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Liver Update: Sunlight phototherapy for neonatal jaundice—time for its day in the sun?

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eMediNexus    14 September 2021

Filtered-sunlight phototherapy (FSPT) have been shown to be efficacious and safe like conventional intensive electric phototherapy (IEPT) for treatment of moderate-to-severe neonatal hyperbilirubinaemia. FSPT can be used in conjunction with IEPT as it is cheaper than IEPT and feasible to set up. 

It is necessary to recognise whether FSPT can be used alone in low-income rural settings. 

There are various limitations with the low-income countries as- 

Non- availability of upgraded FSPT room with a polycarbonate roof and walls lined with imported film, 

Use of substandard filters that do not meet safety standards 

Unavailability of suitable physical space to build such a facility, 

Choosing available space for skin-to-skin kangaroo care for premature neonates rather than FSPT. 

FSPT, when combined with Skin-to-skin care could cause a more rapid rate of decline in total bilirubin concentrations than FSPT alone, possibly due to improved breastfeeding, increased temperature stability, and generally improved wellbeing.

The minimum number of hours of FSPT needed per 24 h to treat moderate-to-severe neonatal hyperbilirubinaemia has been suggested to be 12 h or less by Slusher and colleagues, demanding further study in real rural settings. 

The follow-up of neonates after treatment is necessary to establish the effects of FSPT on health outcomes and to establish its cost-effectiveness when utilized without IEPT in such routine situations. 

Neonates who can have FSPT alone safely and neonates in whom FSPT could be effective need to be considered carefully. 

Role of FSPT in rural health facilities in low-income settings needs to be explored in further studies. FSPT should be studied for its adaptability in the rural areas without IEPT or electricity, where referrals to higher levels of care can be challenging or impossible. It should also be assessed for usability, acceptability, affordability, and sustainability in further studies in rural settings. 

Source: Colbourn T, Mwansambo C. Sunlight phototherapy for neonatal jaundice—time for its day in the sun? The Lancet, Global Health, 2018;6(10):E1052-E1053

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