I RRADI ANCE OF PHOTOTHERAPY EQUI PMENT I N MATERNI TY W ARDS I N MACEI Ó
Anne Laur a Cost a Fer r eir a1 Renat a Medeir os do Nascim ent o2 Regina Célia Sales Sant os Ver íssim o3
Fer r eira ALC, Nascim ent o RM, Ver íssim o RCSS. I r r adiance of phot ot her apy equipm ent in m at er nit y war ds in Maceió. Rev Lat ino- am Enfer m agem 2009 set em br o- out ubr o; 17( 5) : 695- 700.
The effect iveness of neonat al hyperbilirubinaem ia t reat m ent depends direct ly on t he am ount of energy em it t ed
by light ( ir r adiance) . This cr oss- sect ional st udy aim ed t o det er m ine t he ir r adiance of phot ot her apy equipm ent
in m at ernit y wards in Maceió, AL, Brazil. All equipm ent in use in t he neonat al unit s in Maceió was included in t he
st udy , t ot aling 36 dev ices, ex cept t hose in m aint enance. The m easur em ent of ir r adiance w as car r ied out w it h
a r adiom et er . We obser v ed t h at 7 2 . 2 0 % of t h e equ ipm en t pr esen t ed ef f icien t ir r adian ce an d 2 7 . 7 6 % w er e
in ef f icien t . Th e con clu sion is t h at t h e m aj or it y of ph ot ot h er apy dev ices ar e em it t in g t h e m in im u m r equ ir ed
ir r adiance for neonat al j aundice t r eat m ent .
DESCRI PTORS: j aundice; phot ot her apy ; infant , new bor n; light ; r adiat ion m easur em ent
LA I RRADI ACI ÓN DE LOS APARATOS DE FOTOTERAPI A EN LAS
MATERNI DADES DE MACEI Ó
La eficacia del t r at am ient o de la hiper bilir r ubinem ia neonat al depende dir ect am ent e de la cant idad de ener gía
em it ida por la luz ( ir r adiación) . Est e es un est udio t r ansv er sal que obj et iv ó det er m inar la ir r adiación de los
apar at os de fot ot er apia en las m at er nidades de Maceió. Es un m uest r eo por censo, y a que incluy ó t odos los
aparat os en uso en las unidades neonat ales de Maceió, en el t ot al de t reint a y seis aparat os ( 36) , excluyéndose
aq u ellos q u e est ab an en m an u t en ción . La m ed ición d e la ir r ad iación f u e r ealizad a con u n r ad ióm et r o. Se
observó que 72,20% de los aparat os present aron irradiación eficaz y 27,76% de los aparat os fueron ineficaces.
Se concluy e que la m ay or ía de los apar at os de fot ot er apia est á em it iendo la ir r adiación m ínim a t er apéut ica
par a el t r at am ient o de la ict er icia neonat al.
DESCRI PTORES: ict er icia; fot ot er apía; r ecién nacido; luz; m edición de r adiación
I RRADI ÂNCI A DOS APARELHOS DE FOTOTERAPI A NAS MATERNI DADES DE MACEI Ó
A eficácia do t r at am ent o da hiper bilir r ubinem ia neonat al est á na dependência dir et a da quant idade de ener gia
em it ida pela luz ( irradiância) . Est e é um est udo t ransversal que obj et ivou det erm inar a irradiância dos aparelhos
de fot ot er apia nas m at er nidades de Maceió. A am ost r agem foi censit ár ia, pois incluiu t odos os apar elhos em
u so n as u n idades n eon at ais de Maceió, n o t ot al de t r in t a e seis apar elh os ( 3 6 ) , ex clu in do- se aqu eles qu e
est avam em m anut enção. A m edição da irradiância foi realizada com um radiôm et ro. Observou- se que 72,20%
d os ap ar elh os ap r esen t ar am ef icácia q u an t o à su a ir r ad iân cia e 2 7 , 7 6 % d os ap ar elh os f or am in ef icazes.
Concluiu- se que a m aior ia dos apar elhos de fot ot er apia est á em it indo a ir r adiância m ínim a t er apêut ica par a o
t r at am ent o da ict er ícia neonat al.
