Variation in the Phototherapy Practices and Irradiance of Devices in a Major Metropolitan Area

Abstract

Background: Phototherapy (PT) is widely used to prevent and treat severe hyperbilirubinemia and its associated risks for both acute and chronic bilirubin encephalopathy. Intensive PT, recommended for inpatient treatment of hyperbilirubinemia in term and near-term infants, is defined as having a spectral irradiance of ≥30 μW/cm²/nm. Objectives: We aimed to assess local PT practices by measuring the irradiance of PT devices in local neonatal intensive care units and newborn nurseries. Methods: The irradiance footprint, including maximum irradiance at the center of the footprint, of 39 PT devices in 7 area hospitals was measured according to current practice in these facilities. Results: The mean ± SD (range) footprint irradiance was 20.7 ± 5.8 (8.8-29.4) μW/cm²/nm. The mean ± SD maximum irradiance at the footprint center for all devices at a mean clinically used treatment distance of 33.1 ± 9.3 (25.5-60.0) cm was 27.8 ± 7.0 (14.7-42.0) μW/cm²/nm. Sixty-two percent of the devices did not meet the minimum recommended spectral irradiance for intensive PT. For the sites without irradiance-based protocols, the maximum irradiance of the devices (n = 33) at the treatment distances was 25.8 ± 6.1 μW/cm²/nm. Conclusions: Despite established PT guidelines, local protocols and practices vary. Based on an assessment of 7 local hospitals, intensive PT was suboptimal for 62% of devices. Straightforward changes, such as decreasing the distance between an infant and the light source and establishing a consistent irradiance-based protocol, could substantially improve the quality of the intervention.

Improving Effectiveness of Phototherapy in an Academic Center: A Quality Improvement Project

“…In this study we measured irradiances at distances ranging from 15 to 32 cm above 5 points (box 16, 39, 41, 43, and 68) on the grid that represented neonatal anatomy (ie, central PT point on the infant, head, foot, arms) in both an open bassinet and in an isolette. 18 As previously described, the PT unit was centered directly over the grid at the prescribed distance above the irradiance meter laid on the grid. 18 The mean irradiance of all 5 footprint measurements (MFR) as well as the maximum irradiance at the center of the grid were calculated at each distance.…”

“…Even in high-income countries such as the Netherlands only 48% of PT units delivered the minimal recommended irradiance level of 10 µW/cm 2 /nm. 17 Borden et al, 18 studied the level of irradiance provided by PT at 7 metropolitan hospitals, including our own center, in Minneapolis, Minnesota. While 100% of PT units provided the minimum of 8-10 μW/cm 2 /nm, only 38% provided intensive phototherapy (≥30 µW/cm 2 /nm).…”

Comparative outcome of overhead and total body phototherapy for treatment of severe neonatal jaundice in Nigeria

“…The condition is usually benign (physiological jaundice) [1], except in severe cases which are usually associated with delay in diagnosis and lack of effective therapy. Associated risks include acute and chronic bilirubin encephalopathy [3] and other long-term morbidities such as hearing impairment, cerebral palsy, especially the choreoathetoid type [4], epilepsy, speech and language disorders, mental retardation and the wider complications of kernicterus spectrum disorders [5,6].…”

“…Some Nigerian centres have introduced other treatment variables which could help to reduce the need for invasive EBT with its attendant high risks. Some of these include: (i) the use of light reflective foil to maximize the reach of phototherapy light rays [14]; (ii) algorithms for rigorous classification of diagnoses to carefully select a preferred combination of treatment options; (iii) placing LED phototherapy units at varying distances between the light source and the patient [3]; and (iv) anticipatory techniques and prophylactic interventions which include rehydration of the neonate, administration of intravenous albumin and early initiation of phototherapy for all very lowbirthweight infants [15,16]. All of these are practised across Nigeria with little modification; hence, there are small inter-centre variables which have not been shown to create significant differences in overall outcome across the country.…”

Revisão de literatura acerca dos tratamentos de hiperbilirrubinemia neonatal / Literature review about neonatal hyperbilirubinemia treatments

“…Além dos efeitos adversos aumentados, a exemplo: eritema, letargia, desidratação, queimaduras e lesões de retina. Componentes tais, que associados resultam em uso de fototerapia a níveis subterapêuticos de irradiância, quando esses parâmetros não são atingidos(BORDEN et al, 2018). acordo com os resultados apresentados porMathew (2015), o tratamento da hiperbilirrubinemia neonatal com luz solar não se mostrou inferior a fototerapia convencional, ainda que deve-se verificar as possíveis complicações deste método, como episódios de hipertermia, hipotermia e os efeitos nocivos dos raios ultravioleta e infravermelho no RN.Contudo, tal opção se mostra viável quando analisado o nível social do RN, já que a fototerapia convencional exige disponibilidade de unidades apropriadas, eletricidade ininterrupta, medição da irradiância constante e capacitação da equipe médica, tornando-se assim, um método mais oneroso.…”