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Observational Study
. 2019 Jun 8;19(1):188.
doi: 10.1186/s12887-019-1552-1.

Current phototherapy practice on Java, Indonesia

Mahendra T A Sampurna  1 , Kinanti A Ratnasari  2 , Darto Saharso  2 , Arend F Bos  3 , Pieter J J Sauer  3 , Peter H Dijk  3 , Christian V Hulzebos  3
Affiliations
Observational Study

Current phototherapy practice on Java, Indonesia

Mahendra T A Sampurna et al. BMC Pediatr. .

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/cm2/nm and in eight hospitals irradiance failed to reach the levels for intensive phototherapy: 30 μW/cm2/nm. Three hospitals provided very high irradiance levels: > 50 μW/cm2/nm. Half of the distances between device and model were greater than recommended. Distance was inversely correlated with irradiance levels (R2 = 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.

Keywords: Curtain; Distance; Hyperbilirubinemia; Irradiance; Phototherapy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Mean irradiance levels of all phototherapy devices for each of the 17 hospitals on Java, Indonesia. The unbroken line in the graph indicates the level above which standard phototherapy is effective (10 μW/cm2/nm) and the broken line indicates the level above which phototherapy is considered intensive PT (30 μW/cm2/nm)
Fig. 2
Fig. 2
The relationship between the distance of the phototherapy device and the model and the mean irradiance levels of each device, measured without curtains. For the irradiance levels we calculated the mean of the measurements of the five points marked on the model (see Methods). The line in the graph represents the regression line, the concomitant formula is presented in the upper right-hand corner of the graph
Fig. 3
Fig. 3
Bland-Altman plot showing the difference of irradiance levels of each phototherapy device, with curtains compared to without curtains, for those phototherapy devices that had irradiance levels below 30 μw/cm2/nm. Each phototherapy device presents one dot, the mean (SD) difference was 1.05 (2.08) μW/cm2/nm higher when using curtains (P = 0.370)
Fig. 4
Fig. 4
Bland-Altman plot showing the difference of irradiance levels of phototherapy with curtains compared to without curtains, for phototherapy devices that have irradiance levels above 30 μw/cm2/nm. Each phototherapy device presents one dot. The mean (SD) difference was 2.58 (4.37) μW/cm2/nm higher when using curtains (P = 0.572)
See this image and copyright information in PMC

References

    1. Burke BL, Robbins JM, Bird TM, Hobbs CA, Nesmith C, Tilford JM. Trends in hospitalizations for neonatal jaundice and kernicterus in the United States, 1988-2005. Pediatrics. 2009;123(2):524–532. doi: 10.1542/peds.2007-2915. - DOI - PubMed
    1. Le Pichon JB, Riordan SM, Watchko J, Shapiro SM. The neurological sequelae of neonatal hyperbilirubinemia: definitions, diagnosis and treatment of the kernicterus Spectrum disorders (KSDs) Curr Pediatr Rev. 2017;13(3):199–209. - PubMed
    1. Greco C, Arnolda G, Boo NY, Iskander IF, Okolo AA, Rohsiswatmo R, et al. Neonatal jaundice in low- and middle-income countries: lessons and future directions from the 2015 Don Ostrow Trieste yellow retreat. Neonatology. 2016;110(3):172–180. doi: 10.1159/000445708. - DOI - PubMed
    1. American Academy of Pediatrics Subcommittee on H Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297–316. doi: 10.1542/peds.114.1.297. - DOI - PubMed
    1. National Collaborating Centre for Women’s and Children’s Health (UK) Neonatal Jaundice. London: RCOG Press; 2010. - PubMed

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