DESCRI TORES: ict er ícia; fot ot er apia; r ecém - nascido; luz; m edição de r adiação
1RN, e- m ail: annelaura1@hot m ail.com ; 2RN, e- m ail: m edeiros_renat a@hot m ail.com ; 3Assist ant Professor, Universidade Federal de Alagoas, Brazil, e- m ail:
salesregina@hot m ail.com .
I NTRODUCTI ON
H
y p er b ilir u b in aem ia is t h e m ost f r eq u en t pat hology in t he neonat al period. I t is est im at ed t hat about 60% of newborns develop serum bilirubin levels above 5 m g/ dl and about 25% develop serum bilirubin levels above 7 m g/ dl associat ed t o visible j aundice( 1). Cur r ent ly, t he m ost used t herapies t o cont r ol ser um -u n co n j -u g at ed h y p er b i l i r -u b i n aem i a i n t h e n eo n at al p e r i o d i n c l u d e p h o t o t h e r a p y a n d e x c h a n g e t ransfusions( 2). Phot ot herapy is t he m ost used specific t her apy because it is a non- inv asiv e m et hod of high im pact t h at dim in ish es lev els of plasm at ic bilir u bin , r egar dless of n eon at al m at u r it y, pr esen ce or n ot of h em oly sis or d eg r ee of cu t an eou s p ig m en t at ion( 3 ). Th ese t r eat m en t act ion m ech an ism s m ain ly in clu de con f igu r at ion al an d st r u ct u r al ph ot oisom er izat ion of t he bilir ubin m olecule w it h phot oisom er s com pounds, which are excret ed t hrough biliary and urinary rout es w it hout t he need for hepat ic conj ugat ion( 2).Hist or ically, ex ch an g e t r an sf u sion w as t h e m o s t u s e d t h e r a p y, p r o b a b l y d u e t o i n e f f i c i e n t p h o t o t h e r a p y , w h i c h i n c r e a s e s t h e r i s k o f m or bim or t alit y t hat v ar ied accor ding t o t he ser v ices and neonat ologist s’ ex per ience( 4 ).
The efficacy of neonat al hy per bilir ubinaem ia t r eat m ent depends dir ect ly on t he am ount of ener gy em it t ed by light ( ir r adiance)( 5). Ther efor e, cont r olling phot ot her apy equipm ent in neonat al unit s is needed. There is a m inim um level of irradiance for each type of equipm ent . The bilirrubin m olecule absorbs visible light ranging from 400 and 500nm , wit h peaks around 460 nm( 5). I rradiance is considered t he am ount of energy em itted on a certain surface, by its unit of area(6).
Since phot ot herapy was discovered, 40 years ag o, n ot on ly in d icat ion s f or it s u se h av e ch an g ed consider ably as new and m or e efficient m odels hav e been int r oduced in t he m ar k et( 7).
Assum ing t hat t here is variabilit y in t he t ype of dev ice and light bulb used, t he char act er ist ics of e a c h t y p e o f d e v i c e h a v e t o b e k n o w n . Th e conv ent ional or com m on phot ot her apy uses fr om six t o eight w hit e fluor escent bulbs ( day light )( 6); som e devices already have int erspersed blue bulbs, at least t w o. The m inim um ir r adiance of t his dev ice is 4m w / cm2/ nm( 5- 8).
I n devices wit h blue bulbs, t he lengt h of each w av e ach iev es f r om 4 2 5 t o 4 7 5 n m , w it h ir r adian ce equal t o 22 m w/ cm2/ nm ( com posed of 7 blue bulbs) . These devices present an irradiance t wo t o t hree t im es h i g h e r t h a n t h a t o b se r v e d i n d e v i ce s w i t h w h i t e bulbs( 6,8). This kind of bulb is not m ade in Brazil and i t s i m p o r t a t i o n i s h i n d e r e d b y a d m i n i s t r a t i v e bur eaucr acy and high cost s( 9).
Th e B i l i s p o t® 0 0 6 - B P d e v i c e i s a n o t h e r equipm ent used frequent ly in hospit al unit s. I t consist s of a light sour ce w it h halogen light bulbs, pr efer ably used in prem at ure infant s due t o t he size of t he light sou r ce( 5 ). I t h as ir r ad ian ce ab ov e t h at em it t ed b y convent ional devices. Halogen- t ungst en bulbs are used an d t h ese em it ir r adian ce in a blu e r an ge of 2 5 t o 30m w / cm2/ nm and filt er s for infr ar ed and ult r av iolet
radiat ion, how ev er, it s dist r ibut ion is ir r egular, unlike t he conv ent ional, and giv es a v er y high peak in t he cent er( 10). Bilispot® 006- BP bulbs have t o be changed w hen ir r adiance is below 10 m w / cm2/ nm( 8).
