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新生儿 高胆红素血症 阳光
新生儿高胆红素血症（或新生儿黄疸）在低收入和中等收入国家（LMIC）中的发病率和严重并发症远高于其他地区，这主要是由于血液疾病、败血症患病率增加、产前和产后护理不足以及缺乏治疗资源等多种因素造成的 。医院和诊所经常面临光疗设备短缺和电力供应不稳定的问题 。在这种背景下，阳光作为一种潜在的治疗选择受到了关注，因为它包含光疗机产生的波长 。
然而，将阳光用于新生儿高胆红素血症的治疗和预防，以及其潜在的益处、风险和适用性，在现有证据中存在多方面的描述和研究。
阳光作为治疗方法的潜力与局限性
- 治疗机制与效率： 阳光含有光疗机产生的波长，理论上具有治疗高胆红素血症的潜力 。一项体外研究表明，阳光在异构化胆红素方面可能比常规光疗设备更有效，尤其是在光疗设备通常在病房中以较低强度运行的情况下 。该研究指出，在可比的光强度下，光疗设备与阳光同样有效。然而，当光疗设备在常规操作距离（50厘米）下运行时，其光强度比阳光低六倍。在这种情况下，阳光异构化胆红素的效率约为光疗设备的6.5倍，即使在冬季强度较低时也更有效 。这提示阳光可能是一个可行的替代光疗来源，特别是在缺乏常规光疗设备的地区 。
- 滤过阳光光疗（FS-PT）： 为了解决阳光中紫外线（UV）和红外线（IR）的有害影响，研究人员开发了滤过阳光光疗（FS-PT）技术 。FS-PT通过商业窗户贴膜过滤阳光，去除大部分紫外线和显著水平的红外线，同时传输有效治疗水平的蓝光 。
- 与传统光疗的比较： 两项研究（共621名婴儿）比较了FS-PT与其他光疗源的效果。结果显示，FS-PT与常规或强化电光疗在有效治疗天数上可能没有显著差异 。一项研究报告了急性胆红素脑病（ABE），但没有婴儿发生此结果 。另一项研究报告了因死亡退出研究，但也没有婴儿因死亡退出 。
- 安全性： 虽然FS-PT在治疗黄疸方面显示出希望，但也存在潜在危害。两项研究均显示FS-PT可能增加体温过高（体温高于37.5°C）的风险（典型风险比4.39，95%CI 2.98至6.47；典型风险差0.30，95%CI 0.23至0.36；需要治疗才能产生额外有害结果的例数[NNTH] 3，95%CI 2至4；2项研究，621名婴儿；中等确定性证据） 。然而，体温过低（体温低于35.5°C）方面可能没有差异 。在尼日利亚进行的一项FS-PT研究中，227名婴儿接受了258天的FS-PT治疗，没有婴儿出现晒伤或脱水。尽管在85天（33%）的治疗日中，婴儿因轻微的体温相关不良事件而被短暂移出FS-PT，但所有婴儿都未达到退出研究的标准。该研究得出结论，在适当监测下，滤过阳光是一种新颖、实用且廉价的光疗方法，有望为热带地区缺乏常规光疗设备的国家管理新生儿黄疸提供安全有效的治疗策略 。
- 预防作用： 一项研究报告称，每天两次（30至60分钟）的阳光暴露与不治疗相比，黄疸发生率可能降低（风险比0.61，95%CI 0.45至0.82；风险差-0.14，95%CI -0.22至-0.06；需要治疗才能产生额外有益结果的例数[NNTB] 7，95%CI 5至17；1项研究，482名婴儿；非常低确定性证据），且婴儿黄疸天数可能减少（平均差-2.20天，95%CI -2.60至-1.80；1项研究，482名婴儿；非常低确定性证据） 。该研究还表明，阳光疗法可能降低出院后七天内因高胆红素血症治疗再住院的几率，但证据确定性非常低 。
阳光使用的风险
- 有害辐射： 阳光含有有害的紫外线和红外线，长时间暴露可能导致晒伤、皮肤损伤以及体温过高或过低 。
- 证据确定性低： 关于阳光单独使用或与过滤或放大设备一起使用预防和治疗新生儿高胆红素血症的证据通常确定性较低或非常低 。
在低资源环境中的应用
- 辅助治疗： 阳光可能是LMIC环境中常规光疗的有效辅助手段，可以实现有限光疗设备的轮换使用，并且可能更受家庭青睐，因为它允许增加亲子互动 。
- 创新方法： 滤过阳光被视为解决资源受限环境中新生儿高胆红素血症持续挑战的创新方法之一，这些挑战导致了不可接受的发病率、残疾率和死亡率 。这些创新，包括更有效的光疗和滤过阳光，有望显著减轻新生儿高胆红素血症的负担 。
- 具体实践： 在尼日利亚进行的一项随机对照非劣效性试验旨在评估滤过阳光光疗（FS-PT）与常规光疗（CPT）在治疗尼日利亚新生儿黄疸方面的疗效。该研究假设FS-PT在适当筛选有害紫外线和红外线后，与CPT同样有效 。研究计划使用预先测试过的滤膜天篷，根据日照情况（晴天或阴天）调整滤膜，以维持蓝光辐照度水平在8 μW/cm²/nm以上 。
知识和实践差距
- 医疗专业人员的知识不足： 在尼日利亚伊巴丹，基层卫生工作者（包括社区卫生工作者和社区助产士）对新生儿黄疸的知识普遍不足（80.2%的受访者知识贫乏），并且存在错误的实践（46.4%从事错误实践） 。其中，33.1%的社区卫生工作者和16.4%的社区助产士实践阳光暴露，而28.6%的社区卫生工作者和14.9%的社区助产士给予葡萄糖水 。这表明，虽然阳光暴露可能被基层卫生工作者视为一种治疗方法，但其应用方式和伴随的其他不当实践可能存在问题。
- 传统信仰： 在尼日利亚阿多埃基蒂，关于新生儿黄疸管理和预防的传统信仰仍然普遍存在 。30%的受访者会使用阳光治疗新生儿黄疸，但也有相当一部分人会使用木瓜提取物、抗生素或非处方药，这可能导致延迟适当的医疗护理 。
环境因素的影响
- 日照时间与医疗成本： 一项在日本进行的生态学研究发现，新生儿高胆红素血症的医疗费用存在区域差异，且与日照时间呈弱负相关 。日本东北地区（日本海一侧）和北陆地区可能具有更高的医疗费用和更短的日照时间，这提示日照时间短可能是新生儿高胆红素血症发生的一个预后因素 。
- 病房设计： 一项热带地区产科病房的报告显示，屋顶悬挑的建筑改造（延伸数米，阻挡了大部分日光）导致新生儿黄疸发病率从0.5%急剧增加到17% 。这强调了病房设计中保持充足间接阳光的重要性，以帮助预防新生儿黄疸 。
结论
综合来看，阳光在预防和治疗新生儿高胆红素血症方面具有潜力，特别是在低资源环境中作为常规光疗的辅助或替代方案。滤过阳光光疗（FS-PT）通过去除有害的紫外线和红外线，同时保持治疗性蓝光，显著提高了安全性。然而，在使用阳光或FS-PT时，必须进行充分的监测，以避免体温过高和其他潜在的有害影响 。尽管一些研究显示了阳光在降低黄疸发生率和再住院率方面的益处，但这些证据的确定性普遍较低 。此外，在某些地区，由于医疗专业人员知识不足和传统信仰的普遍存在，对阳光的错误或不当使用仍然是一个挑战 。未来需要更多的研究来确定阳光单独使用作为高胆红素血症治疗方法的安全性和有效性，并提高基层卫生工作者和社区对新生儿黄疸的正确认知和管理实践 。
References
1Sunlight for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates.PubMed
Delia Horn, Danielle Ehret, Kanekal S Gautham, et al.
