title: Treatment of neonatal jaundice with filtered sunlight in Nigerian neonates: study protocol of a non-inferiority, randomized controlled trial.
abstract: BACKGROUND
  Severe neonatal jaundice and its progression to kernicterus is a leading cause of death and disability among newborns in poorly-resourced countries, particularly in sub-Saharan Africa. The standard treatment for jaundice using conventional phototherapy (CPT) with electric artificial blue light sources is often hampered by the lack of (functional) CPT devices due either to financial constraints or erratic electrical power. In an attempt to make phototherapy (PT) more readily available for the treatment of pathologic jaundice in underserved tropical regions, we set out to test the hypothesis that filtered sunlight phototherapy (FS-PT), in which potentially harmful ultraviolet and infrared rays are appropriately screened, will be as efficacious as CPT.
  
  
  METHODS
  This prospective, non-blinded randomized controlled non-inferiority trial seeks to enroll infants with elevated total serum/plasma bilirubin (TSB, defined as 3 mg/dl below the level recommended by the American Academy of Pediatrics for high-risk infants requiring PT) who will be randomly and equally assigned to receive FS-PT or CPT for a total of 616 days at an inner-city maternity hospital in Lagos, Nigeria. Two FS-PT canopies with pre-tested films will be used. One canopy with a film that transmits roughly 33% blue light (wavelength range: 400 to 520 nm) will be used during sunny periods of a day. Another canopy with a film that transmits about 79% blue light will be used during overcast periods of the day. The infants will be moved from one canopy to the other as needed during the day with the goal of keeping the blue light irradiance level above 8 μW/cm²/nm.
  
  
  METHODS
  FS-PT will be as efficacious as CPT in reducing the rate of rise in bilirubin levels. Secondary outcome: The number of infants requiring exchange transfusion under FS-PT will not be more than those under CPT.
  
  
  CONCLUSIONS
  This novel study offers the prospect of an effective treatment for infants at risk of severe neonatal jaundice and avoidable exchange transfusion in poorly-resourced settings without access to (reliable) CPT in the tropics.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT01434810.
authors.affiliation: Center for Global Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA. tslusher@umn.edu.
authors.forename: Tina M
authors.initials: TM
authors.lastname: Slusher
authors.forename: Bolajoko O
authors.initials: BO
authors.lastname: Olusanya
authors.forename: Hendrik J
authors.initials: HJ
authors.lastname: Vreman
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wong
authors.forename: Ann M
authors.initials: AM
authors.lastname: Brearley
authors.forename: Yvonne E
authors.initials: YE
authors.lastname: Vaucher
authors.forename: David K
authors.initials: DK
authors.lastname: Stevenson
mesh_terms: D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002985:Clinical Protocols; D003906:Developing Countries; D006771:Hospitals, Maternity; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood / Q000175:diagnosis / Q000532:radiotherapy*; D009549:Nigeria; D011446:Prospective Studies; D012107:Research Design; D013472:Sunlight; D013997:Time Factors; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*; D015854:Up-Regulation; D019037:Urban Health Services
chemical_list: D015415:Biomarkers; D001663:Bilirubin