title: The need to implement effective phototherapy in resource-constrained settings.
abstract: Phototherapy is the treatment of choice to reduce the severity of neonatal unconjugated hyperbilirubinemia regardless of its etiology. Its implementation requires a technical framework that conforms to existing evidence-based guidelines that promote its safer and effective use worldwide. Optimal use of phototherapy has been defined by specific ranges of total serum bilirubin thresholds configured to an infant's postnatal age (in hours) and potential risk for bilirubin neurotoxicity. Effective phototherapy implies its use at specific blue light wavelengths (peak emission, 450 ± 20 nm) and emission spectrum (range, 400-520 nm), preferably in a narrow bandwidth that is delivered at an irradiance of ≥30 μW/cm(2)/nm to up to 80% of an infant's body surface area. However, this is often not feasible in clinical settings with limited or constrained resources. To identify and bridge implementation barriers, we propose minimum criteria for device performance for safe and practical use of phototherapy as a prophylactic intervention to prevent severe hyperbilirubinemia.
authors.affiliation: Division of Neonatal-Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA 94304, USA. bhutani@stanford.edu
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Bhutani
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Cline
authors.forename: Krista M
authors.initials: KM
authors.lastname: Donaldson
authors.forename: Hendrik J
authors.initials: HJ
authors.lastname: Vreman
mesh_terms: D001663:Bilirubin / Q000097:blood*; D003906:Developing Countries / Q000191:economics; D006301:Health Services Needs and Demand; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000188:drug therapy* / Q000191:economics; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000188:drug therapy* / Q000191:economics; D010789:Phototherapy / Q000191:economics / Q000379:methods*
chemical_list: D001663:Bilirubin