Sunlight For Newborns: Reducing Bilirubin Levels

Newborn jaundice is a common condition that refers to the yellowing of the skin due to high blood levels of bilirubin. While jaundice is common in newborn babies and typically resolves within a couple of weeks, high bilirubin levels can cause permanent brain damage or even death.

Treatment for newborn jaundice typically involves phototherapy, which uses blue light waves to help break down bilirubin in the blood. However, in low- and middle-income countries, access to phototherapy may be limited due to a lack of resources and inconsistent electricity. As an alternative, sunlight contains the same wavelengths of light produced by phototherapy machines and can be used to treat hyperbilirubinemia.

Studies have shown that sunlight therapy may reduce the occurrence and duration of jaundice in infants. However, sunlight also contains harmful ultraviolet rays and infrared radiation, which can lead to sunburn, skin damage, and hyperthermia. To mitigate these risks, filtered sunlight therapy has been proposed, which involves using canopies or tents to block harmful UV rays while allowing jaundice-treating blue wavelengths to reach the skin.

Filtered sunlight therapy has been found to be as safe and effective as conventional phototherapy in treating newborn jaundice, offering a low-cost solution for impoverished settings.

Sunlight may be an effective adjunct to conventional phototherapy

Phototherapy lamps, which emit blue-green light to alter bilirubin so that it can be more easily excreted, are often used to treat jaundice. However, phototherapy machines may not always be available, especially in LMIC settings, where there are frequent shortages and inconsistent access to electricity.

Sunlight, which contains similar wavelengths of light to those produced by phototherapy machines, has the potential to treat hyperbilirubinemia. However, sunlight also contains harmful ultraviolet light and infrared radiation, which can lead to sunburn, skin damage, and hyperthermia or hypothermia.

To address these risks, sunlight can be filtered to block harmful ultraviolet light and infrared radiation. Studies have shown that filtered sunlight phototherapy (FSPT) is as effective as conventional phototherapy in reducing bilirubin levels and is safe when combined with frequent temperature checks for babies.

FSPT involves the use of outdoor canopies with commercial window-tinting films that filter out harmful rays while allowing jaundice-treating blue wavelengths to reach the baby's skin. In a study conducted in Nigeria, FSPT was found to be effective in 93% of treatment days, compared to 90% for conventional phototherapy.

FSPT offers a low-cost, safe, and effective solution for treating jaundice in newborns, especially in settings with limited access to conventional phototherapy. It may also allow for rotational use of limited phototherapy machines and can be preferable for families as it enables increased bonding.

Sunlight may allow for rotational use of limited phototherapy machines

Sunlight may be an effective adjunct to conventional phototherapy in low- and middle-income countries (LMICs). It may allow for rotational use of limited phototherapy machines and may be preferable to families as it can allow for increased bonding.

In low- and middle-income countries, phototherapy is not always available for babies who need it. Hospitals and clinics in these countries often face frequent shortages of functioning phototherapy machines and inconsistent access to electricity to run the machines.

Sunlight has the potential to treat hyperbilirubinemia as it contains the wavelengths of light that are produced by phototherapy machines. However, it also contains harmful ultraviolet light and infrared radiation, which can cause sunburn and skin damage.

Filtered-sunlight phototherapy (FSPT) has been found to be as safe and effective as conventional phototherapy. In a study conducted in Nigeria, some mothers and babies sat under outdoor canopies that filtered out harmful wavelengths from sunlight, but still allowed jaundice-treating blue wavelengths to reach the babies' skin. The filtered-sunlight treatment was as safe and effective as the blue-light lamps traditionally used to treat infant jaundice.

Sunlight may be preferable to families as it can allow for increased bonding

Sunlight therapy may also allow for rotational use of limited phototherapy machines. In addition, sunlight therapy can be administered at home, reducing the need for hospitalisation and allowing for increased bonding between newborns and their mothers.

However, it is important to note that sunlight also emits harmful ultraviolet rays and infrared radiation, which can cause sunburn and skin cancer. Exposing babies to sunlight might also mean they get too warm or too cold, depending on the climate. Filtration of sunlight to block harmful ultraviolet light and frequent temperature checks for babies under sunlight may be necessary safety measures.