Phot ot herapy efficacy depends direct ly on t he a m o u n t o f e n e r g y e m i t t e d i n t h e w a v e r a n g e correspondent t o t he absorpt ion of light by t he bilirubin m olecule, on t he wave lengt h ( color) and int ensit y of ir r adiance ( ener gy ) of t he used sour ce( 1).
Th e n o n - o b se r v a n ce o f t e ch n i ca l cr i t e r i a appr opr iat e for t he use of t his t echnology can har m t he efficacy of t he t herapy and t he qualit y of t reat m ent deliver ed t o new bor ns w it h j aundice( 2). The m er e act of ex posing t he new bor n t o light w hen phot ot her apy is init iat ed does not necessarily im ply t he delivery of appr opr iat e t r eat m ent( 7 ).
Tr e a t i n g n e o n a t a l j a u n d i c e a l s o m e a n s m onit oring t he bulbs used in t he phot ot herapy devices, a i m i n g t o a l w a y s k e e p a p p r o p r i a t e i r r a d i a n c e . Knowledge about how light act s and t he t ype of bulb used should be const ant ly m onit ored for it s applicat ion in neonat al hyperbilirubinaem ia t reat m ent . The device w hose ir r adiance is not m onit or ed can aggr avat e t he new borns’ clinical condit ion and consequent ly prolong h ospit alizat ion .
favor the identification of the need to change or m aintain the device, optim izing the qualit y of care delivery.
OBJECTI VE
This st udy aim ed t o det erm ine t he irradiance of phot ot herapy devices in m at ernit y wards in Maceió, AL, Br azil.
METHOD
This is a cross- sect ional and descript ive st udy w it h a qu alit at iv e appr oach . Th e st u dy w as car r ied ou t b et w een Sep t em b er 2 0 0 7 an d Feb r u ar y 2 0 0 8 , w hen 36 phot ot her apy dev ices w er e ev aluat ed, used in six m at ernit y wards in Maceió, AL, Brazil. This st udy was not subm it t ed t o any Research Et hics Com m it t ee because it does not inv olv e hum an subj ect s.
T h e s a m p l i n g p r o c e s s i n c l u d e d t h e m at er n it ies r egist er ed in t h e Un if ied Healt h Sy st em Dat abase ( DATASUS) . Am on g t h e sev en m at er n it ies ch osen , on ly on e d id n ot au t h or ize t h e st u d y. Th e r e m a i n d e r si g n e d t h e d o cu m e n t a u t h o r i zi n g t h e st u dy. Th e h ospit als w er e clar if ied abou t t h e st u dy o b j e ct i v e s a n d t h e w a y d a t a w o u l d b e co l l e ct e d . An on y m it y an d access t o d at a w er e en su r ed , an d it w as gu ar an t eed t h at dat a w ou ld on ly be u sed f or s c i e n t i f i c p u r p o s e s . Eq u i p m e n t s i n u s e i n t h e m at er n it ies w er e in clu ded in t h e st u dy an d all t h ose i n m ai n t en an ce w er e ex cl u d ed .
