Home Phototherapy Research Articles

Is home phototherapy an effective and safe option for treatment of neonatal hyperbilirubinemia?

Is home phototherapy an effective and safe option for treatment of neonatal hyperbilirubinemia?

52334 Home phototherapy utilization among United States Medicare beneficiaries from 2000 to 2021

52334 Home phototherapy utilization among United States Medicare beneficiaries from 2000 to 2021

A novel reverse perilesional home phototherapy can promote the repigmentation of vitiligo patches with complete leukotrichia: A 12-week, open-label, double-arm, multicenter, randomized clinical trial.

Existing phototherapies are ineffective for treating patients with vitiligo with complete leukotrichia. We compared the efficacy of reverse perilesional irradiation, during which only the lesional areas are covered, with conventional narrowband ultraviolet B (NB-UVB) home phototherapy for repigmentation of non-segmental vitiligo in patients with complete leukotrichia. This was a 12-week, open-label, double-arm, multicenter clinical trial, with a total of 121 patients with non-segmental vitiligo who were randomly divided into two groups (both received topical tacrolimus): the conventional NB-UVB irradiation (CI) and reverse perilesional NB-UVB irradiation (RI) groups. A statistically significant difference in improvement from baseline was observed in the RI group compared with the findings in the CI group (-30.8% ± 11.8% vs. -25.5% ± 11.05%, respectively [p = .010]; pair-wise comparison p = .900 at week 4, p = .104 at week 8, and p = .010 at week 12). At week 12, the average percentage change from baseline of leukotrichia in the irradiation area significantly decreased from 100% to 82.2% ± 13.65% in the RI group, and from 100% to 88.7% ± 9.64% in the CI group (p = .027). Adverse events were minor, including desquamation, dryness, erythema, and blisters. No severe or lasting side effects were observed during the study. RI mediated better repigmentation of vitiligo with complete leukotrichia than CI.

Acceptability and operational feasibility of community health worker-led home phototherapy treatment for neonatal hyperbilirubinemia in rural Bangladesh

There is an unmet need for phototherapy treatment in low- and middle-income countries (LMICs) to prevent disability and death of newborns with neonatal hyperbilirubinemia. Home phototherapy deployed by community health workers (CHWs) in LMICs may help increase access to essential newborn postnatal care in a more acceptable way for families and lead to an increase in indicated treatment rates for newborns with hyperbilirubinemia. We aimed to investigate the operational feasibility and acceptability of a CHW-led home phototherapy intervention in a rural sub-district of Bangladesh for families and CHWs where home delivery was common and a treatment facility for neonatal hyperbilirubinemia was often more than two hours from households. We enrolled 23 newborns who were ≥ 2 kg in weight and ≥ 35 weeks gestational age, without clinical danger signs, and met the American Academy of Pediatric treatment criteria for phototherapy for hyperbilirubinemia. We employed a mixed-method investigation to evaluate the feasibility and acceptability of home phototherapy through surveys, in-depth interviews and focus group discussions with CHWs, mothers, and grandparents. Mothers and family members found home phototherapy worked well, saved them money, and was convenient and easy to operate. CHWs found it feasible to deploy home phototherapy and identified hands-on training, mHealth job aids, a manageable workload, and prenatal education as facilitating factors for implementation. Feasibility and acceptability concerns were limited amongst parents and included: a lack of confidence in CHWs’ skills, fear of putting newborn infants in a phototherapy device, and unreliable home power supply. CHW-led home phototherapy was acceptable to families and CHWs in rural Bangladesh. Further investigation should be done to determine the impact of home phototherapy on treatment rates and on preventing morbidity associated with neonatal hyperbilirubinemia. Clinical Trial (CT) registration ID: NCT03933423, full protocol can be accessed at https://doi.org/10.1186/s13102-024-00824-6. Name of the trial registry: clinicaltrials.gov. Clinical Trial (CT) registration Date: 01/05/2019.

The burning truth about light therapy: a retrospective analysis of the MAUDE database on UV phototherapy and photodynamic therapy complications 2013-2023.

