Current phototherapy practice on Java, Indonesia

Management challenges in the treatment of severe hyperbilirubinemia in low- and middle-income countries: Encouraging advancements, remaining gaps, and future opportunities

Neonatal jaundice (NJ) is common in newborn infants. Severe NJ (SNJ) has potentially negative neurological sequelae that are largely preventable in high resource settings if timely diagnosis and treatment are provided. Advancements in NJ care in low- and middle-income countries (LMIC) have been made over recent years, especially with respect to an emphasis on parental education about the disease and technological advancements for improved diagnosis and treatment. Challenges remain, however, due to lack of routine screening for SNJ risk factors, fragmented medical infrastructure, and lack of culturally appropriate and regionally specific treatment guidelines. This article highlights both encouraging advancements in NJ care as well as remaining gaps. Opportunities are identified for future work in eliminating the gaps in NJ care and preventing death and disability related to SNJ around the globe.

Irradiance footprint of phototherapy devices: a comparative study

BACKGROUND

Phototherapy (PT) is the standard treatment of neonatal unconjugated hyperbilirubinemia. The irradiance footprint, i.e., the illuminated area by the PT device with sufficient spectral irradiance, is essential for PT to be effective. Irradiance footprint measurements are not performed in current clinical practice. We describe a user-friendly method to systematically evaluate the high spectral irradiance (HSI) footprint (illuminated area with spectral irradiance of ≥30 μW cm^-2 nm^-1) of PT devices in clinical practice.

MATERIALS AND METHODS

Six commercially available LED-based overhead PT devices were evaluated in overhead configuration with an incubator. Spectral irradiance (µW cm^-2 nm^-1) and HSI footprint were measured with a radiospectrometer (BiliBlanket Meter II).

RESULTS

The average measured spectral irradiance ranged between 27 and 52 μW cm^-2 nm^-1 and HSI footprint ranged between 67 and 1465 cm², respectively. Three, two, and one PT devices out of six covered the average BSA of an infant born at 22, 26-32, and 40 weeks of gestation, respectively.

CONCLUSION

Spectral irradiance of LED-based overhead PT devices is often lower than manufacturer's specifications, and HSI footprints not always cover the average BSA of a newborn infant. The proposed measurement method will contribute to awareness of the importance of irradiance level as well as footprint measurements in the management of neonatal jaundice.

IMPACT

While a sufficient spectral irradiance footprint is essential for PT to be effective, some PT devices have spectral irradiance footprints that are too small to cover the entire body surface area (BSA) of a newborn infant. This study introduces a user-friendly, accessible method to systematically evaluate the spectral irradiance level and footprint of PT devices. This study supports awareness on the role of the spectral irradiance footprint in the efficacy of PT devices. Irradiance footprint can be easily measured during phototherapy with the proposed method.

An evaluation of phototherapy device performance in a tertiary health facility

INTRODUCTION

A range of phototherapy devices are commercially available. The American Academy of Pediatrics (2004) recommends routine intensity measurement of phototherapy devices to ensure that babies affected by hyperbilirubinemia receive effective phototherapy.

OBJECTIVE

The aims of this study were to calculate the irradiance decay velocity of phototherapy devices used in a tertiary care hospital to evaluate whether current maintenance procedures for phototherapy devices are effective, and to contribute to the improvement of a standardized maintenance procedure in daily practice, thus helping to ensure that all babies affected by hyperbilirubinemia receive prompt treatment.

METHODS

This research represents a prospective observational study conducted at Dr. Soetomo Academic Teaching Hospital in Surabaya, Indonesia from February 2019-July 2019. The intensities of 11 phototherapy devices were measured at specific times using a Bili Blanket Meter II. We calculated the Δ irradiance differences in μW/cm2/nm and calculated them as velocity μW/cm2/nm/hour of use.

RESULTS

Among the 11 phototherapy devices included in this study, nine were fluorescent and two were light-emitting diode (LED) machines. The mean (standard deviation) irradiance decay velocity of the fluorescent lamps was 0.02 (±0.03) μW/cm2/nm/hour of use, while that of the LED lamps was 0.015 (±0.007) μW/cm2/nm/hour of use. The fastest irradiance decay velocity was 0.08 μW/cm2/nm/hour of use, while the slowest irradiance decay velocity was <0.01 μW/cm2/nm/hour of use, both of which were from fluorescent-based devices. There was one fluorescent-based device that provided an intensity lower than the therapeutic level.

CONCLUSION

Irradiance decay occurred in all phototherapy device lamps. It is important to perform routinely intensity measurements, regardless of manufacturer recommendations, to avoid ineffective phototherapy resulting from intensities lower than the required therapeutic levels.