Safety and efficacy of filtered sunlight in treatment of jaundice in African neonates

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 temperature-related 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/cm2/nm, measured by the BiliBlanket Meter II.

Conclusions: With appropriate monitoring, filtered sunlight is a novel, practical, and inexpensive method of PT that potentially offers safe and efficacious treatment strategy for management of neonatal jaundice in tropical countries where conventional PT treatment is not available.

FIGURE 1

Aerial photograph of canopies (note: nurses put a white sheet under the canopy they were not using for their work area and moved that as needed when infants moved, on right side in the photo).

FIGURE 2

Treatment days with 1 or more axillary temperature excursions in the designated ranges. On 174 treatment days, no temperature excursions occurred. ^aOne infant was too hot and too cold in 1 day, accounting for 259 events.

FIGURE 3

Distribution of the hourly or semi-hourly irradiance measurements under the canopy (left) and outside the canopy (right).