Cochrane Database Syst Rev. 2021 Jul 6;7(7):CD013277. doi: 10.1002/14651858.CD013277.pub2.
BACKGROUND: Acute bilirubin encephalopathy (ABE) and the other serious complications of severe hyperbilirubinemia in the neonate occur far more frequently in low- and middle-income countries (LMIC). This is due to several factors that place babies in LMIC at greater risk for hyperbilirubinemia, including increased prevalence of hematologic disorders leading to hemolysis, increased sepsis, less prenatal or postnatal care, and a lack of resources to treat jaundiced babies. Hospitals and clinics face frequent shortages of functioning phototherapy machines and inconsistent access to electricity to run the machines. Sunlight has the potential to treat hyperbilirubinemia: it contains the wavelengths of light that are produced by phototherapy machines. However, it contains harmful ultraviolet light and infrared radiation, and prolonged exposure has the potential to lead to sunburn, skin damage, and hyperthermia or hypothermia. OBJECTIVES: To evaluate the efficacy of sunlight administered alone or with filtering or amplifying devices for the prevention and treatment of clinical jaundice or laboratory-diagnosed hyperbilirubinemia in term and late preterm neonates. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 5), MEDLINE, Embase, and CINAHL on 2 May 2019. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs. We updated the searches on 1 June 2020. SELECTION CRITERIA: We included RCTs, quasi-RCTs, and cluster RCTs. We excluded crossover RCTs. Included studies must have evaluated sunlight (with or without filters or amplification) for the prevention and treatment of hyperbilirubinemia or jaundice in term or late preterm neonates. Neonates must have been enrolled in the study by one-week postnatal age. DATA COLLECTION AND ANALYSIS: We used standard methodologic procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Our primary outcomes were: use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, chronic bilirubin encephalopathy, and death. MAIN RESULTS: We included three RCTs (1103 infants). All three studies had small sample sizes, were unblinded, and were at high risk of bias. We planned to undertake four comparisons, but only found studies reporting on two. Sunlight with or without filters or amplification compared to no treatment for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates One study of twice-daily sunlight exposure (30 to 60 minutes) compared to no treatment reported the incidence of jaundice may be reduced (risk ratio [RR] 0.61, 95% confidence interval [CI] 0.45 to 0.82; risk difference [RD] -0.14, 95% CI -0.22 to -0.06; number needed to treat for an additional beneficial outcome [NNTB] 7, 95% CI 5 to 17; 1 study, 482 infants; very low-certainty evidence) and the number of days that an infant was jaundiced may be reduced (mean difference [MD] -2.20 days, 95% CI -2.60 to -1.80; 1 study, 482 infants; very low-certainty evidence). There were no data on safety or potential harmful effects of the intervention. The study did not assess use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, and long-term consequences of hyperbilirubinemia. The study showed that sunlight therapy may reduce rehospitalization rates within seven days of discharge for treatment for hyperbilirubinemia, but the evidence was very uncertain (RR 0.55, 95% CI 0.27 to 1.11; RD -0.04, -0.08 to 0.01; 1 study, 482 infants; very low-certainty evidence). Sunlight with or without filters or amplification compared to other sources of phototherapy for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia Two studies (621 infants) compared the effect of filtered-sunlight exposure to other sources of phototherapy in infants with confirmed hyperbilirubinemia. Filtered-sunlight phototherapy (FSPT) and conventional or intensive electric phototherapy led to a similar number of days of effective treatment (broadly defined as a minimal increase of total serum bilirubin in infants less than 72 hours old and a decrease in total serum bilirubin in infants more than 72 hours old on any day that at least four to five hours of sunlight therapy was available). There may be little or no difference in treatment failure requiring exchange transfusion (typical RR 1.00, 95% CI 0.06 to 15.73; typical RD 0.00, 95% CI -0.01 to 0.01; 2 studies, 621 infants; low-certainty evidence). One study reported ABE, and no infants developed this outcome (RR not estimable; RD 0.00, 95% CI -0.02 to 0.02; 1 study, 174 infants; low-certainty evidence). One study reported death as a reason for study withdrawal; no infants were withdrawn due to death (RR not estimable; typical RD 0.00, 95% CI -0.01 to 0.01; 1 study, 447 infants; low-certainty evidence). Neither study assessed long-term outcomes. Possible harms: both studies showed a probable increased risk for hyperthermia (body temperature greater than 37.5 °C) with FSPT (typical RR 4.39, 95% CI 2.98 to 6.47; typical RD 0.30, 95% CI 0.23 to 0.36; number needed to treat for an additional harmful outcome [NNTH] 3, 95% CI 2 to 4; 2 studies, 621 infants; moderate-certainty evidence). There was probably no difference in hypothermia (body temperature less than 35.5 °C) (typical RR 1.06, 95% CI 0.55 to 2.03; typical RD 0.00, 95% CI -0.03 to 0.04; 2 studies, 621 infants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Sunlight may be an effective adjunct to conventional phototherapy in LMIC settings, may allow for rotational use of limited phototherapy machines, and may be preferable to families as it can allow for increased bonding. Filtration of sunlight to block harmful ultraviolet light and frequent temperature checks for babies under sunlight may be warranted for safety. Sunlight may be effective in preventing hyperbilirubinemia in some cases, but these studies have not demonstrated that sunlight alone is effective for the treatment of hyperbilirubinemia given its sporadic availability and the low or very low certainty of the evidence in these studies.
2Innovative approaches to neonatal jaundice diagnosis and management in low-resourced settings.PubMed
Haroon Saloojee
S Afr Fam Pract (2004). 2024 Feb 29;66(1):e1-e5. doi: 10.4102/safp.v66i1.5833.
