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Home phototherapy is recommended as an alternative to hospital-based therapy for neonatal jaundice in otherwise healthy full-term infants. With a reliable device for transcutaneous bilirubin (TcB) measurement, bilirubin values could be monitored at home during treatment. This study aimed to examine the accuracy of TcB measurement of bilirubin levels before, during, and after home phototherapy. Patients requiring phototherapy were assigned to home (intervention) or hospital-based phototherapy (control). Transcutaneous bilirubin measurement was made at the sternum (uncovered skin) and at sacrum (covered by the diaper during treatment). Simultaneously, total serum bilirubin (TSB) level was collected through a blood sample. The agreement between TcB and TSB before, during, and after phototherapy was assessed using Bland-Altman plots. Altogether 141 patients and 856 paired bilirubin values were included. The results show that TcB measurements underestimate TSB levels. Before phototherapy, the mean difference between TcB and TSB was 75 ± 36 μmol/L at the sternum and 135 ± 39 μmol/L at sacrum, with no difference between study groups. During phototherapy, the mean difference at the sternum was larger in the control group, 105 ± 73 μmol/L, than in the intervention group, 50 ± 41 μmol/L; at sacrum, the mean difference was 125 ± 44 μmol/L, comparable in both study groups. After phototherapy, the TcB–TSB agreement improved, with a mean difference of 29 ± 33 μmol/L (sternum) and 87 ± 35 μmol/L (sacrum), and no difference between study groups. In conclusion this study shows that full-term infants who qualified for phototherapy show poor agreement between TcB measurement and TSB, suggesting that TcB measurements cannot replace measurement of TSB level before, during, or after home phototherapy.

Background: Phototherapy using blue light is the treatment of choice worldwide for neonatal hyperbilirubinemia. However, treatment with turquoise light may be a desirable alternative. Therefore, the aim of this randomized, controlled study was to compare the bilirubin isomer distribution in serum of jaundiced neonates after 24 h of therapy with narrow-band (LED) light centered at 497 nm (turquoise) vs. 459 nm (blue), of essentially equal irradiance. Materials: Eighty-three neonates (≥33 wk gestational age) with uncomplicated hyperbilirubinemia were included in the study. Forty neonates were exposed to light centered at 497 nm and 43 infants with light centered at 459 nm. Irradiances were 5.2 × 10 15 and 5.1 × 10 15 photons/cm 2 /s, respectively. Results: After 24 h of treatment no significant differences in serum concentrations of total bilirubin isomers and Z,Z-bilirubin were observed between the 2 groups. Interestingly, concentrations of Z,E-bilirubin, and thus also total bilirubin isomers formed during therapy, were highest for infants receiving light centered at 459 nm, while the concentration of E,Z-bilirubin was highest for those receiving light centered at 497 nm. No significant difference was found between concentrations of E,Z-lumirubin. Conclusion: Therapy with LED light centered at 497 nm vs. 459 nm, applied with equal irradiance on the infants, resulted in a different distribution of bilirubin isomers in serum.

Background: Blue light with peak emission around 460 nm is the preferred treatment of neonatal hyperbilirubinemia. However, studies using fluorescent light tubes have suggested that turquoise light with peak emission at 490 nm may be more efficient. At present, the predominant light source for phototherapy is light emitting diodes (LEDs). Hence, the aim of this study was to compare the bilirubin-reducing effect in jaundiced neonates treated either with turquoise or with blue LED light with peak emission at 497 or 459 nm, respectively, with equal irradiance on the infants. Methods: Infants with gestational age ≥33 wk and uncomplicated hyperbilirubinemia were randomized to either turquoise or blue LED light and were treated for 24 h. The mean irradiance footprint at skin level was 5.2 × 10 15 and 5.1 × 10 15 photons/cm 2 /s, respectively. Results: Forty-six infants received turquoise light and 45 received blue light. The median (95% confidence interval) decrease of total serum bilirubin was 35.3% (32.5; 37.3) and 33.1% (27.1; 36.8) for infants treated with turquoise and blue lights, respectively. The difference was nonsignificant ( P = 0.53). The decrease was positively correlated to postnatal age and negatively to birth weight. Conclusion: Using LED light of equal irradiance, turquoise and blue lights had equal bilirubin-reducing effect on hyperbilirubinemia of neonates.

Objective This study aimed to create a group of nursing intervention (cluster nursing) strategies of phototherapy for neonates and to evaluate clinical effects of intervention measures on reducing neonatal jaundice in neonates. Methods We performed a prospective study. A total of 141 patients with neonatal ABO hemolytic jaundice were included and randomly divided into two groups: intervention group and control group. The intervention group adopted cluster nursing measures in combination with continuous phototherapy (blue light), while the control group adopted routine nursing together with continuous phototherapy (blue light). Results No differences were observed in general characteristics between the groups. On the seventh day of treatment, percutaneous bilirubin levels were significantly lower in the intervention group than in the control group. On the seventh day of treatment, milk intake was significantly higher and the duration of hospitalization was significantly shorter in the intervention group than in the control group. Conclusion Use of cluster nursing measures in combination with phototherapy in neonatal ABO hemolysis can effectively reduce bilirubin levels, improve symptoms of jaundice, and shorten the course of the disease.