Phototherapy and photodynamic therapy (PDT) are ultraviolet light (UV) based therapies for patients with skin diseases, and are sometimes associated with potential adverse events (AE)s, including erythema, pain, pruritus, burns, and photoaging. We investigated UV phototherapy and PDT safety using the United States (US) Food and Drug Administration's (FDA)'s Manufacturer and User Facility Device Experience (MAUDE) database. The MAUDE database, including medical device reports (MDR)s informed by voluntary and obligatory reporters since 1991, was searched for AEs associated with UV phototherapy and PDT 1/1/91-3/1/23. There were 59 UV phototherapy and 33 PDT related MDRs. Burns were the most common AE type for both phototherapy and PDT. The majority of phototherapy AEs occurred during 2021 (52.3%), and were significantly more likely to occur at home than in the clinic. Overall, 76.1% of MDRs associated with home light boxes were prescribed by online retailers, most of the MDRs (59.3%) mentioned that it is prohibited to sell phototherapy devices not prescribed by physicians, and only 8.5% noted poorly written home light box instructions. The COVID-19 pandemic prohibited in-person light treatments, and social distancing requirements may have resulted in increased frequency of home-based light treatments. Hence, while at home treatment may be easier and more accessible, in-office physician supervised UV treatments are associated with less frequent AEs. Moreover, some phototherapy MDRs reported poorly written instructions accompanying the home light box, and some PDT MDRs documented patients receiving inadequate education regarding the procedure. With the rise of at-home treatment options and the ease of obtaining devices on the internet, it is physicians' duty to advise patients against self-treating with home light boxes without prescribed treatment regimens and educate patients that are considering home phototherapy to ensure safer patient experiences.

A prospective randomized half-body study: 308 nm LED light vs. 308 nm excimer laser for localized psoriasis.

Psoriasis is a chronic skin disease affecting approximately 3.2% of the population. The 308 nm light emitting diode (LED) is a novel, portable, and cost-effective light source, may have potential in the treatment of localized psoriasis patients in a home setting. To compare the clinical and dermoscopic responses in localized psoriatic patients undergoing localized phototherapy with 308 nm LED light and excimer laser. Twenty-two patients with mild-to-moderate psoriasis and symmetrical skin lesions were included in this prospective, randomized, left-to-right body trial. The target lesions were randomly treated with either LED light or excimer laser twice a week for 12 weeks. The responses were evaluated by the local psoriasis severity index (LPSI) scores, and dermoscopic features of the target lesions were examined and analyzed. Out of the 22 included psoriasis patients, 10 successfully completed the 12 weeks study. Both treatment sides showed similar clinical improvement in terms of clinical response, as evidenced by a LPSI 50 rate of 70% on the LED side and 80% on the excimer side, p > 0.05. Furthermore, the dermoscopic features also exhibited comparable improvement. The efficacy and safety of 308 nm LED light therapy are comparable to 308 nm excimer laser therapy. Moreover, given the portability and cost-effectiveness of 308 nm LED light, it holds great promise as a home phototherapy in the treatment of psoriasis.

The cost-effectiveness of home phototherapy for hyperbilirubinemia in neonates: results from a randomized controlled trial

This study aimed to establish the cost-effectiveness of home phototherapy versus hospital phototherapy treating hyperbilirubinemia in neonates more than 36 weeks. Based on clinical results from a randomised controlled trial showing that home phototherapy for hyperbilirubinemia in term neonates is as effective as hospital phototherapy, we performed a cost-minimisation analysis to identify the most cost-effective alternative. We included costs for health care resource use as well as costs for transportation in connection with re-visits. The cost per patient was €337 for home phototherapy compared with €1156 for the hospital alternative indicating average cost savings of €819 (95% confidence interval €613–1025) or 71% per patient. Transportation and outpatient costs were higher in the home treatment group and hospital care costs were higher in the hospital group. Sensitivity analysis shows that results are robust also when allowing for uncertainty. Home phototherapy for neonates more than 36 weeks costs less than in-hospital phototherapy while being equally effective, meaning that home phototherapy is a cost-effective alternative to hospital treatment for infants with neonatal hyperbilirubinemia.Trial registrationNCT03536078. Date of registration: 24/05/2018.

Home Phototherapy Improves Access to Dermatologic Care: A Novel Stakeholder Alliance to Facilitate Its Implementation.

Home Phototherapy Improves Access to Dermatologic Care: A Novel Stakeholder Alliance to Facilitate Its Implementation.