Persistent challenges in addressing severe neonatal hyperbilirubinaemia in resource-constrained settings have led to ongoing and often unacceptable rates of morbidity, disability and mortality. These challenges stem from limitations such as inadequate, inefficient or financially inaccessible diagnostic and therapeutic options. However, over the past decade, noteworthy innovations have emerged to address some of these hurdles, and these innovations are increasingly poised for broader implementation. This review provides a concise summary of these novel, economically viable diagnostic solutions, encompassing point-of-care assays and smartphone applications, as well as treatment modalities, notably more effective phototherapy and filtered sunlight. These advancements hold promise and have the potential to meaningfully reduce the burden of neonatal hyperbilirubinaemia, signifying a promising shift in the landscape of neonatal healthcare.
3Filtered sunlight, solar powered phototherapy and other strategies for managing neonatal jaundice in low-resource settings.PubMed
Tina M Slusher, Louise Tina Day, Tolulope Ogundele, et al.
Early Hum Dev. 2017 Nov;114:11-15. doi: 10.1016/j.earlhumdev.2017.09.008. Epub 2017 Sep 15.
Challenges in treating severe neonatal jaundice in low and middle-income country settings still exist at many levels. These include: a lack of awareness of causes and prevention by families, communities and even sometimes health care professionals; insufficient, ineffective, high quality affordable diagnostic and therapeutic options; limited availability of rehabilitation provision for kernicterus. Collectively these challenges lead to an unacceptably high global morbidity and mortality from severe neonatal jaundice. In the past decade, there has been an explosion of innovations addressing some of these issues and these are increasingly available for scale up. Scientists, healthcare providers, and communities are joining hands to explore educational tools, low cost screening and diagnostic options including at point-of-care and treatment modalities including filtered sunlight and solar powered phototherapy. For the first time, the possibility of eliminating the tragedy of preventable morbidity and mortality from severe NNJ is on the horizon, for all.
4Primary health workers' knowledge and practices relating to neonatal jaundice in Ibadan, Nigeria.PubMed
Adebola E Orimadegun, Adeola O Ojebiyi
Afr J Prim Health Care Fam Med. 2017 Jan 30;9(1):e1-e7. doi: 10.4102/phcfm.v9i1.1081.
BACKGROUND: Over half of births and newborn care occur in primary healthcare facilities in Nigeria, but information on activities of personnel working there is scarce. AIM: To assess the knowledge and practices relating to neonatal jaundice (NNJ) among community health workers (CHWs) and community birth attendants (CBAs) in Nigeria. SETTING: We conducted a cross-sectional survey of all 227 CHWs and 193 registered CBAs in Ibadan, Nigeria. METHODS: Knowledge and practices regarding NNJ were measured using a pretested questionnaire. Knowledge and practices were assessed on a 33-point scale and a 13-point scale, respectively. Scores ≤ 17 and ≤ 9 was regarded as poor knowledge and as wrong practice, respectively. RESULTS: Many (64.5%) of the respondents could not correctly describe examination for NNJ (CHWs: 49.4%; CBAs: 50.6%). Of the 200 (47.6%) who treated NNJ 3 months prior to the study, 62.5% (CHWs: 66.9% and CBAs: 53.7%) treated NNJ with orthodox drugs. Drugs prescribed included: antibiotics (93.3%), antimalarials (5.3%), multivitamins (28.0%), paracetamol (6.2%) and phenobarbitone (7.1%). Significantly more CHWs than CBAs practiced exposure to sunlight (33.1% versus 16.4%) and administration of glucose water (28.6% versus 14.9%), while 58.0% of all respondents referred cases to secondary health facilities. Overall, 80.2% had poor knowledge (CHWs: 78.9%; CBAs: 81.9%) and 46.4% engaged in wrong practices (CHWs: 57.3%; CBAs: 33.7%). CHWs were more likely to indulge in wrong practices than CBAs (OR = 2.22, 95% CI = 1.03, 4.79). CONCLUSION: Primary Health Workers in Ibadan had poor knowledge and engaged in wrong practices about NNJ. The needs to organise regular training programmes were emphasised.
5Regional variation in the development of neonatal hyperbilirubinemia and relation with sunshine duration in Japan: an ecological study.PubMed
Yasutaka Kuniyoshi, Haruka Tokutake, Natsuki Takahashi, et al.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):4946-4951. doi: 10.1080/14767058.2021.1873270. Epub 2021 Jan 17.
BACKGROUND: Few studies have investigated the regional variations in the development of neonatal hyperbilirubinemia. This study aimed to investigate regional variations in medical costs for neonatal hyperbilirubinemia and the correlations between sunshine duration and medical care costs for neonatal hyperbilirubinemia in an ecological study, using the National Database of Japan. METHODS: We obtained data on the annual medical costs for neonatal hyperbilirubinemia, annual live births, and annual sunshine duration in each prefecture from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data, Vital Statistics in Japan, and System of Social and Demographic Statistics Prefectural Data Basic Data from 2014 to 2017. We created choropleth maps showing the regional variations (quartiles) in the annual medical costs for neonatal hyperbilirubinemia per 10 live births and the annual sunshine duration in each prefecture. We used Pearson's correlation coefficients to evaluate the associations between the annual sunshine duration and annual medical care costs for neonatal hyperbilirubinemia per 10 live births in each prefecture. RESULTS: The Tohoku region (on the Sea of Japan side) and the Hokuriku region were likely to have higher medical care costs for neonatal hyperbilirubinemia and shorter sunshine duration than the rest of the country. There were weak and negative correlations between the annual sunshine duration and the annual medical care costs for neonatal hyperbilirubinemia. The correlation coefficients ranged from -0.086 to -0.33. CONCLUSION: There could be regional variations in the medical care costs for neonatal hyperbilirubinemia in Japan. Short sunshine duration could be a prognostic factor for the development of neonatal hyperbilirubinemia.
6Ward design and neonatal jaundice in the tropics: report of an epidemic.PubMed
P Barss, K Comfort
Br Med J (Clin Res Ed). 1985 Aug 10;291(6492):400-1. doi: 10.1136/bmj.291.6492.400.
Architectural modifications to an existing tropical obstetric ward involved extension of the roof overhangs to a width of several metres. These extensions excluded most of the daylight from the ward. An alarming increase in the incidence of jaundice (bilirubin concentration greater than or equal to 240 mumol/l (greater than or equal to 14 mg/100 ml] from 0.5% to 17% in newborn infants occurred after the modifications. Tropical obstetric wards and nurseries should continue to be built with windows facing north-south for coolness. They should, however, have as many windows as possible and the roof overhangs should be limited to about 1 m to allow adequate indirect sunlight to enter, giving a high intensity of illumination, and help prevent neonatal jaundice.
7Traditional beliefs in the management and prevention of neonatal jaundice in Ado-Ekiti, Nigeria.PubMed
Deborah Tolulope Esan, Fatimah Muhammad, Agatha Ogunkorode, et al.
Enferm Clin (Engl Ed). 2022 Jun;32 Suppl 1:S73-S76. doi: 10.1016/j.enfcle.2021.09.006.
