Letters to the Editor

Indian Pediatrics 2002; 39:792

Reply

We thank Dr. Ahlawat and Dr. Sanklecha for their keen interest in our article(1).

There are several ways by which efficacy of phototherapy can be increased. This includes measures such as maximizing exposure time, exposing more surface area by turning the sides of baby and removing diaper, bringing light closer to baby, ensuring proper feeding and lining the bassinet with white cloth and putting a white curtain around phototherapy(2). However, none of these measures are substitute for using proper lights giving adequate irradiance (which should be documented frequently). These mesures should be used as an adjunct to maximize the effects of rather than excuse of "effective phototherapy unit".

Sunlight has traditionally been used for the treatment of neonatal hyperbilirubinemia(1). It contains useful amounts of irradiance in the blue spectrum for treatment of neonatal hyperbilirubinemia and can be helpful for treatment of mild jaundice. However, direct exposure to sunlight is not recommended, as it contains harmful ultraviolet and infrared radiation, which can cause hyperthermia and skin tanning. Having an infant in open shade outside or inside in a sunlit room is a good way to deliver useful light spectrum for lowering serum bilirubin level in mild jaundice(3). Light in ultraviolet spectrum is filtered out as the sunlight passes through the glass. But there are no appropriate controlled trials of the use of sunlight as a means of providing phototherapy.

Dr. Ahlawat is referring to clipping in Indian Pediatrics(4). This is a in vitro study which examined efficiency of sunlight in isomerizing bilirubin, when aqueous bilirubin solutions were exposed to periodic sunlight over one year(4). We should not recommend routine sunlight for treatment of babies with jaundice as parents might consider this as adequate home therapy and more severe cases of jaundice would be missed. One should remember that providing sunlight for treatment of pathological jaundice without investigating the cause is unacceptable and if jaundice is moderate to severe, risks of bilirubin brain damage will be overlooked.

References

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

2. American Academy of Pediatrics. Practice Parameter: Management of hyperbili-rubinemia in the healthy term newborn. Pediatrics 1994; 94: 558-567.

3. Maisels J M. Neonatal hyperbilirubinemia. In: Care of the High Risk neonate. Klaus MH, Fanaroff AA (Eds). 5th Edition, W.B. Saunders Company, Philadelphia, 2001, pp 357.

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