Filtered-sunlight may effectively treat neonatal jaundice in resource-poor settings

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1. Filtered-sunlight phototherapy (FS-PT) was effective for the treatment of clinically significant jaundice in term and late preterm Nigerian infants on 92% of treatment days.

2. While minor temperature-related adverse outcomes occurred on 33% of treatment days, no FS-PT-treated infants experienced sunburn or dehydration.

Evidence Rating Level: 4 (Below Average)                  

Study Rundown: Phototherapy devices are effective for the treatment of unconjugated hyperbilirubinemia, but may be unavailable in resource-poor settings due to cost and unreliable electricity. This study examined the safety and efficacy of filtered-sunlight phototherapy (FS-PT) as a substitute for standard phototherapy in the treatment of clinically significant jaundice in Nigerian neonates. Effective therapy, defined as a total bilirubin rate of rise < 0.2 mg/dL/h for infants ≤ 72 hours or overall decrease in total bilirubin for infants ˃ 72 hours, occurred on 92% of treatment days. A total of 33% of infants experienced minor temperature-related adverse events, most of which were due to mild hyperthermia. None were affected by sunburn or dehydration. This study is limited by a lack of generalizability to infants cared for in colder climates and lack of a control cohort. However, this study provides support for a novel, potential alternative neonatal jaundice therapy useful in resource-poor settings with ample sunlight.

Click to read the study, published today in Pediatrics

Relevant Reading: A global need for affordable neonatal jaundice technologies

In-Depth [case-series]: A total of 227 term and late preterm infants (55.5% male, average age = 36 hours) ≤ 14 days old were enrolled in the study from December 2011 to August 2012 at the Island Maternity Hospital in Lagos, Nigeria. Clinically significant jaundice was diagnosed by transcutaneous bilirubinometer (3 mg/dL below the American Academy of Pediatrics [AAP] guidelines for initiating phototherapy). In total, the infants received 258 treatment days with 11.0% requiring 2 days of therapy and 2.6% requiring 3. The filtered-sunlight canopies used for FS-PT excluded most UV and infrared light and irradiance exceeded AAP conventional phototherapy guidelines in 97.5% of measurements. Twenty-four infants developed hypothermia (mild = 35.0-35.4°C [n = 21]; moderate < 35.0°C [n = 3]) and 61 developed hyperthermia (mild = 38.0-39.1°C [n = 60]; moderate ˃ 39.1°C [n = 1]). No infants developed sunburn or dehydration. Effective therapy was achieved on 92% of treatment days. Overall, average total bilirubin change rate was -0.06 ± 0.19 mg/dL/h.

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