AIM: Traditional beliefs about neonatal jaundice persist in Sub-Saharan Africa, and because those beliefs might worsen the outcomes of the disease by delaying care or by treating it at home with unproven remedies; our study sought to identify the traditional beliefs of antenatal mothers regarding the management and prevention of neonatal jaundice in rural areas of Ekiti State, Southwestern Nigeria. METHODS: The study employed a descriptive cross-sectional design. A total of 190 women who attended two primary health care centers in Ekiti State were recruited for the study from April 1 to May 31, 2017, by convenience sampling through the antenatal clinic register. Data was collected by the use of an adapted self-administered, structured questionnaire. RESULTS: Of the women selected, 56% had at least one child before.36% of all the respondents would use pawpaw extract to treat neonatal jaundice, 30% would use sunlight, 26% would use antibiotics, 16% would use over the counter drugs, and 5% would use phototherapy. With regards of preventive measures, 48% indicated that neonatal jaundice can be prevented by breast feeding, 11% by drinking herbal concoctions by both mother and baby, 26% by giving glucose water to the baby and 12% of respondents by avoidance of cold water when pregnant. CONCLUSION: Our study showed that traditional beliefs regarding the management and prevention of neonatal jaundice are prevalent in Ado Ekiti, Nigeria.
8Treatment of neonatal jaundice with filtered sunlight in Nigerian neonates: study protocol of a non-inferiority, randomized controlled trial.PubMed
Tina M Slusher, Bolajoko O Olusanya, Hendrik J Vreman, et al.
Trials. 2013 Dec 28;14:446. doi: 10.1186/1745-6215-14-446.
BACKGROUND: Severe neonatal jaundice and its progression to kernicterus is a leading cause of death and disability among newborns in poorly-resourced countries, particularly in sub-Saharan Africa. The standard treatment for jaundice using conventional phototherapy (CPT) with electric artificial blue light sources is often hampered by the lack of (functional) CPT devices due either to financial constraints or erratic electrical power. In an attempt to make phototherapy (PT) more readily available for the treatment of pathologic jaundice in underserved tropical regions, we set out to test the hypothesis that filtered sunlight phototherapy (FS-PT), in which potentially harmful ultraviolet and infrared rays are appropriately screened, will be as efficacious as CPT. METHODS/DESIGN: This prospective, non-blinded randomized controlled non-inferiority trial seeks to enroll infants with elevated total serum/plasma bilirubin (TSB, defined as 3 mg/dl below the level recommended by the American Academy of Pediatrics for high-risk infants requiring PT) who will be randomly and equally assigned to receive FS-PT or CPT for a total of 616 days at an inner-city maternity hospital in Lagos, Nigeria. Two FS-PT canopies with pre-tested films will be used. One canopy with a film that transmits roughly 33% blue light (wavelength range: 400 to 520 nm) will be used during sunny periods of a day. Another canopy with a film that transmits about 79% blue light will be used during overcast periods of the day. The infants will be moved from one canopy to the other as needed during the day with the goal of keeping the blue light irradiance level above 8 μW/cm²/nm. PRIMARY OUTCOME: FS-PT will be as efficacious as CPT in reducing the rate of rise in bilirubin levels. Secondary outcome: The number of infants requiring exchange transfusion under FS-PT will not be more than those under CPT. CONCLUSION: This novel study offers the prospect of an effective treatment for infants at risk of severe neonatal jaundice and avoidable exchange transfusion in poorly-resourced settings without access to (reliable) CPT in the tropics. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01434810.
9Can sunlight replace phototherapy units in the treatment of neonatal jaundice? An in vitro study.PubMed
F M Salih
Photodermatol Photoimmunol Photomed. 2001 Dec;17(6):272-7. doi: 10.1034/j.1600-0781.2001.170605.x.
BACKGROUND/AIM: Light can be efficiently used for the treatment of neonatal jaundice. Sunlight, which covers a large portion of the light spectrum including the bilirubin-absorbing range, is abundant in the Middle East. Such advantages prompted the present study to investigate the efficiency of sunlight in isomerizing bilirubin. This may introduce a practical source of light for the treatment of hyperbilirubinic infants in areas where phototherapy units are not available. METHODS: The efficiency of sunlight was quantified by a comparison with a phototherapy unit. Aqueous bilirubin solutions were exposed to periodic sunlight over the entire year and the reduction of bilirubin concentration was monitored spectrophotometrically. Bilirubin solutions were also exposed to a phototherapy unit intensity comparable to that of sunlight (17 cm away from the source). RESULTS: The data indicated that at this comparable light intensity, the phototherapy unit was as effective as sunlight. However, for the treatment of neonatal jaundice, phototherapy units are usually operated at a distance of 50 cm (where the light intensity is six times less than that of sunlight). When this distance was tested, only 16% of bilirubin was isomerized in the first 5 min of exposure. In contrast, about 65% of bilirubin was isomerized when the phototherapy unit was placed at a distance of 17 cm and when the bilirubin solutions were exposed to sunlight for the same time period. The hourly and seasonal changes in sunlight intensity affected the reduction in bilirubin concentration significantly. CONCLUSION: Data revealed that sunlight is almost 6.5 times more effective than a phototherapy unit when operating at the ward geometry after taking isomerization efficiency and area of exposure into consideration. Moreover, sunlight is still more effective during the winter season, when its intensity is lower. Thus, sunlight may be considered an alternative phototherapy source for the treatment of neonatal jaundice, particularly in areas where conventional phototherapy units are unavailable.
10Safety and efficacy of filtered sunlight in treatment of jaundice in African neonates.PubMed
Tina M Slusher, Hendrik J Vreman, Bolajoko O Olusanya, et al.
Pediatrics. 2014 Jun;133(6):e1568-74. doi: 10.1542/peds.2013-3500.
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.