Community health worker-led household screening and management of neonatal hyperbilirubinemia in rural Bangladesh: a cluster randomized control trial protocol

Background: Extreme hyperbilirubinemia leading to neurologic disability and death is disproportionately high in low to middle income countries (LMIC) such as Bangladesh, and is largely preventable through timely treatment. Of the estimated 50% of newborns born in LMICs born at home, few receive screening or treatment for hyperbilirubinemia, leading to 6 million newborns per year who need phototherapy treatment for hyperbilirubinemia but are untreated. Household screening and treatment for neonatal hyperbilirubinemia with phototherapy administered by a trained community health worker (CHW) may increase indicated treatment for neonatal hyperbilirubinemia in comparison to the existing care system in Bangladesh. Methods: 530 Bangladeshi women in their 2nd or 3rd trimester of pregnancy from the rural community of Sakhipur, Bangladesh will be recruited for a cluster randomized trial and randomized to the intervention arm — home screening and treatment for neonatal hyperbilirubinemia — or the comparison arm to receive usual care. In the intervention arm, CHWs will provide mothers with two prenatal visits, visit newborns by 2 days of age and then daily for 3 days to measure transcutaneous bilirubin (TcB) and monitor clinical danger signs. Newborns without danger signs but with a TcB above the treatment threshold <15 mg/dL will be treated with light-emitting diode (LED) phototherapy at home. Newborns with danger signs or TcB >15 mg/dL will be referred to a hospital for treatment. Treatment rates for neonatal hyperbilirubinemia in each arm will be compared. Conclusion: This study will evaluate the effectiveness of CHW-led home phototherapy to increase neonatal hyperbilirubinemia treatment rates in rural Bangladesh. LMICs are expanding access to postnatal care by using CHWs, and our work will give CHWs a curative treatment option for neonatal hyperbilirubinemia. Similar projects in other LMICs can be pursued to dramatically extend healthcare access to vulnerable newborns with hyperbilirubinemia.

Design Of A Vitiligo Home Phototherapy Using Narrow Band Ultraviolet-B (NB-UVB) Based On Arduino Uno

Vitiligo is one of the skin diseases where there is a disorder in skin pigmentation (skin color disorder), which is characterized by the presence of macula hypopigmentation (a condition that causes part of the skin color to become lighter than the surrounding skin color) caused by the loss of melanocyte function (a special cell found under the skin epidermis that functions to produce skin pigments/melanin) chronically and progressively from the epidermis. This disease if left untreated can spread to other parts of the body. Phototherapy is a method to help reduce the spread of spotting on the body by using NB-UVB rays. This therapy should be carried out on an ongoing basis. To reduce contact with others during the Covid-19 pandemic and there is a vitiligo disease therapy protocol, the author designed the Home Phototherapy Vitiligo device. The author made this device by using NB-UVB lamps and HC-SR04 sensors to detect the exposure distance of 3 cm. The radiation dose starts from 150 mJ/cm2 – 3000 mJ/cm2. The author measured the irradiation of the device obtained 2.6 mW/cm2 and then converted to a radiation dose formula to get how long the therapy time was. The therapy time is obtained level 1 (58 seconds) – level 22 (1085 seconds). In this device obtained the accuracy of the therapy time at the 58th second, the 540th second and the 1085th second is 99.99%. For the value of the accuracy of the distance at 1 cm is 99.82%, at a distance of 2 cm is 99.96%, at a distance of 3 cm is 99.33%, at a distance of 5 cm is 99.944%.

Neonatal healthcare providers’ perceptions of the feasibility of home phototherapy in neonatal jaundice

PurposeThis project aims to explore healthcare professionals’ perceptions of providing home phototherapy for neonatal jaundice as part of standard care. Design and MethodsIn-depth, semi-structured interviews were conducted with a purposive sample of nine healthcare professionals from the Neonatal Intensive Care Unit. The data was analyzed according to the Interpretive Phenomenological Analysis using six steps devised by Braun and Clarke for thematic analysis using NVivo Software. ResultsSix major themes were identified that encompassed healthcare professionals’ perceptions of home phototherapy for neonatal jaundice. These themes included: baby factors for home phototherapy, better in own environment, parent factors for home phototherapy, perceived benefits for home phototherapy, perceived risks of home phototherapy, and system factors impacting home phototherapy. ConclusionsHome phototherapy was perceived positively amongst the healthcare professionals. The healthcare professionals expressed many perceived benefits of home phototherapy such as family-centred care, improved bonding, improved establishment of breastfeeding, and decreased healthcare expenditure. Practice implicationsEnables understanding of the barriers to establishing home phototherapy programs and provides a scaffold for the development of these programs.

Long-Awaited AAP Hyperbilirubinemia Guidelines Have Arrived.

Long-Awaited AAP Hyperbilirubinemia Guidelines Have Arrived.

