Can use of low-cost white reflecting curtains increase the efficacy of phototherapy?

Abstract

Context: In the face of a steep rise in the rate of bilirubin in neonates, we often seek improvisations to increase the efficacy of phototherapy machines. In addition, in resource-limited setup, a need is felt for the methods of reducing the duration of phototherapy so that the same machine can be used for more number of neonates. Aim: To study the effect of using white reflecting curtains around phototherapy machines on the efficacy of phototherapy for the treatment of neonatal jaundice. Settings and Design: Double-blind, parallel, randomized controlled trial. Level 2 Neonatal Intensive Care Unit and Neonatal Ward of a tertiary care hospital between June 2011 and May 2012. Subjects and Methods: About 102 term neonates with jaundice were randomized into two groups of 51 neonates each. Group A (the study group) received curtains and Group B (the control group) did not receive curtains during phototherapy. Two phototherapy units were designed so that the white curtains could be hung or removed as required. Along with baseline variables including blood count, reticulocyte count, and G6PD, total serum bilirubin (TSB) was measured for each neonate at 4, 12, and 24 h from the initiation of phototherapy. The primary outcome measure was the mean difference in TSB measured at baseline and after 4, 12, and 24 h of phototherapy. The secondary outcome was the duration of phototherapy in hours and also the mean difference in bilirubin between 12 and 24 h. Results: The mean bilirubin concentration of Group A was significantly less (17.42 ± 1.04 mg/dL at 4 h, 14.52 ± 1.05 mg/dL at 12 h, and 11.33 ± 1.11 mg/dL at 24 h of phototherapy) than Group B (18.02 ± 1.13 mg/dL at 4 h, 17.6 ± 1.09 mg/dL at 12 h, and 16.65 ± 1.11 mg/dL at 24 h) with similar bilirubin concentrations initially. The mean duration of phototherapy in Group A (28.87 ± 4.11 h) was significantly less than Group B (51.14 ± 18.62 h) (P < 0.01). Conclusions : Using white reflecting curtains significantly reduces the mean bilirubin concentration and the duration of phototherapy in jaundiced neonates.