检索问题
新生儿 高胆红素血症 阳光
新生儿高胆红素血症（Neonatal Hyperbilirubinemia）是一种常见的新生儿疾病，俗称新生儿黄疸。阳光，尤其是经过过滤的阳光，因其含有与光疗设备相同波长的光，被认为在预防和治疗新生儿高胆红素血症方面具有潜力，尤其是在资源有限地区（LMIC）。然而，直接暴露于阳光也存在潜在的风险，需要谨慎评估其益处与危害。
1. 阳光在预防和治疗新生儿高胆红素血症中的作用
- 治疗潜力： 阳光含有光疗设备产生的波长光，理论上具有治疗高胆红素血症的潜力。体外研究表明，在可比的光强度下，光疗设备与阳光在异构化胆红素方面同样有效。甚至有研究指出，在考虑异构化效率和暴露面积后，阳光在病房几何结构下的效果比光疗设备高出约6.5倍，即使在冬季阳光强度较低时也更有效。
- 预防潜力： 一项研究发现，每天两次阳光照射（30至60分钟）可能降低新生儿黄疸的发生率和持续天数。在日本的一项生态学研究中，年日照时间与新生儿高胆红素血症的医疗费用呈弱负相关，表明日照时间短可能是新生儿高胆红素血症发生的一个预后因素，间接支持阳光可能具有预防作用。
- 资源有限地区的替代方案： 在低收入和中等收入国家，由于功能性光疗设备短缺、电力供应不稳定以及缺乏诊断和治疗资源，新生儿高胆红素血症的发病率和严重并发症发生率更高。在这些地区，过滤阳光疗法（FSPT）和太阳能光疗被认为是创新且经济可行的治疗方案，有望显著降低新生儿高胆红素血症的负担。
2. 过滤阳光疗法（FSPT）
- 安全性与有效性： 过滤阳光疗法通过使用商业窗户贴膜过滤掉大部分紫外线和显著水平的红外线，同时传输有效水平的治疗性蓝光。
- 有效性： 两项研究（共621名婴儿）比较了过滤阳光照射与传统或强化电光疗法的效果，结果显示两者在有效治疗天数上可能没有显著差异。治疗失败（需要换血治疗）的风险可能很小或没有差异。一项在尼日利亚进行的研究表明，过滤阳光疗法在92%的评估治疗日中有效，没有婴儿出现晒伤或脱水。虽然有33%的治疗日婴儿因轻微体温相关不良事件被短暂移开，但没有婴儿达到研究退出标准。
- 安全性： 主要的关注点是过热（体温高于37.5°C）。两项研究显示，使用过滤阳光疗法可能增加过热的风险（典型风险比4.39），每3名婴儿中就有1名可能出现额外的有害结果。然而，体温过低（体温低于35.5°C）方面可能没有差异。为了安全起见，建议在使用阳光时对婴儿进行频繁的体温检查。
- 优势：
- 成本效益和可及性： 过滤阳光疗法是一种新颖、实用且廉价的光疗方法，在传统光疗设备不可用的热带国家，它有望成为管理新生儿黄疸的安全有效治疗策略。
- 改善亲子关系： 阳光疗法可能受到家庭的青睐，因为它允许增加亲子间的联结。
- 辅助传统光疗： 在资源有限地区，阳光可作为传统光疗的有效辅助手段，允许有限的光疗设备进行轮换使用。
3. 阳光暴露的潜在危害和注意事项
- 紫外线和红外线： 阳光含有有害的紫外线和红外辐射。长时间暴露可能导致晒伤、皮肤损伤以及体温过高或过低。
- 过热风险： 已有研究明确指出，过滤阳光疗法可能增加婴儿过热的风险。因此，在进行阳光疗法时，必须对婴儿的体温进行密切监测。
- 不确定性和缺乏证据： 尽管阳光可能在某些情况下有效预防高胆红素血症，但目前的研究并未证明单纯阳光能有效治疗高胆红素血症，这主要是由于其不稳定的可及性以及现有证据的确定性较低或非常低。一项系统评价指出，评估阳光暴露与无治疗相比的研究样本量小、未盲法、偏倚风险高，且没有关于安全或潜在有害影响的数据。
- 医疗专业人员的错误认知： 在一些地区，医护人员对阳光治疗新生儿黄疸的建议可能存在不当之处。例如，在尼日利亚的一项研究中，30%的受访者表示会使用阳光治疗新生儿黄疸。在澳大利亚昆士兰州的一项调查显示，近一半的护士（49.5%）和三分之一的医生（34.9%）错误地认为阳光可以治疗新生儿黄疸，其中42%的医护人员推荐阳光暴露治疗新生儿黄疸，但相对较少的医护人员会指定通过窗户晒太阳。儿科医生和新生儿科医生比产科医生和其他医生更不倾向于推荐阳光治疗新生儿黄疸。这表明需要开展教育计划，以改变医护人员推荐治疗性阳光暴露的做法。
- 病房设计影响： 建筑设计也会影响阳光照射。一项报告指出，扩建屋檐以阻挡大部分日光进入热带产科病房后，新生儿黄疸的发生率从0.5%急剧增加到17%。建议热带产科病房和育婴室应尽可能多地设置窗户，并限制屋檐的宽度（约1米），以允许足够的间接阳光进入，提供高强度的照明，从而有助于预防新生儿黄疸。
- 对经皮胆红素测量（TcB）的影响： 白天日光可能是影响额头部位经皮胆红素测量准确性和可靠性的重要因素，导致额头TcB读数与血清胆红素浓度之间的相关性较差。
4. 总结与建议
阳光，特别是经过过滤的阳光，在资源有限地区作为新生儿高胆红素血症的预防和治疗辅助手段具有显著潜力，因为它能提供与传统光疗相似的治疗波长，且成本低廉、易于获取。然而，其使用必须谨慎，以避免紫外线损伤、晒伤和体温过高等潜在危害。
关键建议包括：
- 过滤阳光： 建议过滤阳光以阻挡有害的紫外线，并对在阳光下的婴儿进行频繁的体温检查，以确保安全。
- 严密监测： 在使用过滤阳光疗法时，应密切监测婴儿的体温，防止过热或过冷。
- 教育与培训： 鉴于一些医护人员对阳光治疗黄疸存在不当的认知和实践，需要针对医护人员开展定期的培训和教育项目，以提高他们对新生儿黄疸的知识和正确实践。
- 研究与发展： 尽管初步证据显示过滤阳光疗法有前景，但仍需要更多高质量、更大样本的研究来确立其作为独立治疗方案的有效性和长期安全性，特别是在比较单纯阳光暴露与传统光疗的疗效方面。
总而言之，阳光对于预防和治疗新生儿高胆红素血症具有一定的潜在益处，尤其是在传统光疗资源受限的环境中。但是，为了最大化其益处并最小化风险，过滤阳光和严密监测是必不可少的措施。
References
1Sunlight for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates.PubMed
Delia Horn, Danielle Ehret, Kanekal S Gautham, et al.
Cochrane Database Syst Rev. 2021 Jul 6;7(7):CD013277. doi: 10.1002/14651858.CD013277.pub2.