O81 - Clinical outcomes and cost-effectiveness of large-scale midwifery-led, home phototherapy and neonatal jaundice surveillance

We aimed to evaluate a large midwifery-led, paediatrician-overseen home jaundice surveillance and home phototherapy (HPT) program. This is a uniquely holistic model of care, where the surveillance and management of neonatal jaundice is part of the overall midwifery-led care for women who have recently given birth and their infants. We conducted a retrospective cohort study over 2019. Included were all infants with birth gestation ≥ 35 weeks, discharged at 4–96 hours and receiving care from midwifery-at-home (a 12-hour daily, 365-days hospital-based outreach service, supported by hospital paediatricians). Phototherapy was delivered via BiliSoft blanket with treatment thresholds determined by standard nomograms. The main outcomes of interest were unplanned readmissions, and cost-effectiveness based on hospital finance department actual costs. Also examined were parental compliance, device issues and safety. During 2019, 4308 infants received home jaundice surveillance with 86% hospital-discharged before 72 hours, 82% exclusively breastfed and 69% having overseas-born mothers. Four hundred infants received HPT, comprising 101 continuing from inpatient phototherapy (IPT), 56 rebounding after IPT, and 243 home-diagnosed as needing phototherapy and triaged to HPT. Only 1/400 (0.25%) HPT infants required readmission. Additionally, there were 80 home-diagnosed jaundiced infants triaged to immediate readmission for IPT. Maximal serum bilirubin was 454 µmol/L. No exchange transfusion, encephalopathy or HPT-device problems occurred. An early 2019 bilirubin analyser upgrade resulted in higher bilirubin readings and some unintended subthreshold phototherapy. Supported by midwives, most parents managed HPT with ease. HPT cost $640/day compared to $2100/day for infant IPT readmission and $1000/day for a longer birth-admission stay. Up to 2 weeks’ midwifery-at-home care for the whole cohort cost $2 m less than a 2-day longer birth-admission stay. Large-scale, midwifery-led, paediatrician-overseen jaundice surveillance and HPT can achieve very low unplanned readmission rates and be cost-effective.

35046 Home phototherapy: Improving access to dermatologic care

Introduction: Phototherapy is an effective, economic dermatologic treatment with few side effects. Home phototherapy has the potential to overcome barriers that patients face in accessing care (e.g., frequent clinic visits, travel, co-pays, etc.). This study evaluated the feasibility and acceptability of a home phototherapy program at the University of Rochester.

A Pragmatic Study on Nurse-Led Home Phototherapy

BACKGROUND Narrowband ultraviolet phototherapy is a safe and effective treatment option for chronic skin conditions. The requirements of clinic-based phototherapy can be burdensome, with home-based phototherapy as a reasonable alternative. OBJECTIVE This study aimed to analyze the effects of a nurse-led home phototherapy program and describe the clinical resources required. METHODS A pragmatic multicenter prospective observational cohort study was conducted from 2019 to 2021. Eighteen participants were enrolled in the program and followed for 9 months. Outcome measures included clearance rates, erythema incidence, Dermatology Life Quality Index, the burden of treatment scores, dermatologic medication usage, and clinic contacts. RESULTS Fourteen of the 18 patients (77.8%) reported high skin clearance. Mild erythema was common, moderate erythema was rare, and two episodes of severe erythema were recorded overall. Dermatology Life Quality Index and burden of treatment impact were minimal. Adjunct topical medications decreased by half. Nurses successfully reached participants up to the 3-month time point, with completed contacts decreasing over time. Unplanned contacts included phone calls and emails. CONCLUSION Dermatology nurses possess the skills needed to lead safe and effective home phototherapy programs. Although this pragmatic study was small, results are optimistic for the future of nurse-led home phototherapy.

The effect of daily UVA phototherapy for 2 weeks on clinic and 24-h blood pressure in individuals with mild hypertension

Latitude and season determine exposure to ultraviolet radiation and correlate with population blood pressure. Evidence for Vitamin D causing this relationship is inconsistent, and temperature changes are only partly responsible for BP variation. In healthy individuals, a single irradiation with 20 J/cm2 UVA mobilises NO from cutaneous stores to the circulation, causes arterial vasodilatation, and elicits a transient fall in BP. We, therefore, tested whether low-dose daily UVA phototherapy might be an effective treatment for mild hypertension. 13 patients with untreated high-normal or stage 1 hypertension (BP 130-159/85-99 mm Hg), confirmed by 24-h ambulatory blood pressure (ABP), were recruited. Using home phototherapy lamps they were either exposed to 5 J/cm2 full body UVA (320–410 nm) radiation each day for 14 days, or sham-irradiated with lamps filtered to exclude wavelengths <500 nm. After a washout period of 3 ± 1 week, the alternate irradiation was delivered. 24-h ABP was measured on day 0 before either irradiation sequence and on day 14. Clinic BP was recorded on day 0, and within 90 min of irradiation on day 14. There was no effect on 24-h ABP following UVA irradiation. Clinic BP shortly after irradiation fell with UVA (−8.0 ± 2.9/−3.8 ± 1.1 mm Hg p = 0.034/0.029) but not sham irradiation (1.1 ± 3.0/0.9 ± 1.5 mm Hg). Once daily low-dose UVA does not control mildly elevated BP although it produces a transient fall shortly after irradiation. More frequent exposure to UVA might be effective. Alternatively, UVB, which photo-releases more NO from skin, could be tried.