The Radiom et er/ Phot om et er Fanem â- Mod 620 was used, wit h reading range fixed bet ween 380 and 530nm ( 10% point s) and peak at 450 nm , calibrat ed i m m ed i at el y b ef or e d at a col l ect i on . I t i s a si m p l e dev ice, operat ed w it h a 9- v olt bat t er y. I t s r eading is don e in spect r al ir r adian ce ( m w / cm2/ n m ) , w h ich is t he av er age ir r adiance in r elat ion t o t he br eadt h of t he r eading r ange. The aver age t her apy used w as in accordance t o each evaluat ed device. Aware t hat t here is n o con sen su s r egar din g v alu es t h at w ou ld defin e p h ot ot h er ap y as ef f icien t( 6 ), t h e f ollow in g sp ect r al a v e r a g e s w e r e u s e d a s p a r a m e t e r : f o r t h e con v en t ion al t y pe, t h e av er age w as 4 m w / cm 2 / n m t o 35cm from t he newborn; for t he Bilispot ® 006- BP t y pe, t h e u sed av er age w as 5 t o 8 m w / cm 2 / n m t o
50cm from t he newborn and for t he Bilit ron t ype, t he average of 10 m w/ cm 2/ nm t o 35cm from t he newborn. This st udy was guided by Fernando Facchini’s Pr oposal of St andar dizat ion, w hich for t he ev aluat ion o f c o n v e n t i o n a l d e v i c e s , r e c o m m e n d s t h e m easurem ent of irradiance on t he surface of t he m at w it h a sheet of car dboar d m easur ing 34x 60cm fix ed on t he sur face. An ar ea of 42x 34cm w as m ar k ed in t h e cen t er of t h is sh eet , w h ich cor r esp on d s t o t h e proj ect ion of t he phot ot herapy device, since it is used in t ransverse posit ion in relat ion t o t he incubat or. This ar ea w as div ided in n in e r ect an gles of equ al ar eas and, in t he cent er of each, a part was cut in t he form o f t h e r a d i o m e t e r u s e d f o r t h e r e a d i n g s . Th e arit hm et ic average of t hese nine port ions is considered t h e av er age spect r al ir r adian ce, w h ich t h e n ew bor n under t reat m ent is subj ect t o( 6).
To ev alu at e t h e Bilisp ot ® 0 0 6 - BP d ev ices, ir r adiance w as m easur ed w it h t he use of a pr oj ect ed circle, draw n on a cardboard and subdivided in t hree co n ce n t r i c a r e a s, o b t a i n e d b y t h e sh a p e o f t w o addit ion al cir cles of 2 . 5 an d 5 cm of r adiu s, w h ich divide t he circle in t hree areas ( A, B, C) of 19.6, 58.9 and 9 8 . 2 cm2, r espect ively. I n each of t hese ar eas, four diam et r ically opposed point s w er e m ar ked so as t o serve as t he m easurem ent sit e of irradiance, which a c c o r d i n g t o t h e m a n u f a c t u r e r i t s e l f, r e d u c e s c o n s i d e r a b l y f r o m t h e c e n t e r t o t h e p e r i p h e r y. A r i t h m e t i c a v e r a g e s o f t h e s e f o u r p o i n t s , o n c e w eig h t ed w it h t h eir r esp ect iv e ar eas an d su m m ed , p r ov id ed t h e sp ect r al av er ag e of t h e en er g y b eam t h er apy( 6 ).
Tot al ASI = ASI A x 19.6/ 176.7 + ASI B x 58.9/ 176.7 + ASI C x 98.2/ 176.7
ASI A = av er age spect r al ir r adian ce obt ain ed in t h e four point s of area A
ASI B= av er ag e sp ect r al ir r ad ian ce ob t ain ed in t h e four point s of area B
ASI C= av er ag e sp ect r al ir r ad ian ce ob t ain ed in t h e four point s of ar ea C
176.7= t ot al area in cm2 of t he circle of light proj ect ed by t he device( 6).
analysis was carried out using t he St at ist ical Package for t he Social Sciences ( SPSS) v er sion 15. 0.
RESULTS
Th e 3 6 d ev ices w er e an aly zed in t er m s of t h eir spect r al ir r adian ce, t y pe of dev ice, u sed bu lb an d qu an t it y of bu lbs by dev ice, in addit ion t o t h e exist ence of r adiom et er s in t he six st udied hospit als. Ther e w as a pr edom inance of Bilispot® 006-B P d e v i c e s , w h i c h i s e v i d e n c e d b y i t s d i c h r o i c c o n f i g u r a t i o n , i n w h i c h o n l y 4 0 % o f t h e v a l u e a c c o m p a n i e s t h e l i g h t b e a m( 6 ). Th e d e v i c e h a s ir r ad ian ce ab ov e t h at em it t ed b y t h e con v en t ion al t ype, but it s dist ribut ion is irregular, which dim inishes it s efficacy in r elat ion t o t he ir r adiance v alue.