BACKGROUND: Acute bilirubin encephalopathy (ABE) and the other serious complications of severe hyperbilirubinemia in the neonate occur far more frequently in low- and middle-income countries (LMIC). This is due to several factors that place babies in LMIC at greater risk for hyperbilirubinemia, including increased prevalence of hematologic disorders leading to hemolysis, increased sepsis, less prenatal or postnatal care, and a lack of resources to treat jaundiced babies. Hospitals and clinics face frequent shortages of functioning phototherapy machines and inconsistent access to electricity to run the machines. Sunlight has the potential to treat hyperbilirubinemia: it contains the wavelengths of light that are produced by phototherapy machines. However, it contains harmful ultraviolet light and infrared radiation, and prolonged exposure has the potential to lead to sunburn, skin damage, and hyperthermia or hypothermia. OBJECTIVES: To evaluate the efficacy of sunlight administered alone or with filtering or amplifying devices for the prevention and treatment of clinical jaundice or laboratory-diagnosed hyperbilirubinemia in term and late preterm neonates. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 5), MEDLINE, Embase, and CINAHL on 2 May 2019. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs. We updated the searches on 1 June 2020. SELECTION CRITERIA: We included RCTs, quasi-RCTs, and cluster RCTs. We excluded crossover RCTs. Included studies must have evaluated sunlight (with or without filters or amplification) for the prevention and treatment of hyperbilirubinemia or jaundice in term or late preterm neonates. Neonates must have been enrolled in the study by one-week postnatal age. DATA COLLECTION AND ANALYSIS: We used standard methodologic procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Our primary outcomes were: use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, chronic bilirubin encephalopathy, and death. MAIN RESULTS: We included three RCTs (1103 infants). All three studies had small sample sizes, were unblinded, and were at high risk of bias. We planned to undertake four comparisons, but only found studies reporting on two. Sunlight with or without filters or amplification compared to no treatment for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates One study of twice-daily sunlight exposure (30 to 60 minutes) compared to no treatment reported the incidence of jaundice may be reduced (risk ratio [RR] 0.61, 95% confidence interval [CI] 0.45 to 0.82; risk difference [RD] -0.14, 95% CI -0.22 to -0.06; number needed to treat for an additional beneficial outcome [NNTB] 7, 95% CI 5 to 17; 1 study, 482 infants; very low-certainty evidence) and the number of days that an infant was jaundiced may be reduced (mean difference [MD] -2.20 days, 95% CI -2.60 to -1.80; 1 study, 482 infants; very low-certainty evidence). There were no data on safety or potential harmful effects of the intervention. The study did not assess use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, and long-term consequences of hyperbilirubinemia. The study showed that sunlight therapy may reduce rehospitalization rates within seven days of discharge for treatment for hyperbilirubinemia, but the evidence was very uncertain (RR 0.55, 95% CI 0.27 to 1.11; RD -0.04, -0.08 to 0.01; 1 study, 482 infants; very low-certainty evidence). Sunlight with or without filters or amplification compared to other sources of phototherapy for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia Two studies (621 infants) compared the effect of filtered-sunlight exposure to other sources of phototherapy in infants with confirmed hyperbilirubinemia. Filtered-sunlight phototherapy (FSPT) and conventional or intensive electric phototherapy led to a similar number of days of effective treatment (broadly defined as a minimal increase of total serum bilirubin in infants less than 72 hours old and a decrease in total serum bilirubin in infants more than 72 hours old on any day that at least four to five hours of sunlight therapy was available). There may be little or no difference in treatment failure requiring exchange transfusion (typical RR 1.00, 95% CI 0.06 to 15.73; typical RD 0.00, 95% CI -0.01 to 0.01; 2 studies, 621 infants; low-certainty evidence). One study reported ABE, and no infants developed this outcome (RR not estimable; RD 0.00, 95% CI -0.02 to 0.02; 1 study, 174 infants; low-certainty evidence). One study reported death as a reason for study withdrawal; no infants were withdrawn due to death (RR not estimable; typical RD 0.00, 95% CI -0.01 to 0.01; 1 study, 447 infants; low-certainty evidence). Neither study assessed long-term outcomes. Possible harms: both studies showed a probable increased risk for hyperthermia (body temperature greater than 37.5 °C) with FSPT (typical RR 4.39, 95% CI 2.98 to 6.47; typical RD 0.30, 95% CI 0.23 to 0.36; number needed to treat for an additional harmful outcome [NNTH] 3, 95% CI 2 to 4; 2 studies, 621 infants; moderate-certainty evidence). There was probably no difference in hypothermia (body temperature less than 35.5 °C) (typical RR 1.06, 95% CI 0.55 to 2.03; typical RD 0.00, 95% CI -0.03 to 0.04; 2 studies, 621 infants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Sunlight may be an effective adjunct to conventional phototherapy in LMIC settings, may allow for rotational use of limited phototherapy machines, and may be preferable to families as it can allow for increased bonding. Filtration of sunlight to block harmful ultraviolet light and frequent temperature checks for babies under sunlight may be warranted for safety. Sunlight may be effective in preventing hyperbilirubinemia in some cases, but these studies have not demonstrated that sunlight alone is effective for the treatment of hyperbilirubinemia given its sporadic availability and the low or very low certainty of the evidence in these studies.
2Innovative approaches to neonatal jaundice diagnosis and management in low-resourced settings.PubMed
Haroon Saloojee
S Afr Fam Pract (2004). 2024 Feb 29;66(1):e1-e5. doi: 10.4102/safp.v66i1.5833.
Persistent challenges in addressing severe neonatal hyperbilirubinaemia in resource-constrained settings have led to ongoing and often unacceptable rates of morbidity, disability and mortality. These challenges stem from limitations such as inadequate, inefficient or financially inaccessible diagnostic and therapeutic options. However, over the past decade, noteworthy innovations have emerged to address some of these hurdles, and these innovations are increasingly poised for broader implementation. This review provides a concise summary of these novel, economically viable diagnostic solutions, encompassing point-of-care assays and smartphone applications, as well as treatment modalities, notably more effective phototherapy and filtered sunlight. These advancements hold promise and have the potential to meaningfully reduce the burden of neonatal hyperbilirubinaemia, signifying a promising shift in the landscape of neonatal healthcare.
3Filtered sunlight, solar powered phototherapy and other strategies for managing neonatal jaundice in low-resource settings.PubMed
Tina M Slusher, Louise Tina Day, Tolulope Ogundele, et al.
Early Hum Dev. 2017 Nov;114:11-15. doi: 10.1016/j.earlhumdev.2017.09.008. Epub 2017 Sep 15.
Challenges in treating severe neonatal jaundice in low and middle-income country settings still exist at many levels. These include: a lack of awareness of causes and prevention by families, communities and even sometimes health care professionals; insufficient, ineffective, high quality affordable diagnostic and therapeutic options; limited availability of rehabilitation provision for kernicterus. Collectively these challenges lead to an unacceptably high global morbidity and mortality from severe neonatal jaundice. In the past decade, there has been an explosion of innovations addressing some of these issues and these are increasingly available for scale up. Scientists, healthcare providers, and communities are joining hands to explore educational tools, low cost screening and diagnostic options including at point-of-care and treatment modalities including filtered sunlight and solar powered phototherapy. For the first time, the possibility of eliminating the tragedy of preventable morbidity and mortality from severe NNJ is on the horizon, for all.
4Primary health workers' knowledge and practices relating to neonatal jaundice in Ibadan, Nigeria.PubMed
Adebola E Orimadegun, Adeola O Ojebiyi
Afr J Prim Health Care Fam Med. 2017 Jan 30;9(1):e1-e7. doi: 10.4102/phcfm.v9i1.1081.
