Oxidative stress in neonates with hyperbilirubinemia before and after phototherapy: malondialdehyde and catalase activity

Main Article Content

Putu Junara Putra
Rinawati Rohsiswatmo
Pustika Amalia Wahidiyat


Background Phototherapy is used to treat neonatal hyperbilirubinemia, but is currently thought to cause photodynamic stress and can induce lipid peroxidation. There is increasing evidence that many severe diseases of the neonates are caused by oxidative injury and lipid peroxidation. In the present communique, we review the oxidative succeptibility of the neonate and the evidence now available that phototherapy induces oxidative stress. Malondialdehyde (MDA) is a metabolic product of free radicals. Catalase is a antioxidant that binds free radicals.

Objective To compare the levels of oxidants and antioxidants before and after phototherapy in neonates with hyperbilirubinemia.

Methods This pretest-posttest control group study was conducted in Sanglah Hospital, Bali from November 2016 to April 2017. Thirty babies with gestational age ≥35 weeks and hyperbilirubinemia with total bilirubin levels requiring phototherapy were included in this study. The MDA levels and catalase activity were measured before and after 24 hours of phototherapy.

Results Comparative analysis using paired T-test showed a significant increase of malondialdehyde level, with mean MDA 23.73 (SD 8.20) nmol/mL before and 53.05 (SD 10.18) nmol/mL after phototherapy (P<0.001). However, catalase activity significantly decreased from of 72.33 (SD 10.63) kU/L before phototherapy to 44.85 (SD 14.79) kU/L after phototherapy (P<0.001). The MDA level had a significant, negative association with catalase activity after phototherapy (r =-0.4; P=0.028).

Conclusion Neonates with hyperbilirubinemia are found to have increased oxidative stress after phototherapy, as indicated by increased MDA levels and decreased CAT activity after 24 hours of phototherapy.

Article Details

How to Cite
Putra P, Rohsiswatmo R, Wahidiyat P. Oxidative stress in neonates with hyperbilirubinemia before and after phototherapy: malondialdehyde and catalase activity. PI [Internet]. 13Dec.2018 [cited 6Dec.2021];58(6):269-3. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1879
Received 2018-05-28
Accepted 2018-11-26
Published 2018-12-13


1. Mishra S, Agarwal R, Deorari AK, Paul VK. Jaundice in the newborns. Indian J Pediatr. 2008;75:157-63. https://doi.org/10.1007/s12098-008-0024-7 PMid:18334797
2. Blackburn S. Maternal, fetal & neonatal physiology, a clinical perspective. 3rd ed. St. Louis: Saunders Elsevier; 2007. p.105-23.
3. Vreman HJ, Wong RJ, Stevenson DK. Phototherapy: current methods and future directions. Semin Perinatol. 2004;28:326-33. https://doi.org/10.1053/j.semperi.2004.09.003 PMid:15686263
4. Maisels MJ. Neonatal jaundice. Pediatr Review. 2006;27:443-54. https://doi.org/10.1542/pir.27-12-443
5. Xiaong T, Qu Y, Cambier S, Mu D. The side effects of phototherapy for neonatal jaundice: what do we know? What should we do? Eur J Pediatr. 2011;170:1247-55. https://doi.org/10.1007/s00431-011-1454-1 PMid:21455834
6. Aycicek A, Erel O. Total oxidant/antioxidant status in jaundice newborns before and after phototherapy. J Pediatr (Rio J). 2007;83:319-22. https://doi.org/10.1590/S0021-75572007000500006 https://doi.org/10.2223/JPED.1645 PMid:17625638
7. Dahiya K, Tiwari AD, Shankar V, Kharb S, Dhankhar R. Antioxidant status in neonatal jaundice before and after phototherapy. Indian J Clin Biochem. 2006;21:157-60. https://doi.org/10.1007/BF02913086 PMid:23105589 PMCid:PMC3453759
8. Gulbayzar S, Arica V, Hatipoglu M, Kaya A, Arica S, Karatekin G. Malondialdehyde level in the cord blood of newborn infants. Iran J Pediatr. 2011;21:313-9. PMid:23056807 PMCid:PMC3446175
9. Block G, Dietrich M, Norkus EP, Morrow JD, Hudes M, Caan B, et al. Factors associated with oxidative stress in human populations. Am J Epidemiol. 2002;156:274-85. https://doi.org/10.1093/aje/kwf029 PMid:12142263
10. Abdel Latief DAK, Sabry RN, Youness IR, Fathy GA. The effect of phototherapy on the oxidant stress status in neonatal hyperbilrubinemia. Int J Acad Res. 2012;4:17-22. https://doi.org/10.7813/2075-4124.2012/4-4/A.3
11. Thiagarajan AN, Chand P, Bhat BV, Sridhar MG. Assessment of oxidative stress in babies under phototherapy for neonatal jaundice. Int J Adv Med Health Res. 2014;1:66-8. https://doi.org/10.4103/2349-4220.148004
12. Buettner GR. Molecular targets of photosensitization. [cited 2017 March 12]. Available from http://photobiology.info/Buettner.html.
13. Jetawattana S. Malondialdehyde (MDA), a lipid oxidation product. Free Radicals in Biology and Medicine Spring. 2005;77:222.
14. Demirel G, Uras N, Celik IH, Aksoy HT, Oguz SS, Erdeve O, et al. Comparison of total oxidant/antioxidant status in unconjugated hyperbilirubinemia of newborn before and after conventional and LED phototherapy: a prospective randomized controlled trial. Clin Invest Med. 2010;33:E335-41. https://doi.org/10.25011/cim.v33i5.14359 PMid:20926040