Current phototherapy practice on Java, Indonesia

Abstract

Background In Indonesia, the burden of severe hyperbilirubinemia is higher compared to other countries. Whether this is related to ineffective phototherapy (PT) is unknown. The aim of this study is to investigate the performance of phototherapy devices in hospitals on Java, Indonesia. Methods In 17 hospitals we measured 77 combinations of 20 different phototherapy devices, with and without curtains drawn around the incubator/crib. With a model to mimic the silhouette of an infant, we measured the irradiance levels with an Ohmeda BiliBlanket Meter II, recorded the distance between device and model, and compared these to manufacturers’ specifications. Results In nine hospitals the irradiance levels were less than required for standard PT: < 10 μW/cm 2 /nm and in eight hospitals irradiance failed to reach the levels for intensive phototherapy: 30 μW/cm 2 /nm. Three hospitals provided very high irradiance levels: > 50 μW/cm 2 /nm. Half of the distances between device and model were greater than recommended. Distance was inversely correlated with irradiance levels (R 2 = 0.1838; P < 0.05). The effect of curtains on irradiance levels was highly variable, ranging from − 6.15 to + 15.4 μW/cm2/nm, with a mean difference (SD) of 1.82 (3.81) μW/cm2/nm ( P = 0.486). Conclusions In half of the hospitals that we studied on Java the levels of irradiance are too low and, in some cases, too high. Given the risks of insufficient phototherapy or adverse effects, we recommend that manufacturers provide radiometers so hospitals can optimize the performance of their phototherapy devices. Electronic supplementary material The online version of this article (10.1186/s12887-019-1552-1) contains supplementary material, which is available to authorized users.

An evaluation of phototherapy device performance in a tertiary health facility

“…The current practice of maintenance for PT in Indonesia is to change the lamps based on hour-meters, or when the PT lamp has dimmed or died [ 9 ]. This study indicates that as PT devices are used, an unpredictable decrease occurs in the intensity of PT lamps, as measured by an intensity-meter.…”

“…The fluorescent-based PT devices indicated more varied irradiance and several could only provide standard PT, with only two among nine fluorescent-based PT devices being able to provide intensive PT. It is extremely important for healthcare personnel to know the strengths and weaknesses of their PT devices [ 9 ]. This underlines the importance of having intensity meters in neonatal units.…”

“…Studies in developing countries such as Cameroon and Nigeria reported that inadequate light intensity is sometimes used for PT, thus not achieving adequate therapeutic levels [ 7 , 8 ]. According to a study by Sampurna et al (2019), eight out of 17 hospitals studied in Indonesia also use PT devices which do not achieve therapeutic levels [ 9 ]. Therefore, suboptimal PT may still exist, which can translate into ineffective therapy that is unable to decrease bilirubin levels.…”

Evaluasi Penggunaan Fototerapi Konvensional dalam Tata laksana Hiperbilirubinemia Neonatal: Efektif, tetapi Tidak Efisien

“…13 Sebuah laporan penelitian yang mengejutkan bahwa tingkat radiasi (irradiance levels) alat fototerapi di 17 rumah sakit di pulau Jawa yang mempunyai fasilitas perawatan neonatus level II dan III, didapatkan separuh alat fototerapi memiliki tingkat radiasi terlalu rendah (<10 μw/cm 2 /nm) dan beberapa RS terlalu tinggi. 14 Sebagian besar kasus ikterus neonatorum merupakan ikterus fisiologis, tetapi 3%-5% kasus merupakan proses patologis dan berisiko terjadi ensefalopati bilirubin/ kernikterus. 4,15,16 Sebanyak 25% kasus hiperbilirubinemia neonatal memiliki risiko gangguan bicara, bahasa, dan kelainan perkembangan lainnya 16 sehingga perlu deteksi dini dan pengelolaan dini yang efektif dan efisien.…”

Irradiance footprint of phototherapy devices: a comparative study

“…[16][17][18][19][20][21] Various authors stress the importance of spectral irradiance measurements during PT that enables to adjust spectral irradiance to desired intensity levels. 4,6,9,10,14,15,22 Increasing the spectral irradiance of a PT device produces a faster decline of TSB levels. [23][24][25][26][27] Decades ago, Tan suggested a saturation point of 30 μW cm −2 nm −1 beyond which an increase in the spectral irradiance would not increase efficacy of PT.…”