Intermittent phototherapy with “12 h on and then 12 h off” schedule in comparison with continuous phototherapy for neonatal hyperbilirubinemia may save costs and decrease anxiety of parents. In this non-inferiority-randomized controlled trial, healthy late preterm (>34 weeks) and term neonates with neonatal hyperbilirubinemia under phototherapy for 8 h and total serum bilirubin (TSB) < 18 mg/dL were randomized either into intermittent (IPT) or continuous (CPT) group. Infants in IPT group received 12 h on and 12 h off cycles of phototherapy. In both arms, phototherapy was continued until TSB < 13 mg/dL. Primary outcome was rate of fall of bilirubin. Seventy-five infants (IPT n  = 36 vs. CPT n  = 39) were enrolled in the study. The rate of fall of bilirubin was significantly higher with “IPT” phototherapy ( p  = 0.002). Conclusion : In term and late preterm infants with non-hemolytic moderate hyperbilirubinemia, intermittent phototherapy with 12 h on and 12 h off cycles is as efficacious as continuous phototherapy.

Background Infant massage is a natural way for caregivers to improve health, sleep patterns, and reduce colic. We aimed to investigate the effects of infant massage on neonates with jaundice who are also receiving phototherapy. Methods Full-term neonates with jaundice, admitted for phototherapy at a regional teaching hospital, were randomly allocated to either a control group or a massage group. The medical information for each neonate, including total feeding amount, body weight, defecation frequency, and bilirubin level, was collected and compared between two groups. Results A total of 56 patients were enrolled in the study. This included 29 neonates in the control group and 27 in the experimental group. On the third day, the massage group showed significantly higher defecation frequency ( p  = 0.045) and significantly lower bilirubin levels ( p  = 0.03) compared with the control group. No significant differences related to feeding amount or body weight were observed between the two groups. Conclusion Infant massage could help to reduce bilirubin levels and increase defecation frequency in neonates receiving phototherapy for jaundice.

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/cm 2 /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

Severe neonatal hyperbilirubinemia (SNH) is a serious condition that occurs worldwide. Timely recognition with bilirubin determination is key in the management of SNH. Visual assessment of jaundice is unreliable. Fortunately, transcutaneous bilirubin measurement for screening newborn infants is routinely available in many hospitals and outpatient settings. Despite a few limitations, the use of transcutaneous devices facilitates early recognition and appropriate management of neonatal jaundice. Unfortunately, however, advanced and often costly screening modalities are not accessible to everyone, while there is an urgent need for inexpensive yet accurate instruments to assess total serum bilirubin (TSB). In the near future, novel icterometers, and in particular optical bilirubin estimates obtained with a smartphone camera and processed with a smartphone application (app), seem promising methods for screening for SNH. If proven reliable, these methods may empower outpatient health workers as well as parents at home to detect jaundice using a simple portable device. Successful implementation of ubiquitous bilirubin screening may contribute substantially to the reduction of the worldwide burden of SNH. The benefits of non-invasive bilirubin screening notwithstanding, any bilirubin determination obtained through non-invasive screening must be confirmed by a diagnostic method before treatment. Impact Key message: Screening methods for neonatal hyperbilirubinemia facilitate early recognition and timely treatment of severe neonatal hyperbilirubinemia (SNH). Any bilirubin screening result obtained must be confirmed by a diagnostic method. What does this article add to the existing literature? Data on optical bilirubin estimation are summarized. Niche research strategies for prevention of SNH are presented. Impact: Transcutaneous screening for neonatal hyperbilirubinemia contributes to the prevention of SNH. A smartphone application with optical bilirubin estimation seems a promising low-cost screening method, especially in low-resource settings or at home.

Invasive bilirubin measurements remain the gold standard for the diagnosis and treatment of infants with severe neonatal hyperbilirubinemia. The present paper describes different methods currently available to assess hyperbilirubinemia in newborn infants. Novel point-of-care bilirubin measurement methods, such as the BiliSpec and the Bilistick, would benefit many newborn infants, especially in low-income and middle-income countries where the access to costly multi-analyzer in vitro diagnostic instruments is limited. Total serum bilirubin test results should be accurate within permissible limits of measurement uncertainty to be fit for clinical purposes. This implies correct implementation of internationally endorsed reference measurement systems as well as participation in external quality assessment programs. Novel analytic methods may, apart from bilirubin, include the determination of bilirubin photoisomers and bilirubin oxidation products in blood and even in other biological matrices. Impact Key message: Bilirubin measurements in blood remain the gold standard for diagnosis and treatment of severe neonatal hyperbilirubinemia (SNH). External quality assessment (EQA) plays an important role in revealing inaccuracies in diagnostic bilirubin measurements. What does this article add to the existing literature? We provide analytic performance data on total serum bilirubin (TSB) as measured during recent EQA surveys. We review novel diagnostic point-of-care (POC) bilirubin measurement methods and analytic methods for determining bilirubin levels in biological matrices other than blood. Impact: Manufacturers should make TSB test results traceable to the internationally endorsed total bilirubin reference measurement system and should ensure permissible limits of measurement uncertainty.