BACKGROUND: Over half of births and newborn care occur in primary healthcare facilities in Nigeria, but information on activities of personnel working there is scarce. AIM: To assess the knowledge and practices relating to neonatal jaundice (NNJ) among community health workers (CHWs) and community birth attendants (CBAs) in Nigeria. SETTING: We conducted a cross-sectional survey of all 227 CHWs and 193 registered CBAs in Ibadan, Nigeria. METHODS: Knowledge and practices regarding NNJ were measured using a pretested questionnaire. Knowledge and practices were assessed on a 33-point scale and a 13-point scale, respectively. Scores ≤ 17 and ≤ 9 was regarded as poor knowledge and as wrong practice, respectively. RESULTS: Many (64.5%) of the respondents could not correctly describe examination for NNJ (CHWs: 49.4%; CBAs: 50.6%). Of the 200 (47.6%) who treated NNJ 3 months prior to the study, 62.5% (CHWs: 66.9% and CBAs: 53.7%) treated NNJ with orthodox drugs. Drugs prescribed included: antibiotics (93.3%), antimalarials (5.3%), multivitamins (28.0%), paracetamol (6.2%) and phenobarbitone (7.1%). Significantly more CHWs than CBAs practiced exposure to sunlight (33.1% versus 16.4%) and administration of glucose water (28.6% versus 14.9%), while 58.0% of all respondents referred cases to secondary health facilities. Overall, 80.2% had poor knowledge (CHWs: 78.9%; CBAs: 81.9%) and 46.4% engaged in wrong practices (CHWs: 57.3%; CBAs: 33.7%). CHWs were more likely to indulge in wrong practices than CBAs (OR = 2.22, 95% CI = 1.03, 4.79). CONCLUSION: Primary Health Workers in Ibadan had poor knowledge and engaged in wrong practices about NNJ. The needs to organise regular training programmes were emphasised.
5Regional variation in the development of neonatal hyperbilirubinemia and relation with sunshine duration in Japan: an ecological study.PubMed
Yasutaka Kuniyoshi, Haruka Tokutake, Natsuki Takahashi, et al.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):4946-4951. doi: 10.1080/14767058.2021.1873270. Epub 2021 Jan 17.
BACKGROUND: Few studies have investigated the regional variations in the development of neonatal hyperbilirubinemia. This study aimed to investigate regional variations in medical costs for neonatal hyperbilirubinemia and the correlations between sunshine duration and medical care costs for neonatal hyperbilirubinemia in an ecological study, using the National Database of Japan. METHODS: We obtained data on the annual medical costs for neonatal hyperbilirubinemia, annual live births, and annual sunshine duration in each prefecture from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data, Vital Statistics in Japan, and System of Social and Demographic Statistics Prefectural Data Basic Data from 2014 to 2017. We created choropleth maps showing the regional variations (quartiles) in the annual medical costs for neonatal hyperbilirubinemia per 10 live births and the annual sunshine duration in each prefecture. We used Pearson's correlation coefficients to evaluate the associations between the annual sunshine duration and annual medical care costs for neonatal hyperbilirubinemia per 10 live births in each prefecture. RESULTS: The Tohoku region (on the Sea of Japan side) and the Hokuriku region were likely to have higher medical care costs for neonatal hyperbilirubinemia and shorter sunshine duration than the rest of the country. There were weak and negative correlations between the annual sunshine duration and the annual medical care costs for neonatal hyperbilirubinemia. The correlation coefficients ranged from -0.086 to -0.33. CONCLUSION: There could be regional variations in the medical care costs for neonatal hyperbilirubinemia in Japan. Short sunshine duration could be a prognostic factor for the development of neonatal hyperbilirubinemia.
6Ward design and neonatal jaundice in the tropics: report of an epidemic.PubMed
P Barss, K Comfort
Br Med J (Clin Res Ed). 1985 Aug 10;291(6492):400-1. doi: 10.1136/bmj.291.6492.400.
Architectural modifications to an existing tropical obstetric ward involved extension of the roof overhangs to a width of several metres. These extensions excluded most of the daylight from the ward. An alarming increase in the incidence of jaundice (bilirubin concentration greater than or equal to 240 mumol/l (greater than or equal to 14 mg/100 ml] from 0.5% to 17% in newborn infants occurred after the modifications. Tropical obstetric wards and nurseries should continue to be built with windows facing north-south for coolness. They should, however, have as many windows as possible and the roof overhangs should be limited to about 1 m to allow adequate indirect sunlight to enter, giving a high intensity of illumination, and help prevent neonatal jaundice.
7Safety and efficacy of filtered sunlight in treatment of jaundice in African neonates.PubMed
Tina M Slusher, Hendrik J Vreman, Bolajoko O Olusanya, et al.
Pediatrics. 2014 Jun;133(6):e1568-74. doi: 10.1542/peds.2013-3500.
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.
8Can sunlight replace phototherapy units in the treatment of neonatal jaundice? An in vitro study.PubMed
F M Salih
Photodermatol Photoimmunol Photomed. 2001 Dec;17(6):272-7. doi: 10.1034/j.1600-0781.2001.170605.x.
BACKGROUND/AIM: Light can be efficiently used for the treatment of neonatal jaundice. Sunlight, which covers a large portion of the light spectrum including the bilirubin-absorbing range, is abundant in the Middle East. Such advantages prompted the present study to investigate the efficiency of sunlight in isomerizing bilirubin. This may introduce a practical source of light for the treatment of hyperbilirubinic infants in areas where phototherapy units are not available. METHODS: The efficiency of sunlight was quantified by a comparison with a phototherapy unit. Aqueous bilirubin solutions were exposed to periodic sunlight over the entire year and the reduction of bilirubin concentration was monitored spectrophotometrically. Bilirubin solutions were also exposed to a phototherapy unit intensity comparable to that of sunlight (17 cm away from the source). RESULTS: The data indicated that at this comparable light intensity, the phototherapy unit was as effective as sunlight. However, for the treatment of neonatal jaundice, phototherapy units are usually operated at a distance of 50 cm (where the light intensity is six times less than that of sunlight). When this distance was tested, only 16% of bilirubin was isomerized in the first 5 min of exposure. In contrast, about 65% of bilirubin was isomerized when the phototherapy unit was placed at a distance of 17 cm and when the bilirubin solutions were exposed to sunlight for the same time period. The hourly and seasonal changes in sunlight intensity affected the reduction in bilirubin concentration significantly. CONCLUSION: Data revealed that sunlight is almost 6.5 times more effective than a phototherapy unit when operating at the ward geometry after taking isomerization efficiency and area of exposure into consideration. Moreover, sunlight is still more effective during the winter season, when its intensity is lower. Thus, sunlight may be considered an alternative phototherapy source for the treatment of neonatal jaundice, particularly in areas where conventional phototherapy units are unavailable.
9Treatment of neonatal jaundice with filtered sunlight in Nigerian neonates: study protocol of a non-inferiority, randomized controlled trial.PubMed
Tina M Slusher, Bolajoko O Olusanya, Hendrik J Vreman, et al.
