![]() ![]() 24 found a linear relation between TSB decline and spectral irradiance between 20 up to 55 μW cm −2 nm −1. 23– 27 Decades ago, Tan suggested a saturation point of 30 μW cm −2 nm −1 beyond which an increase in the spectral irradiance would not increase efficacy of PT. 4, 6, 9, 10, 14, 15, 22 Increasing the spectral irradiance of a PT device produces a faster decline of TSB levels. Various authors stress the importance of spectral irradiance measurements during PT that enables to adjust spectral irradiance to desired intensity levels. This hinders an objective comparison between spectral irradiance based on technical specifications. Manufacturers of PT devices use a variety of methods for irradiance measurements. 4 The number of spectral irradiance measurements and measurement locations are not mentioned. The American Academy of Pediatrics (AAP) recommends to average spectral irradiance measurements at multiple sites, because of a decay in spectral irradiance towards the periphery of the illuminated area. 14, 15 Distinction between these factors may enable customized use of a PT device and facilitate comparison between PT devices. In these studies, user factors and technical factors were varied simultaneously. 11– 13 Several studies show high variability in spectral irradiance between PT devices. Patient characteristics include severity of hyperbilirubinemia, BSA, pigmentation, thickness and blood perfusion of the skin. 2, 6– 10 These technical factors are affected by device type, spectral irradiance settings, age, intensity of use and status of maintenance. 2, 5 Technical factors of the efficacy of PT relate to: (1) spectral emission range and peak wavelength (nm) (2) spectral irradiance level (3) irradiance footprint and (4) uniformity of the spectral irradiance. User factors relate to: (1) the duration of the PT treatment (2) distance between the PT device and the infant (3) effective irradiated body surface area (BSA), which is influenced by the presence of diapers, electrode patches, etcetera. 4 The efficacy of PT is determined by user factors, technical factors of the PT device, and patient characteristics. 3 The American Academy of Pediatrics recommends at least 30 μW cm −2 nm −1 for intensive PT that should be delivered to as much of the infant’s surface area as possible. 2 Appropriate spectral irradiance is essential for PT to be effective. PT reduces total serum bilirubin (TSB) levels and the need for exchange transfusions (ETs). 1 Phototherapy (PT) is considered a safe and effective treatment for neonates of more than 35 weeks gestation with severe hyperbilirubinemia. Neonatal jaundice, resulting from unconjugated hyperbilirubinemia, is a common phenomenon, that may either be relatively benign or progress to potential harmful conditions, i.e., acute bilirubin encephalopathy and kernicterus spectrum disorders (KSDs). ![]()
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