Letters to the Editor

Indian Pediatrics 2002; 39:791

Neonatal Hyperbilirubinemia

I read with interest the article on neonatal hyperbilirubinemia(1). I would like to make some comments on this issue.

Simple measures like lining the bassinet with white linen and putting a white curtain around the phototherapy unit and bassinet have been found to increase the efficiency of phototherapy several fold(2). I think that this simple and inexpensive measure could be routinely practiced in our country where the efficiency of most of the phototherapy units has been found to be sub optimal(3).

Exposure to sunlight has traditionally been said to be not only ineffective but also potentially hazardous(1). But a study quoted in the same issue of the journal finds sunlight even more effective than a phototherapy unit(4). May we then recommend sun exposure for the treatment of mild to moderate hyperbilirubinemia in infants of underprivileged families?

In the article "Unconjugated hyperbilirubinemia in newborns: Current perspective"(1) the authors conclusively state that for hyperbilurubinemia, sunlight is relatively ineffective because of low blue content of light. Also the dangers of skin burns and hyperpyrexia is there. At the same time in the same issue, we have mention of a study in "Clippings"(2) stating that "sunlight may be considered as an alternative phototherapy source for the treatment of neonatal jaundice, particularly in areas where conventional phototherapy units are unavailable since invitro, sunlight is 6.5 times more effective than phototherapy." The earlier authors need to be more cautious while making such an emphatic statement against sunlight phototherapy, a mode of treatment being followed for decades. In fact, no conclusive statement should be made until clearcut data becomes available regarding sunlight as form of therapy. On the contrary more data is needed on recommendations such as the duration of exposure to sunlight as also the time of the day when this should be done as well as to put down the limitations such as inability to use it in night or in cloudy or rainy conditions.

References

1. Agrawal R, Deorari AK. Unconjugated hyperbilirubinemia in newborn; current perspective. Indian Pediatr 2002; 39: 30-42.

2. Hansen TWR. Neonatal Jaundice, eMedicine Journal 2001; 2: Available from URL: www.emedicine.com/pediatrics/neonatology.

3. Pejaver RK, Vishwanath J. An audit of phototherapy units. Indian J Pediatr 2000; 67: 883-884.

4. Gupta G. Clippings. Indian Pediatr 2002; 39: 121-122.

5. Agrawal R, Deorari AK. Unconjugated hyperbilirubinemia in newborn; current perspective. Indian Pediatr 2002; 39: 30-42.

6. Gupta G. Clippings. Indian Pediatr 2002; 39: 121-122.