Table 1 – Ty pe of phot ot herapy dev ice by m at er nit y. Maceió, AL, Br azil 2008
y t i n r e t a
M Typeofphototherapydevice Totalofdevices
) % ( y t i n r e t a m y b t o p s i l i
B Bilitron Conventional
A 10 0 1 11(30.55)
B 2 2 3 7(19.44)
C 3 0 3 6(16.66)
D 1 1 3 5(13.88)
E 1 2 2 5(13.88)
F 0 0 2 2(5.55)
l a t o
T 17 5 14 36(100)
I n r elat ion t o t he t y pe of used bulbs, t her e w a s a p r e d o m i n a n ce o f t u n g st e n h a l o g e n b u l b s, ch ar act er ized by h igh - em it t ed ir r adian ce, cooled by a syst em of forced air circulat ion t o dissipat e som e of t h e pr odu ced h eat . Th ey h av e a filt er in g sy st em of undesir able r adiat ions, such as t hose of t he infr ar ed band in phot ot her apy( 6).
Ta b l e 2 - Nu m b er o f d ev i ces i n h o sp i t a l f a ci l i t i es according t o t he t ype of bulb. Maceió, AL, Brazil 2008
l a t i p s o H b l u b f o e p y t e h t o t g n i d r o c c a e c i v e D ) % ( e t i h
W Blue(%) Blueandwhite(%) Halogen(%)
A 1(2.77) 0(0) 0(0) 10(27.77)
B 0(0) 2(5.55) 3(8.33) 2(5.55)
C 3(8.33) 0(0) 0(0) 03(8.33)
D 0(0) 1(2.77) 3(8.33) 01(2.77)
E 2(5.55) 2(5.55) 0(0) 01(2.77)
F 1(2.77) 0(0) 1(2.77) 0(0)
l a t o
T 7(19.44) 5(13.88) 7(19.44) 17(47.22)
The presence of radiom et ers in t he hospit als r e v e a l e d co n ce r n w i t h m o n i t o r i n g t h e i r r a d i a n ce em i t t ed b y t h ese d ev i ces an d h al f o f t h e st u d i ed hospit als had dev ices t o m easur e ir r adiance.
Tab le 3 – Pr esen ce of r ad iom et er b y h osp it al u n it . Maceió, AL, Br azil 2008
Com paring t he irradiances in lim it param et ers of em it t ed dosage, w e v er if ied t h at 2 7 . 7 6 % of t h e devices em it t ed irradiance below 4 m w/ cm2/ nm , which is t h e ir r adian ce w it h t h e least ef f icaciou s dose f or j aundice t r eat m ent by phot ot her apy( 6, 8, 11).
We also verified t hat Bilispot ® 006- BP devices ( 33.33% ) present ed irradiance above 10 m w/ cm2/ nm , which is est ablished as fast and efficacious t herapy in t er m s of em it t ed ir r adiance.
Table 4 – Num ber of phot ot herapy relat ed t o em it t ed irradiance and t he t ype of device used in t he hospit als in Maceió, AL, Br azil 2008
l a t i p s o
H Diameters Percentage(%)
t i e v a
H 3 50
t i e v a h t o n o
D 3 50
l a t o
T 6 100
( e r u s a e
M µµµµµW/cm2/nm)
e c n a i d a r r i x y p a r e h t o t o h p f o r e b m u N ) % ( e u l b + e t i h w l a n o i t n e v n o
C Conventionalwhite(%) Bilitron(%) Bilispot(%)
4 w o l e
B 8(22.22) 1(2.77) 0(0) 1(2.77)
0 1 o t 4 m o r
F 4(11.11) 1(2.77) 4(11.11) 4(11.11)
0 1 e v o b
A 0(0) 0(0) 1(2.77) 12(33.33)
l a t o
Ad eq u a t e b u l b s, a cco r d i n g t o t h e t y p e o f d e v i ce , d i r e ct l y i n f l u e n ce t h e e f f i ca cy o f e m i t t e d i r r a d i a n ce . Of t h e st u d i e d d e v i ce s, 8 . 3 2 % w e r e
inappropriat e. I n t erm s of adequat e irradiance by t ype of dev ice, t he st udy show ed t hat , of t he 36 st udied dev ices, 38. 87% w er e not efficacious.
