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CORRECTED-Sunlight is OK for neonatal jaundice, provided UV rays are filtered out

CORRECTED-Sunlight is OK for neonatal jaundice, provided UV rays are filtered out

(Corrects author's first name in paragraph 2.)

By C. Vidya Shankar MD

NEW YORK (Reuters Health) - Keeping babies out in the sun but protected from harmful UV rays is an effective and affordable option for treating neonatal jaundice in resource-poor settings, according to a new study from Nigeria.

"It is very, very exciting to be able to treat jaundice in newborns in the face of large areas of Nigeria and Africa without access to any phototherapy because of problems with both electricity and equipment," lead author Dr. Tina Slusher from the University of Minneapolis, Minnesota, said in her email to Reuters Health.

She is "not quite ready" to recommend this method as the treatment of choice, however. She says more study is needed to determine how to employ it with less monitoring in very rural settings.

As reported May 26 online in Pediatrics, the researchers enrolled 227 neonates born at the Island Maternity Hospital in Lagos, Nigeria, who developed jaundice within the first 14 days of life.

Babies with serum bilirubin levels within 3 mg/dL of the American Academy of Pediatrics(AAP) recommended treatment levels received the filtered sunlight phototherapy for five to six a day. (The AAP guidance for calculating treatment levels is here: http://pediatrics.aappublications.org/content/114/1/297.full.)

Systemically unwell neonates or with severe jaundice needing exchange transfusion were excluded. Serum bilirubin was estimated daily.

Filtered sunlight phototherapy (FS-PT) was improvised using a metal frame covered with commercial plastic sun-control film costing approximately $300. The Air Blue 80 film (CP Films, Fieldale, VA) transmitted 79% of blue light and was used on cloudy days, while the Gila Titanium (CP Films, Inc) that allowed 33% of blue wavelength light was used on sunny days. Both films cut out most of the harmful UV radiation. Babies were placed under the canopy which was exposed to sunlight.

Effective phototherapy was defined as any fall in bilirubin levels among babies older than 3 days or a rise of less than 0.2 mg/dL/ hr in younger babies. FS-PT was discontinued when bilirubin declined below 12 mg/dL.

The mean gestation age of the study group was 38 weeks. The mean age at admission was 36 hours of age with a mean total bilirubin of 7.9 mg/dl. Overall, babies received FS-PT for mean of 1.13 days with a cumulative total of 257 treatment days for the group.

FS-PT provided effective phototherapy on 92% of the 197 of treatment days for which pre and post bilirubin levels were available, with an average bilirubin decline of 0.06 mg/dL per hour.

Adverse effects were restricted to temperature fluctuations needing transient interruptions to the FS-PT. No cases of sunburn or dehydration were reported.

In email to Reuters Health, neonatologist Dr. Vinod Bhutani from Stanford University in California called the results "a brilliant promising first step that can be used as a complement to minimize overcrowding in a neonatal units."

It is not yet the treatment of choice, he added, because "further studies for best modes of delivery (need to be done) and cost-effectiveness needs to be evaluated." Prof. Bhutani was not part of the study team.

FS-PT will be most effective in places with good sunlight for most of the year, the researchers say. Assembling the apparatus was challenging - with the need to import the film and manufacture the canopy locally. Cold and inclement weather could limit the use of the equipment, they admit.

Dr. Slusher recommended larger studies in remote areas and in babies with severe jaundice. "We believe it will be a valuable addition to the treatment options available for neonatal jaundice in resource poor setting and it some locales likely the only option," she concluded.

SOURCE: http://bit.ly/1kOPkiM

Pediatrics 2014.

 
 
 
 
                 
 
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