Filtered sunlight shows promise for neonatal hyperbilirubinemia

Last Updated: 2018-09-17

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Filtered-sunlight phototherapy (FSPT) is safe, affordable, and no less effective than intensive electric phototherapy (IEPT) to treat moderate-to-severe hyperbilirubinemia in newborns, a non-inferiority trial conducted in Nigeria suggests.

"Filtered sunlight phototherapy can be safe and efficacious, either alone or as a bridge to an appropriate referral center, depending on the risk factors, jaundice etiology, time of day, and ability to refer. The treatment offers an alternative for infants in places without access to consistent electricity or effective phototherapy but where sunlight is readily available." lead author Dr. Tina M. Slusher of the University of Minnesota in Minneapolis, told Reuters Health.

"Used correctly within proper guidelines, FSPT has the potential to significantly decrease the number of infants who suffer from acute bilirubin encephalopathy and subsequently die or develop kernicterus spectrum disorder with a lifetime of tragic consequences including cerebral palsy, auditory processing disorders, and deafness," Dr. Slusher noted by email.

As reported in The Lancet Global Health, online August 28, Dr. Slusher and her colleagues expanded their earlier research that showed FSPT to be effective and safe mild-to-moderate neonatal hyperbilirubinemia. In the new study, they present results from neonates with moderate-to-severe hyperbilirubinemia.

For the non-blinded study, conducted in a simulated rural setting in Nigeria, the researchers enrolled near-term or term infants up to 14 days old with total serum bilirubin concentrations at or above recommended treatment levels for high-risk newborns.

They randomly assigned 87 infants to receive FSPT and 87 to receive IEPT. Newborns received phototherapeutic light in a transparent polycarbonate room lined with commercial tinting films that blocked ultraviolet light and reduced infrared transmission.

Altogether, babies in the FSPT group received 215 days of phototherapy, with 82 (38%) days not assessable due to less than four hours of phototherapy delivered. Babies in the IEPT group received 219 treatment days of phototherapy, with 67 (31%) not assessable.

The researchers defined efficacy as increase in total serum bilirubin concentrations less than 3.4 umol/L/hr in infants up to 72 hours of age, or a drop in total serum bilirubin concentrations in those older than 72 hours. They defined safety as absence of sustained hypothermia, hyperthermia, sunburn, or dehydration, over all treatment days.

FSPT was not inferior to IEPT. Median irradiance was 37.3 microwatts/cm2/nanometer in the FSPT group and 50.4 mW/cm2/nm in the IEPT group. FSPT was effective on 116 of 133 treatment days (87.2%) and IEPT was effective on 135 of 152 treatment days (88.8%). Treatment was safe for all babies.

Dr. Charles Mwansambo, chief of health services in the Ministry of Health of the Government of Malawi in Lilongwe and coauthor of a commentary published with the study, told Reuters Health by email, "This is good news in the sense that brain damage due to high bilirubin levels in the blood can potentially be prevented by using a readily available resource in most low- and middle-income countries: the Sun!"

"Further study is needed to define what role, if any, FSPT has in rural health facilities in low-income settings," Dr. Mwansambo and coauthor Tim Colbourn of University College London write in an invited commentary. "Whether FSPT is worth adopting and scaling up in the many rural areas without IEPT or electricity, where referrals to higher levels of care can be challenging or impossible, needs to be assessed in terms of usability, acceptability, affordability, and sustainability."

Dr. Slusher advised by email, "Locales and countries using this exciting therapy need to know that the type of filter matters and that local protocols need to be developed, tested, and appropriately approved to assure it can be done safely, paying attention to temperature regulation."

SOURCE: http://bit.ly/2OsNgQB and http://bit.ly/2OpK6Nr

Lancet Global Health 2018.