗・加藤　晋・岩田幸子・岩田欧介・齋藤伸治

Yutaro HARA，Shin KATO，Sachiko IWATA, Osuke IWATA，Shinji SAITOH

Key Words：hyperbilirubinemia，phototherapy，bilirubin，kernicterus

近年light emitting diode（LED）光線治療器の導入により，重症新生児黄疸に対して，より効果的な波長の光を 高用量で投与できるようになった。2021 年2 月～ 2022 年8 月までに当院のNICU で，交換輸血基準に達する，ま たはそれに近い値を示す重症黄疸のため，交換輸血の前段階治療として光線療法を施行した児の治療効果を検討し た。対象は同期間に新生児黄疸のために入院して光線療法を受けた159 例のうち11 例であった。治療は青色LED 光線治療器を複数台組み合わせ，従来のネオブルーhigh mode と同等，または1.5 倍，2 倍の放射照度で，児から 30cm の距離で照射を行った。このうち交換輸血を要したのは1 例のみで，回避率は91％であった。治療中にブロ ンズベビーを含む皮膚障害，低血圧や高体温などの明らかな合併症を認めた症例はなく，退院前の聴力検査や頭部 MRI 異常を示した症例もなかった。高用量の光線療法を行うことで交換輸血を回避できる可能性が示された。

While the safety and simplicity of phototherapy （PT） are well established, exchange transfusion （ET） procedures are complex and may cause a range of complications, including circulatory changes, transfusion-transmitted infection, and even death. Consequently, ET are performed only in a limited number of neonatal intensive care units（ NICUs）. Intensive PT with high-dose light energy using multiple LED devices may reduce the need to perform ET The objective of this research is to investigate whether intensive PT in newborns who met the criteria for ET and were waiting for preparation of the reconstituted blood, can ultimately reduce the requirement for ET. Among 159 newborns admitted to our tertiary NICU between February 2021 and August 2022, we retrospectively evaluated those patients who were referred to the NICU after meeting the criteria for ET. While awaiting delivery of the reconstituted blood, newborns received PT at positioned approximately 30 cm from the chest wall, using an irradiance level 1.5- to 2-fold higher than the standard intensive PT recommended by the American Academy of Pediatrics. Patient background, etiology of hyperbilirubinemia, total serum bilirubin（ TSB） level before and after PT, and the rate of avoidance of ET were examined. Eleven patients were included in the analysis, with a gestational age of 38 weeks［ 36 ～ 39］, a birth weight of 2,874 g［ 2,598～ 3,798］, and a treatment start date of 3 days［ 0 ～ 4］（ median［ range］）. Eight cases were idiopathic, two had alloimmune hemolytic disease, and one had Gilbert's syndrome. The rate of reduction of TSB was 0.7 mg/dL/h, which resulted in TSB levels below the threshold for ET in all newborns by the time the reconstituted blood became available. The rate of avoidance of ET was 91％. Intensive PT with high-dose light energy helped to reduce the need for ET and avoid its complications in newborns with severe hyperbilirubinemia.