Abstract
BackgroundIn Indonesia, the burden of severe hyperbilirubinemia is higher compared to other countries. Whether this is related to ineffective phototherapy (PT) is unknown. The aim of this study is to investigate the performance of phototherapy devices in hospitals on Java, Indonesia.MethodsIn 17 hospitals we measured 77 combinations of 20 different phototherapy devices, with and without curtains drawn around the incubator/crib. With a model to mimic the silhouette of an infant, we measured the irradiance levels with an Ohmeda BiliBlanket Meter II, recorded the distance between device and model, and compared these to manufacturers’ specifications.ResultsIn nine hospitals the irradiance levels were less than required for standard PT: < 10 μW/cm2/nm and in eight hospitals irradiance failed to reach the levels for intensive phototherapy: 30 μW/cm2/nm. Three hospitals provided very high irradiance levels: > 50 μW/cm2/nm. Half of the distances between device and model were greater than recommended. Distance was inversely correlated with irradiance levels (R2 = 0.1838; P < 0.05). The effect of curtains on irradiance levels was highly variable, ranging from − 6.15 to + 15.4 μW/cm2/nm, with a mean difference (SD) of 1.82 (3.81) μW/cm2/nm (P = 0.486).ConclusionsIn half of the hospitals that we studied on Java the levels of irradiance are too low and, in some cases, too high. Given the risks of insufficient phototherapy or adverse effects, we recommend that manufacturers provide radiometers so hospitals can optimize the performance of their phototherapy devices.
Highlights
In Indonesia, the burden of severe hyperbilirubinemia is higher compared to other countries
Inappropriate phototherapy may contribute to the high burden of severe hyperbilirubinemia in Indonesia: increase the risk of bilirubin encephalopathy as well as the number of exchange transfusions
In half of the hospitals that we studied irradiance levels were too low, while in some the levels were very high
Summary
In Indonesia, the burden of severe hyperbilirubinemia is higher compared to other countries Whether this is related to ineffective phototherapy (PT) is unknown. A recent survey in Indonesia indicated a 7% incidence of hyperbilirubinemia, defined as a serum bilirubin level of > 340 μmol/L (20 mg/dL), in all newborn infants [3]. Studies have shown that PT can reduce total serum bilirubin (TSB) levels and Sampurna et al BMC Pediatrics (2019) 19:188 prevent neurotoxicity and kernicterus spectrum disorders [7, 8]. For it to be effective, PT requires a specific level of irradiance. In a number of devices irradiance levels were suboptimal or insufficient, possibly causing ineffective treatment, while aggressive PT and too high levels of irradiance may be dangerous and associated with adverse effects [12, 13]
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