Safety and Efficacy of Filtered Sunlight in Treatment of Jaundice in African Neonates

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Phototherapy effectively treats unconjugated hyperbilirubinemia. However, in resourcepoor settings, functional phototherapy devices are often unavailable due to financial constraints or erratic electrical power availability.WHAT THIS STUDY ADDS: Filtered-sunlight phototherapy could be a cost-effective option in resource-poor settings with abundant sunlight. abstract OBJECTIVES: Evaluate safety and efficacy of filtered-sunlight phototherapy (FS-PT).METHODS: Term/late preterm infants #14 days old with clinically significant jaundice, assessed by total bilirubin (TB) levels, were recruited from a maternity hospital in Lagos, Nigeria. Sunlight was filtered with commercial window-tinting films that remove most UV and significant levels of infrared light and transmit effective levels of therapeutic blue light. After placing infants under an FS-PT canopy, hourly measurements of axillary temperatures, monitoring for sunburn, dehydration, and irradiances of filtered sunlight were performed. Treatment was deemed safe and efficacious if infants were able to stay in FS-PT for $5 hours and rate of rise of TB was ,0.2 mg/dL/h for infants #72 hours of age or TB decreased for infants .72 hours of age. RESULTS:A total of 227 infants received 258 days of FS-PT. No infant developed sunburn or dehydration. On 85 (33%) of 258 treatment days, infants were removed briefly from FS-PT due to minor temperaturerelated adverse events. No infant met study exit criteria. FS-PT was efficacious in 92% (181/197) of evaluable treatment days. Mean 6 SD TB change was -0.06 6 0.19 mg/dL/h. The mean 6 SD (range) irradiance of FS-PT was 38 6 22 (2-115) mW/cm KEY WORDS newborn jaundice, hyperbilirubinemia, sunlight, phototherapy, irradiance, UV, IR, low-middle income countries ABBREVIATIONS AAP-American Academy of Pediatrics ABT-axillary body temperature FS-PT-filtered-sunlight phototherapy PT-phototherapy TB-total serum/plasma bilirubin Dr Slusher conceptualized and designed the study, approved the design and implementation of the study, coordinated and supervised data collection, drafted the initial manuscript, and critically reviewed and revised the manuscript; Dr Vreman contributed to the design of the study and took responsibility for the selection of the films, design, procurement and building of the treatment canopies, and also critically reviewed and revised the draft manuscript; Dr Olusanya approved the design and implementation of the study, coordinated and supervised data collection, and critically reviewed and revised the manuscript; Mr Wong and Dr Stevenson contributed to the design of the study, participated in the film-selection studies, and critically reviewed and revised the draft manuscript; Dr Brearley served as the statistician for the study, and critically reviewed and revised the manuscript; Dr Vaucher contributed to study design, data analysis, and manuscript preparation, and also critically reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.(Continued on...