The use of filtered-sunlight phototherapy (PT) is safe and not inferior to the use of intensive electric PT for the treatment of hyperbilirubinemia associated with hemolytic disease of the fetus and newborn (HDFN), according to findings from a trial conducted in Nigeria and published recently in Scientific Reports.
Neonatal hyperbilirubinemia, which affects more than 80% of newborns, is the most common cause of re-hospitalizations across the globe. Patients with the disorder are classified as follows, based on their total serum bilirubin (TSB) levels:
- Mild hyperbilirubinemia: <12 mg/dL
- Moderate hyperbilirubinemia: 12 to 19 mg/dL
- Severe hyperbilirubinemia: 20 to 24 mg/dL
- Extreme hyperbilirubinemia: 25 to 29 mg/dL
- Hazardous hyperbilirubinemia: ≥30 mg/dL
In many low-income and middle-income countries, the rates of severe-to-hazardous hyperbilirubinemia are a key concern and may be associated with severe adverse events, including premature death. PT is the first line of treatment among individuals with neonatal hyperbilirubinemia, along with exchange transfusion (ET), when a patient’s TSB level is approaching 20 mg/dL or higher and signs of acute bilirubin encephalopathy are observed.
Currently, the exposure of jaundiced infants with hyperbilirubinemia to direct sunlight heliotherapy, particularly when conventional electric-powered PT is not readily available, is not recommended because of safety concerns. In such situations, filtered-sunlight PT has been shown to be safe and non-inferior for the treatment of neonates with a TSB level of <20 mg/dL.
Read more about the testing and diagnosis of HDFN
Recognizing that no evidence is available on the efficacy and safety of filtered-sunlight PT for treating neonates with all degrees of hyperbilirubinemia, the researchers evaluated results from a study was carried out at Massey Street Children’s Hospital (MSCH), located in Lagos, Nigeria.
A total of 192 newborns were enrolled in the study, with 98 undergoing filtered-sunlight PT and 94 undergoing intensive electric PT. Results of the study revealed that filtered-sunlight PT was effective on 94.2% of the assessable treatment days, compared with an efficacy of 97.1% for intensive electric PT. Thus, the mean difference in efficacy between filtered-sunlight PT and intensive electric PT was 2.9%.
Overall, 2.6% of the infants who underwent filtered-sunlight PT developed controlled hyperthermia. None of the neonates fulfilled the criteria for withdrawal due to safety reasons.
Filtered-sunlight PT “is safe and non-inferior to [intensive electric] PT for treating neonates with severe-to-hazardous hyperbilirubinemia,” the authors noted. The use of filtered-sunlight ”PT is not associated with significantly higher rates of ET and mortality[,] and should be considered where practicable when [intensive electric] PT cannot be assured,” they concluded.
