Friday, May 30, 2014

Filtered Sunlight for Hyperbilirubinemia: Safe & Cost-Effective

Pediatrics Associate Editor William V. Raszka, MD, shares his expert perspective on a new article from our June issue. To learn more about Dr. Raszka and his work in pediatrics and pediatric infectious diseases, check out our Contributors page.

By: William V. Raszka, MD

Photo by Julia Falkner via Pixabay
Severe neonatal jaundice with progression to acute bilirubin encephalopathy and kernicterus is a worldwide problem. Here in the US, health care providers can select from a wide range of effective phototherapy options to treat infants with elevated bilirubin levels. In resource-poor settings, that is not often the case. The expense of the equipment, unreliable electrical power supply, inadequate maintenance programs, and limited number of testing and treatment choices all contribute to a lack of effective phototherapy options.

Slusher and colleagues in the June issue of Pediatrics (doi: 10.1542/peds.2013-3500) report a novel and cost effective way to treat neonatal hyperbilirubinemia. Infants in Lagos, Nigeria with elevated bilirubin levels were exposed to filtered sunlight five to six hours a day under an outdoor canopy. The canopy roof was made of one of two commercially available window-tinting films. The films prevent the transmission of most ultraviolet and infrared light while allowing the transmission of effective levels of therapeutic blue light. Up to six infants and their mothers could stay under each canopy. Investigators showed that during the midday hours, infants were exposed to the correct amount of irradiance and that treatment was effective on more than 92 percent of all treatment days. No infants required exchange transfusion. Some had transient elevated core body temperatures while a smaller number had decreased body temperature. No infants had to be dropped from the study because of adverse effects.

We talk about back-to-basics all the time, but this study demonstrates adherence to such a principle really can provide benefit. The observation that direct sunlight decreases serum bilirubin levels in neonates was originally published in 1958, and since that time we have focused our attention on developing equipment that artificially creates the optimal wavelengths necessary to photoisomerize bilirubin.

However, in many resource-poor areas appropriate equipment is either not available or functional. Exposing infants to direct sunlight increases the risk of sunburn, hyperthermia and other complications. Using a simple readily available film as a filter solves both problems. The film can be stretched over locally available materials at a cost of approximately $50 per canopy. Each canopy lasts approximately six months and this could be extended if they could be protected during storms. While $50 is still a sizable investment, the morbidity prevented is staggering. Though the canopy is most useful in sunny and warm environments, variations (e.g. tinting applied over plastic) might make the intervention useful in cooler climates. This novel, practical and effective method to treat hyperbilirubinemia is welcome news indeed.

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