Insurance Coverage for Phototherapy for Vitiligo in Comparison to Psoriasis and Atopic Dermatitis

Objective: To compare in-office phototherapy and home phototherapy insurance coverage for vitiligo with psoriasis and atopic dermatitis.&#x0D; Methods: Information about phototherapy coverage in Texas was extracted via web search.&#x0D; Results: Vitiligo is the only disease analyzed for which multiple insurances explicitly stated they do not cover in-office phototherapy, and it is also the least covered for home phototherapy. Moreover, more insurances have more prerequisites to cover phototherapy for vitiligo than they do for psoriasis and atopic dermatitis.&#x0D; Conclusions: Our results show that insurance coverage of phototherapy in Texas varies widely and that, compared to patients with psoriasis and atopic dermatitis, patients with vitiligo face higher insurance coverage barriers for phototherapy. As phototherapy is a safe and effective vitiligo treatment, efforts to produce greater parity in coverage between vitiligo and other dermatologic diseases are warranted.

Lifelong Impact? The Effect of Phototherapy Admission on Future Breastfeeding.

Lifelong Impact? The Effect of Phototherapy Admission on Future Breastfeeding.

Parental experiences of home phototherapy for neonatal hyperbilirubinemia.

Newborns with hyperbilirubinemia have traditionally received phototherapy in hospital. Hospital stays for infants, however, may negatively affect parent-infant bonding and induce anxiety and feelings of powerlessness in mothers. This study examined parent's experiences of providing phototherapy to their neonates at home instead. A descriptive qualitative study based on 15 interviews (8mothers and 7 fathers) with parents of 8 children who had been randomised to home phototherapy was conducted during spring 2018 in Örebro county, Sweden. Inductive content analysis was used. The overall experience of home phototherapy was positive, and five categories were identified describing their experiences: continuing life at home, adjusting to having a newborn, feeling secure, experiencing parenthood and accessing information. The findings support the use of home phototherapy. Parents felt secure at home with their infants and emphasised the importance of clear information and round-the-clock access to hospital staff.

Clinical outcomes and cost-effectiveness of large-scale midwifery-led, paediatrician-overseen home phototherapy and neonatal jaundice surveillance: A retrospective cohort study.

AimTo evaluate a large midwifery‐led, paediatrician‐overseen home jaundice surveillance and home phototherapy (HPT) programme.MethodsWe conducted a retrospective cohort study over 2019. Included were all infants with birth gestation ≥35 weeks, discharged at 4–96 h and receiving care from midwifery‐at‐home (a 12‐h daily, 365‐days hospital‐based outreach service, supported by hospital paediatricians). Phototherapy was delivered via BiliSoft blanket with treatment thresholds determined by standard nomograms. The main outcomes of interest were unplanned readmissions, and cost‐effectiveness based on hospital finance department actual costs. Also examined were parental compliance, device issues and safety.ResultsDuring 2019, 4308 infants received home jaundice surveillance with 86% hospital‐discharged before 72 h, 82% exclusively breastfed and 69% having overseas‐born mothers. Four hundred infants received HPT, comprising 101 continuing from inpatient phototherapy (IPT), 56 rebounding after IPT, and 243 home‐diagnosed as needing phototherapy and triaged to HPT. Only 1 of 400 (0.25%) HPT infants required readmission. Additionally, there were 80 home‐diagnosed jaundiced infants triaged to immediate readmission for IPT. Maximal serum bilirubin was 454 μmol/L. No exchange transfusion, encephalopathy or HPT‐device problems occurred. An early 2019 bilirubin analyser upgrade resulted in higher bilirubin readings and some unintended subthreshold phototherapy. Supported by midwives, most parents managed HPT with ease. HPT cost $640/day compared to $2100/day for infant IPT readmission and $1000/day for a longer birth‐admission stay. Up to 2 weeks' midwifery‐at‐home care for the whole cohort cost $2 m less than a 2‐day longer birth‐admission stay.ConclusionLarge‐scale, midwifery‐led, paediatrician‐overseen jaundice surveillance and HPT can achieve very low unplanned readmission rates and be cost‐effective.