Table 5 – Adequacy of irradiance by t ype of device versus adequacy of bulbs in Mat ernit ies in Maceió, AL, Brazil 2 0 0 8
s b l u b f o y c a u q e d a x e c i v e d f o e p y t y b e c n a i d a r r i f o y c a u q e d A
e u l b + e t i h w l a n o i t n e v n o
C Conventionalwhite Bilitron Bilispot
s e
y no yes no yes no yes no
e c n a i d a r r i f o y c a u q e d
A 3(8.33%) 17(19.44%) 2(5.55%) 2(5.55%) 1(2.77%) 4(11.11%) 16(44.44%) 1(2.77%)
s b l u b g n i k r o
W 9(25%) 1(2.77%) 1(2.77%) 2(5.55%) 5(13.88)% 0(0%) 17(47.22%) 0(0%)
DI SCUSSI ON
Phot ot her apy t o t r eat j aundice has been t he m ain ch oice f or m or e t h an 3 0 y ear s an d h as been efficient and safe t o dim inish indices of bilirubin, whose r at e of declin e is pr opor t ion al t o t h e em it t ed ligh t , indicat ing t hat , t he higher t he int ensit y of phot ot herapy ir r adian ce, t h e h igh er it s ef f icacy( 4 ). Th e dosage of phot ot herapy largely det erm ines how fast bilirubin will r e t u r n t o i t s n o r m a l l e v e l s . W h e n i n t e n s i v e phot ot herapy is used, one can expect it will decrease bet ween 0.5 m g and 1 m g/ dl per hour during t he first 4 - 8 hour s of t her apy. Wit h a st andar d of ir radiance considered efficient , bilirubin decreases from 6 t o 20% i n t h e f i r st 2 4 h ou r s( 4 ). Th er ef or e, t h e h i g h er t h e ir r adian ce em it t ed by t h e ph ot ot h er apy dev ice, t h e bet t er and fast er t he t herapy will be( 4).
The need t o m onit or t he m easurem ent of t he phot ot her apy dev ices’ ir r adiance has been descr ibed for som e t im e in int er nat ional lit er at ur e. I n Br azilian l i t e r a t u r e , so m e st u d i e s a d d r e ss t h e a n a l y si s o f ir r adiance of phot ot her apy dev ices in hospit als. The m aj or it y of st u d ies ar e lin k ed t o h ig h er ed u cat ion i n st i t u t i o n s. Th e se st u d i e s f o cu s o n f a ct o r s t h a t int er fer e in t r eat m ent efficacy, including ex posur e of t he new bor n t o light , dist ance of t he new bor n fr om t h e lig h t , ch an g e of d ecu b it u s, ey e p r ot ect ion an d h y dr at ion of babies, w h ile t h e m easu r em en t of t h e dev ices’ ir r adian ce is car r ied ou t in a sin gle cen t r al point , wit h dist ance found above t he newborn, direct ly m e a s u r i n g t h e i r r a d i a n c e , e x c l u d i n g p e r i p h e r a l exposed areas. These st udies also em phasize t he need t o u se b l u e b u l b s t o i n cr ease t h e p o t en cy o f t h e ir r adiance, w it h pr ev alence of w hit e and blue bulbs. How ev er, t h e efficacy of t h e ph ot ot h er apy does n ot depen d on ly on color, bu t also on t h e ir radian ce of light( 12).
Th is st u d y ev alu at ed t h e ir r ad ian ce of t h e d ev ice in sat isf act or y con d it ion s in r elat ion t o t h e d i s t a n c e b e t w e e n t h e l i g h t a n d t h e c r a d l e a n d i n cu b at o r s. Th e m aj o r i t y o f p h o t o t h er ap y d ev i ces p r e se n t e d i n co r r e ct d i st a n ce s i n r e l a t i o n t o t h e new bor n and t hese dist ances w er e cor r ect ed befor e st ar t in g t h e m easu r em en t so as t o av oid t h at t h e d i s t a n c e s t a n d a r d i z a t i o n e r r o r i n t e r f e r e d i n t h e ir r adian ce valu e. We con sider ed t h at t h e ir r adian ce em it t ed by t h e dev ice cou ld ev en be adequ at e, bu t t h a t i n co r r e ct d i st a n ce s co u l d b e i n e f f i ca ci o u sl y dissipat ing t he light .
