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Selectively Filtered Sunlight Phototherapy Is Safe and Efficacious for Treatment of Neonatal Jaundice In Nigeria

Saturday, October 20, 2012: 9:16 AM
Room 346-347 (Morial Convention Center)
Tina M. Slusher1, Hendrik Vreman2, Ronald Wong2, Ann Brearley3, Yvonne Vaucher4, Bolajoko Olusanya5 and David Stevenson2, (1)Pediatrics/Global Pediatrics, University of Minnesota and Hennipen County Medical Center, Minneapolis, MN, (2)Pediatrics, Stanford University, Stanford, CA, (3)Pediatrics/global pediatrics, University of Minnesota, Minneapolis, MN, (4)Pediatrics, University of California, La Jolla, CA, (5)Paediatrics, University of Lagos, Lagos, Nigeria

Purpose: To evaluate safety and efficacy of selectively filtered sunlight PT (FS-PT) for treating jaundice in a Nigerian hospital. Severe newborn jaundice with progression to kernicterus is a leading cause of morbidity and mortality in developing countries and accounts for 8% of neonatal deaths in Africa. Facilities that can provide high quality blue light phototherapy (PT), the standard treatment for jaundice, are scarce in many African countries due to lack of PT devices and/or erratic electrical supply.  

Methods: Infants ≥35 wks gestation with clinically significant jaundice as assessed by total serum bilirubin (TSB) levels were recruited from a large inner-city Nigerian maternity hospital, where effective PT is not always available. Sunlight was filtered with carefully selected, commercial window-tinting film that removes all UV and significantly reduces IR (heat) radiation, but transmits PT-effective blue light. After placing infants under FS-PT canopy, hourly measurements of axillary body temperatures (ABT) and monitoring of sunburn, dehydration and irradiances of filtered sunlight were performed. Infants were removed from FS-PT if ABT was <35.5°C or >38°C and FS-PT resumed when ABT returned to 36.0−37.5°C. Infants were excluded from the study if ABT did not return to normal within 1h or was <35°C or >39°C twice. Treatment was deemed safe and efficacious if the infant was able to stay in FS-PT for ≥5 h/day and if the rate of rise of TSB was less than 0.2 mg/dL/h for an infant≤72h or age or if TSB decreased for an infant >72h of age. TSB was determined at the start and end of each day.

Results: Overall, 107 infants received a total of 121d of FS-PT, with individual times ranging from 1-3d, and with 96/107 requiring only 1d. The percentage of safe days was 100% (121/121). No infant developed sunburn, dehydration or hypothermia.  On 57/121 treatment days (47.1%), children had to be removed briefly from FS-PT due to ABT >38°C. No infant met exclusion criteria. FS-PT was efficacious in 90.2% (101/112) of the infants studied.

Average irradiance from FS-PT was 35 (4-65) mW/cm2/nm as measured by the BiliBlanket II meter.

Conclusion: With appropriate monitoring, this practical, inexpensive and novel method of using   FS-PT offers a safe and efficacious treatment strategy for management of neonatal jaundice in areas of the world where no other treatment is available. Additionally it promotes mother/child bonding during treatment.