Filtration of sunlight to block harmful ultraviolet light may be warranted for safety

Sunlight has the potential to treat hyperbilirubinemia, a condition commonly known as jaundice, in newborns. Hyperbilirubinemia is defined as an elevated level of bilirubin in the blood. Bilirubin is a yellow substance found naturally in a baby's blood, and when present in high levels, can cause the skin and eyes to turn yellow.

Phototherapy is a conventional treatment for hyperbilirubinemia, using blue-green light to alter the bilirubin so that it can be more easily excreted. Sunlight emits light in a similar spectrum to phototherapy lamps, but it also contains harmful ultraviolet (UV) light and infrared radiation. Prolonged exposure to UV light from the sun can lead to sunburn, skin damage, and even skin cancer.

Filtered sunlight therapy (FSPT) is a method of treating hyperbilirubinemia that uses sunlight that has been filtered to remove most UV light and significant levels of infrared radiation. Commercial window-tinting films are used to filter the sunlight. Studies have shown that FSPT is as safe and effective as conventional phototherapy, with similar rates of decline in bilirubin levels.

However, babies treated with FSPT were at an increased risk of hyperthermia (body temperature greater than 37.5°C). This risk could be mitigated by frequent temperature checks for babies under sunlight. Therefore, filtration of sunlight to block harmful UV light may be warranted for safety.

Benefits of FSPT

FSPT has several potential benefits:

• It is a low-cost and effective way to give phototherapy to jaundiced infants, especially in low-resource settings where conventional phototherapy may not be available or reliable.
• It allows for rotational use of limited phototherapy machines.
• It may be preferable to families as it can allow for increased bonding between mothers and babies.
• It may reduce rehospitalization rates for hyperbilirubinemia.

Limitations of FSPT

The effectiveness of FSPT is limited by the sporadic availability of sunlight. Additionally, the studies conducted on FSPT had small sample sizes and were unblinded, leading to a high risk of bias. More research is needed to confirm the effectiveness and safety of FSPT.

Sunlight may be effective in preventing hyperbilirubinemia in some cases

Babies with jaundice are often treated with phototherapy lamps, which emit blue-green light that alters the bilirubin (a yellow substance found naturally in the baby's blood) so that it can be more easily excreted. Sunlight emits light in a similar spectrum, but it also contains harmful ultraviolet rays and infrared radiation, which can cause sunburn and skin cancer.

In low- and middle-income countries (LMICs), phototherapy is not always available for babies who need it. In these countries, babies are at an increased risk of developing dangerous jaundice, where bilirubin in their blood reaches levels that allow it to cross the blood-brain barrier and cause brain damage.

Given that sunlight is readily available, there is an urgent need to determine if sunlight is safe and effective at treating jaundice in babies in LMICs.

Three clinical trials containing 1103 infants from two countries have been conducted to evaluate the efficacy of sunlight in treating hyperbilirubinemia. The trials included infants born at or near their due date (35 weeks of gestation or later) who were less than two weeks old.

One study found that babies exposed to twice-daily sunlight for 30 to 60 minutes may have a reduced occurrence of jaundice and be jaundiced for fewer days compared to babies who received no preventive treatment. However, there were no data on the potential harmful effects of the intervention, and the study did not assess the use of conventional phototherapy, treatment failure requiring exchange transfusion, acute bilirubin encephalopathy (ABE), and long-term consequences of hyperbilirubinemia.

Two other studies compared the effect of filtered sunlight exposure to other sources of phototherapy in infants with confirmed hyperbilirubinemia. These studies found that filtered sunlight phototherapy (FSPT) and conventional or intensive electric phototherapy led to a similar number of days of effective treatment. There was no significant difference in treatment failure requiring exchange transfusion, and no infants in either group developed ABE.

While sunlight may be effective in preventing hyperbilirubinemia in some cases, these studies have not demonstrated that sunlight alone is an effective treatment. Sunlight therapy may be considered as an adjunct to conventional phototherapy in LMIC settings, allowing for rotational use of limited phototherapy machines and increased bonding between mothers and babies. However, filtration of sunlight to block harmful ultraviolet light and frequent temperature checks for babies are necessary to ensure safety.

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