Trials. 2013 Dec 28;14:446. doi: 10.1186/1745-6215-14-446.
BACKGROUND: Severe neonatal jaundice and its progression to kernicterus is a leading cause of death and disability among newborns in poorly-resourced countries, particularly in sub-Saharan Africa. The standard treatment for jaundice using conventional phototherapy (CPT) with electric artificial blue light sources is often hampered by the lack of (functional) CPT devices due either to financial constraints or erratic electrical power. In an attempt to make phototherapy (PT) more readily available for the treatment of pathologic jaundice in underserved tropical regions, we set out to test the hypothesis that filtered sunlight phototherapy (FS-PT), in which potentially harmful ultraviolet and infrared rays are appropriately screened, will be as efficacious as CPT. METHODS/DESIGN: This prospective, non-blinded randomized controlled non-inferiority trial seeks to enroll infants with elevated total serum/plasma bilirubin (TSB, defined as 3 mg/dl below the level recommended by the American Academy of Pediatrics for high-risk infants requiring PT) who will be randomly and equally assigned to receive FS-PT or CPT for a total of 616 days at an inner-city maternity hospital in Lagos, Nigeria. Two FS-PT canopies with pre-tested films will be used. One canopy with a film that transmits roughly 33% blue light (wavelength range: 400 to 520 nm) will be used during sunny periods of a day. Another canopy with a film that transmits about 79% blue light will be used during overcast periods of the day. The infants will be moved from one canopy to the other as needed during the day with the goal of keeping the blue light irradiance level above 8 μW/cm²/nm. PRIMARY OUTCOME: FS-PT will be as efficacious as CPT in reducing the rate of rise in bilirubin levels. Secondary outcome: The number of infants requiring exchange transfusion under FS-PT will not be more than those under CPT. CONCLUSION: This novel study offers the prospect of an effective treatment for infants at risk of severe neonatal jaundice and avoidable exchange transfusion in poorly-resourced settings without access to (reliable) CPT in the tropics. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01434810.
10Traditional beliefs in the management and prevention of neonatal jaundice in Ado-Ekiti, Nigeria.PubMed
Deborah Tolulope Esan, Fatimah Muhammad, Agatha Ogunkorode, et al.
Enferm Clin (Engl Ed). 2022 Jun;32 Suppl 1:S73-S76. doi: 10.1016/j.enfcle.2021.09.006.
AIM: Traditional beliefs about neonatal jaundice persist in Sub-Saharan Africa, and because those beliefs might worsen the outcomes of the disease by delaying care or by treating it at home with unproven remedies; our study sought to identify the traditional beliefs of antenatal mothers regarding the management and prevention of neonatal jaundice in rural areas of Ekiti State, Southwestern Nigeria. METHODS: The study employed a descriptive cross-sectional design. A total of 190 women who attended two primary health care centers in Ekiti State were recruited for the study from April 1 to May 31, 2017, by convenience sampling through the antenatal clinic register. Data was collected by the use of an adapted self-administered, structured questionnaire. RESULTS: Of the women selected, 56% had at least one child before.36% of all the respondents would use pawpaw extract to treat neonatal jaundice, 30% would use sunlight, 26% would use antibiotics, 16% would use over the counter drugs, and 5% would use phototherapy. With regards of preventive measures, 48% indicated that neonatal jaundice can be prevented by breast feeding, 11% by drinking herbal concoctions by both mother and baby, 26% by giving glucose water to the baby and 12% of respondents by avoidance of cold water when pregnant. CONCLUSION: Our study showed that traditional beliefs regarding the management and prevention of neonatal jaundice are prevalent in Ado Ekiti, Nigeria.
11An investigation of professional advice advocating therapeutic sun exposure.PubMed
Simone Harrison, Lesley Hutton, Madeleine Nowak
Aust N Z J Public Health. 2002 Apr;26(2):108-15. doi: 10.1111/j.1467-842x.2002.tb00901.x.
OBJECTIVE: To determine the prevalence of inappropriate professional advice advocating therapeutic sun exposure in infancy and the post-partum period. METHODS: Self-administered postal questionnaires were completed by doctors (n=130; 71% response) and nurses (n=285; 58.6% response) responsible for the care of post-parturient women in eight hospitals in metropolitan and regional Queensland (1999/2000). RESULTS: Both groups reported several risky beliefs about the therapeutic benefits of sun exposure including using sunlight to treat: cracked nipples (41.1% nurses, 46.2% doctors); neonatal jaundice (49.5%, 34.9%); nappy rash (23.3%, 19.5%); and acne (12.3%, 20.2%). Approximately 10% of nurses and doctors recommended sunlight to treat sore/cracked nipples from breastfeeding, while 42% recommended sun exposure to treat neonatal jaundice. Relatively few doctors and nurses who recommended therapeutic sun exposure stipulated sunning through a window. Subtropical residence was a significant predictor of recommending sunlight to treat cracked nipples (p=0.002) and nappy rash (p=0.0005) among nursing staff. Midwives were more likely to recommend sunlight for neonatal jaundice than other nurses (p=0.004). Obstetricians (p=0.046), older doctors (p=0.049) and those who qualified earlier (p=0.031) were more likely to recommend sunlight to treat nappy rash. Paediatricians and neonatologists were less likely to recommend sunlight to treat neonatal jaundice than obstetricians and other doctors (p=0.009). CONCLUSIONS AND IMPLICATIONS: An education program is needed to change the practices of health professionals who recommend therapeutic sun exposure and should coincide with a health promotion campaign aimed at reducing the prevalence of related risky beliefs among parents.
12Factors affecting transcutaneous bilirubin measurement: effect of daylight.PubMed
Y Yamauchi, I Yamanouchi
Acta Paediatr Jpn. 1991 Oct;33(5):658-62. doi: 10.1111/j.1442-200x.1991.tb01882.x.
The purpose of this study was to determine whether daylight might affect the accuracy and reliability of TcB measurement at the forehead and sternum. One hundred and seven full-term newborn infants were divided into two groups. Babies in group I (N = 59) were kept near the window which was sometimes directly exposed to daylight, and babies in group II (N = 48) were kept on the door side of the room which had no direct daylight, during the first week of life. The result indicates that daylight is one of the significant factors affecting TcB measurement at the forehead, contributing to poor correlation between TcB reading at the forehead and serum bilirubin concentrations. We suggest the necessity of obtaining TcB readings at the forehead and sternum, at least, in order to improve the accuracy and reliability of such measurements in infants.
13Sunburn from the treatment of neonatal jaundice.PubMed
A K Leung
Burns Incl Therm Inj. 1986 Apr;12(4):291-2. doi: 10.1016/0305-4179(86)90134-8.
A newborn infant with sunburn from the treatment of neonatal jaundice is described. The importance of avoiding the exposure of newborn infants to strong sunlight is emphasized.