We also m easured all point s reflect ed by light o n t h e n e w b o r n , e st a b l i sh i n g a sp e ct r a l a v e r a g e accor ding t o Facchini’s pr oposal( 6). I r radiance has t o be m easured in m ult iple sit es below t he light ed area, b y u n i t , a n d t h e a v e r a g e m e a s u r e m e n t s w e r e calculat ed because t he m easurem ent at t he cent er of t he light source can be t wice t he m easurem ent at t he p er ip h er y( 4 ). Th ese st r at eg ies allow ed u s t o ob t ain m or e r eliable dat a.
A n a n a l y s i s a b o u t t h e i r r a d i a n c e o f p h o t o t h er a p y d ev i ces w a s ca r r i ed o u t i n 2 0 0 3 i n h osp it als in Cu r it ib a, PR, Br azil an d t h e con clu sion w a s t h a t a l m o st h a l f o f t h e d e v i ce s u se d i n t h e t r eat m ent of neonat al j aundice w er e inefficacious( 9 ). Anot her st udy was carried out in 2006 in Brasilia, also addressing t he irradiance of phot ot herapy in a t eaching hospit al, w hich concluded t hat t he facilit y needed t o ar r an ge f or t h e dev ices’ m ain t en an ce an d bu y n ew phot ot her apy equipm ent( 13).
Result s also show t hat phot ot her apy dev ices ar e bein g cor r ect ly m on it or ed an d t h at 5 0 % of t h e m a t e r n i t i e s p o s s e s s m e a s u r e m e n t m o n i t o r s ( radiom et ers) . I t shows t hat t he professionals of t hese m a t e r n i t i e s a r e a w a r e o f t h e i m p o r t a n ce o f t h i s equipm ent and it s use, indicat ing t hat newborns wit h j aundice w ho ar e r eceiv ing phot ot her apy hav e gr eat ch an ces o f b ei n g ap p r o p r i at el y t r eat ed , si n ce t h e m aj orit y of t he m at ernit y wards in Maceió have devices wit h adequat e irradiance. However, t reat m ent efficacy does not depend only on spect ral irradiance, but also on t he spect r um of em it t ed light , spect r al pow er in r elat ion t o t he ex posed sur face and on t he cause of t he j aundice( 4). Adequat e ir r adiance of phot ot her apy dev ices is on ly on e of t h e sev er al cr it er ia r equ ir ed f or t r eat m en t su ccess. I n ad d it ion , p osit ion in g t h e newborn at t he ideal dist ance for each t ype of device, ex posin g t h e lar gest possible body su r f ace an d t h e t im e new bor ns ar e ex posed t o light also int er fer e in t h er apy su ccess.
Efficacy of t her apy should be assessed in all cases and t he lev el of ir r adiance should be indicat ed and recorded. I t should also be m easured in m ult iple sit es below t he light ed area by unit of m easurem ent , because irradiance dim inishes as one get s away from t he cent r al ar ea( 4).
There is a large num ber of devices em itting the m inim um recom m ended irradiance value to prom ote the reduct ion of serum bilirubin levels. The m aint enance of param eters of irradiance and consequent interference of this m aintenance in the efficacy of newborns treatm ent depends direct ly on a qualified nursing t eam . Efficient p h o t o t h er a p y d i m i n i sh es t h e n ew b o r n s’ t i m e o f hospitalization and unnecessary exposure to phototherapy treatm ent for a prolonged tim e.
CONCLUSI ON
Th i s s t u d y s h o w s t h a t 7 2 . 2 0 % o f t h e p h o t o t h e r a p y d e v i ce s o f t h e m a t e r n i t y w a r d s i n Maceió, AL, Br azil p r esen t ad eq u at e ir r ad ian ce f or n eon at al h y per bilir u bin aem ia t r eat m en t w it h v alu es abov e 4 m w / cm2/ n m . How ev er, it is im perat iv e t h at p r o f e s s i o n a l s m a k e p o s s i b l e t h e i n c l u s i o n o f m e a su r e m e n t a n d m a i n t e n a n ce r o u t i n e o f t h e se dev ices, fav or ing a higher em ission of ir r adiance.
Th e e x p r e s s i o n “ n o t e v e r y t h i n g t h a t illu m in at es, t r eat s” ( 1 4 ) t r an slat es t h e im por t an ce of ch eck in g t h e ir r adian ce of t h ese dev ices as w ell as t he m aint enance of t hese bulbs, creat ing a rout ine t o change and calibrat e t he radiom et er.
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