Bili Lights

Everything There Is to Know About Bili Lights

Bili lights are a type of phototherapy that is a treatment for newborn jaundice. In jaundice, there is a yellow discoloration of the eyes and skin caused by an excess of a yellow-colored substance called bilirubin. The therapy of hyperbilirubinemia involves irradiation of the baby by shining fluorescent illumination on their bare skin. This radiation is concentrated from the region of the spectrum that contains blue light with wavelengths ranging from 420-500 nm, which can oxidize bilirubin and eliminate it through stool and urine. Its unit has a radiant source, a means of allowing the illumination to irradiate the infant with a bank of 20-watt lamps, that gets placed 30-40 cm above the infant. Overhead lamps can be freestanding, mounted on the ceiling, casters, wall-mounted, or have attachments for infant incubators and/or radiant infant warmers. Some units subsume an hour-meter to record infant-treatment time and bulb life. To maintain measured irradiance at therapeutic levels, regular measurement with a photometer of radiation at the patient surface is necessary. Some radiant warmers have an accessory or integral phototherapy unit. During practice, the group gets wheeled to the neonate's bedside and illuminated by the lamp's output. A fiber optic cable delivers filtered blue radiations from the source.

History of Bili Lights 

From the earliest times, light has played an essential role in the management of diseases. Modern inventions, such as the electric lightbulb or the electric generator, and recent discoveries such as ultraviolet radiation and balneological experiments of sunlight therapy, offer the change from heliotherapy to artificial phototherapy at the end of the 19th century. William Henry Goeckerman used an ultraviolet B radiation for psoriasis management. Nils Ryberg Finsen was the first to practice what is most similar to modern phototherapy. Later, phototherapy with artificial illumination sources became famous in the management of skin diseases. In methoxy psoralen isolation in 1947, improvements in the effectiveness of dermatologic phototherapy occurred. In the 1950s, the effects of light in the treatment of jaundice in infants was first discovered at Rochford General Hospital, Essex. Sister J Ward discovered it and she oversaw the hospital's premature newborn nursery and trusted the benefits of fresh air and sunlight above the confines of an airless incubator. On sunny summer days, she would take babies outside and one day, realized that sunlight reduced levels of bilirubin in premature and newborn babies. During the 20th century, this form of therapy was introduced to new areas of practice like neonatology, ophthalmology, and psychiatry.

Indications to Use Bili Lights  

The primary use of bili lights is to help treat several disease processes, including hyperbilirubinemia, which features raised bilirubin concentrations in the blood. It is a result of hemoglobin that has broken down. It remains in the human body until the liver converts it to an excretable form. As mentioned before, jaundice is a disease in which a yellowish discoloration of the eyes skin and mucous membranes happens. It occurs when the bilirubin concentration in the blood is too high. High levels can occur because of an immature liver’s inability to dissolve high levels of bilirubin, especially in neonates.

The bili lights are inexpensive and easy to use; the products are nontoxic for the central nervous system and get easily eliminated by the liver and kidneys; it is the most effective in all modes of prevention and management of neonatal hyperbilirubinemia. The only exception is exchange-transfusion. Bilirubin absorbs light, which results in its breakdown of products that the body of the baby can process and excrete. Bili lights have compact fluorescent illumination tubes & blue light-emitting diode devices that are for the babies' phototherapy treatment. The distance between these instruments’ and the babies' bodies should be relatively short as they do not produce much heat.

There are two major protocols for babies with jaundice. One way is to cover the baby's eyes and place them under fluorescent lamps or halogen spotlights. For preterm babies or those who have already been treated by the conventional overhead lights, biliblankets, which consist of fiber optic pads and portable illuminators, are a better option for them. Biliblankets are available with fiber-optic cables that shine the blue light on the baby's back and body. 

Complications of using Bili Lights 

Immediate Side Effects: In newborn infants, the side effects of Bili lights include increased insensible water loss with poor weight gain; decreased intestinal transit time with greenish, loose stools; skin rashes, and, sometimes, brownish discoloration of plasma skin, and urine. 

The most noticeable complication of treatment is bronze baby syndrome, in which a grayish-brown discoloration of the skin occurs, particularly in infants with cholestatic jaundice. Bronze baby syndrome occurs when porphyrins, and particularly copper porphyrin's photoproducts of brown color, accumulate in the skin with impaired excretion by cholestasis. The device can damage red-blood-cell membranes and enhance their susceptibility to lipid peroxidation & hemolysis. The effects contribute to the pathogenesis of problems prevalent in the very low birth weight infant, such as bronchopulmonary dysplasia, necrotizing enterocolitis, and retinopathy of prematurity. 

