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High variability and low irradiance of phototherapy devices in Dutch NICUs
  1. Deirdre E van Imhoff1,
  2. Christian V Hulzebos1,
  3. Maaike van der Heide1,
  4. Vera W van den Belt1,
  5. Hendrik J Vreman2,
  6. Peter H Dijk1,
  7. the BARTrial Study Group
  1. 1Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, The Netherlands
  2. 2Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
  1. Correspondence to Peter H Dijk, Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9713 GZ Groningen, The Netherlands; p.h.dijk{at}


Objective To evaluate phototherapy practices by measuring the irradiance levels of phototherapy (PT) devices.

Design Prospective study.

Setting Tertiary neonatal intensive care units.

Patients None.

Interventions Irradiance levels of PT devices used in the 10 Dutch Neonatal Intensive Care Units (NICUs) were measured according to the local PT practice patterns. The irradiance levels of all overhead and fibre-optic PT devices were measured with a radiometer using an infant silhouette model.

Results Eight different PT devices were used in the 10 NICUs; five were overhead devices and three fibre-optic pads. The median (range) irradiance level for overhead PT devices was 9.7 (4.3–32.6) µW/cm2/nm and for fibre-optic pads 6.8 (0.8–15.6) µW/cm2/nm. Approximately 50% of PT devices failed to meet the minimal recommended irradiance level of 10 µW/cm2/nm. Maximal irradiance levels for overhead PT spot lights were inversely related to the distance between device and infant model (R2=0.33). The distances ranged from 37 cm to 65 cm.

Conclusions PT devices in the Dutch NICUs show considerable variability with often too low irradiance levels. These results indicate that suboptimal PT is frequently applied and may even be ineffective towards reducing total serum bilirubin levels. These results underline the need for greater awareness among all healthcare workers towards the requirements for effective PT including measurements of irradiance and distance.

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  • Collaborators The BART trial Study Group members are L van Toledo-Eppinga, Academic Medical Center University of Amsterdam, The Netherlands. A L M Mulder. University Medical Center Maastricht, The Netherlands. P Govaert, Erasmus Medical Center Rotterdam, The Netherlands. R A van Lingen, Isala Clinics Zwolle, The Netherlands. E Lopriore, University Medical Center Leiden, The Netherlands. J Buijs, Maxima Medical Center Veldhoven, The Netherlands. D E van Imhoff, P H Dijk, C V Hulzebos, University Medical Center Groningen, The Netherlands. K D Liem, University Medical Center St. Radboud Nijmegen, The Netherlands. M J N L Benders, University Medical Center Utrecht, The Netherlands. W P F Fetter, University Medical Center Amsterdam, The Netherlands.

  • Funding This study preceded the Netherlands Neonatology Research Network RCT ‘Reducing bilirubin induced neurological dysfunction in premature newborns: additional use of the bilirubin/albumin ratio in the treatment of hyperbilirubinaemia’ (BARTrial: ISRCTN 7446543). The trial was funded by the ZonMW Cost-Effectiveness programme (nr: 94507407).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.