Other rare side effects of bili lights are bullous eruptions and purpura that can occur in infants with elevated levels of bilirubin. The application is contraindicated in infants with congenital erythropoietic porphyria, as it can cause blistering and photosensitivity.

General Specifications of Bili Lights 

There are several designs of bili lights with different specifications available on the market. however, we are going to cite the general specifications:

Approx. dimensions (mm): for overhead lamp type - 1200 x 650 x 250; for fiberoptic type - 200 x 350 x 150. 

Blue-light wavelengths: approximately 420 to 500 nanometers, 

Approx. weight (kg): for overhead lamp type 36; for fiberoptic example 2 

Consumables of Bili Lights: disposable pad covers and Light bulbs

Price range (USD): $400-7,600 when considering all variations and types 

Typical product lifetime: 10 years

How They Work 

Phototherapy converts bilirubin in the superficial capillaries and interstitial spaces of the subcutaneous tissues and skin to water-soluble isomers, which are excretable without further metabolization in the liver. When the device illuminates the surface, an infusion of energy occurs by discrete photons absorption by bilirubin, just like a drug molecule binds to a receptor. In light-exposed skin, the molecules undergo quick structural isomerization, photochemical reactions—configurational isomerization, and photooxidation—to make non-toxic, excretable isomers. 

These isomers are of different shapes and are more polar, and excretable from the liver into the bile without requiring special transport or undergoing conjugation for their excretion. Gastrointestinal and urinary elimination remain essential to the process of decreasing the bilirubin load. For the treatment, the newborn gets placed under the bili lights, just wearing a diaper, and all other clothes are off. Covering of eyes is essential to protect them from the bright sun. There is a frequent turning of babies. The eye mask is a must before placing the baby in the bassinet. The health care team carefully measures the infant's body temperature, vital signs, and responses to the light. They also notice how long the treatment lasted. An IV fluid must be in therapy to avoid the dehydration of the baby from the bili lights. Blood tests are mandatory to check the substance level. When the standards have dropped sufficiently, treatment is complete. Usually, the procedure is for 1 to 3 days. Some infants receive it at home. In this case, a nurse visits daily & for testing draws a sample of blood.

Based on the configuration, lamp distance depends on whether the infant has wrapped in an fiberoptic pad or intensity of therapy desired. Here are some critical aspects of this treatment: ensuring effective irradiation, provision of eye protection, assessing skin exposure, hydration level, proper positioning and thermoregulation, and monitoring of bilirubin level.

Market Leaders 

NAOS, NAOS PLUS

These lamps have 6 Power Blue LEDs to deal with jaundiced newborns emit light energy in wavelengths around 455nm. The LEDs raise power, 5 to 6 times.

ELIOS

The Elios is a unique kind of lamp, designed to add intensive phototherapy & heating treatment of newborns who can be placed in beds and changing tables.

MIRA

The phototherapy lamp, MIRA, uses the latest LED technology to create blue therapeutic light of 460nm and fiber optics to provide therapy to little patients of jaundice.  

XHZ-200

It has a 360-degree blue light irradiation system for all-dimensional phototherapy treatments for neonates with jaundice. It has an air temperature regulation system.

MEDWARM

Its mechanism is centralizing the red light on the baby. By lockable wheels and telescopic structure, the control stand provides safe use.  

BILILED MAXI

Super LED Technology Bililed Maxi provides faster bilirubin serum breakdown by its high-intensity radiation, super LED technology, and advanced monitoring. It is the best therapeutic option for active term newborns.

BILILED MINI

It is the smallest & the most ergonomic phototherapy device Worldwide. Due to its ergonomic design, the device has direct use in incubators.

BILISPHERE 360

It is a multidirectional intensive phototherapy system designed for the fastest serum bilirubin breakdown and blood exchange elimination. With it, healthcare workers can reduce the duration of therapy.

Here are a few more options:

  • Wallaby Respironics
  • GE
  • Olympic
  • Drager
  • Minoltra

Conclusion 

Bili lights are a standard of care in the management of hyperbilirubinemia in newborns. They may have prevented almost as much morbidity and mortality in neonatal care as the use of oxygen. They have certainly done so with few complications. With wavelengths ranging from 420 to 500 nm, the blue light breaks the bilirubin in capillaries, making it easy for the liver to remove its sub-products. Health care practitioners are very comfortable with this therapy for treating jaundice in newborn infants. In rare instances, jaundice in term and preterm infants can lead to critical complications. Significantly, neonatal caregivers use the device to its fullest potential while treating the standard but not the benign problem of neonatal hyperbilirubinemia. A considerable amount of care is necessary for eye protection—position of baby, distances between lamp and infant. Higher hydration levels and thermoregulation are critical for the best treatment protocols.

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