Costakos, Dennis T.

OBJECTIVE In phototherapy for neonatal hyperbilirubinemia, the use of covers placed between the newborn and the phototherapy source is variable. Guidelines often recommend a cover for the phototherapy blanket pad. Because covers could affect illumination levels, we assessed phototherapy irradiance levels from an overhead phototherapy system and a phototherapy blanket, with and without commercial covers. METHODS In this nonclinical study, the overhead phototherapy system used calibrated radiometer measurements from 420 to 500 nm at 2 distances below the light source; the phototherapy blanket used measurements from 400 to 520 nm. We measured irradiance in 4 different variations using 2 types of covers (a mesh swaddle and a phototherapy blanket pad). RESULTS For the overhead system, at 30.5 cm below the light source and with a mesh swaddle covering the meter, the irradiance was 29.5 μW/cm2/nm, which was 14% lower than the value without covering (34.4 μW/cm2/nm). The mean irradiance at 15 cm from the light source with the mesh covering the meter (38.5 μW/cm2/nm) was 15% lower than without a cover (45.4 μW/cm2/nm). The irradiance under the zipper of the mesh swaddle was substantially lower at either distance. For the phototherapy blanket, the irradiance measured in all the posterior covering variations ranged from 61.1 (nest plus swaddle) to 98.5 μW/cm2/nm (no covering). CONCLUSIONS Clinicians should be aware that commercial phototherapy coverings affect irradiance; however, optimal irradiance can be achieved and may even exceed current American Academy of Pediatrics (AAP) recommendations of 25 to 35 μW/cm2/nm.

The present study evaluated end-user experience for effectiveness, efficiency, and satisfaction of a mobile application (app) to estimate the risk of rebound hyperbilirubinemia within 72 hours after initial phototherapy ends for infants at 35 weeks’ gestation or longer and age younger than 14 days. This prospective parallel study was performed at one medical center. The 26 participants are neonatology and pediatric and family physicians, neonatal and family nurse practitioners, and family practice residents, who were asked to estimate the risk of rebound hyperbilirubinemia when phototherapy is stopped for a fictional newborn. Participants in Group 1 (no app) were compared with Group 2 (with app). Satisfaction measured from 1 (0%) to 7 (100%). Group 1 had fewer correct answers than Group 2 (38.5% vs. 84.6%; P = .04). The mean satisfaction score for Group 1 was 2, lower than the score for Group 2, 6.6 (P < .001). This provider-developed app is effective and receives high end-user satisfaction.

At the Mayo Health System in LaCrosse, Wisconsin, there are &gt;1000 infant total parenteral nutrition (TPN) orders placed per year. It is the most complicated order that the pharmacy fills, so a recent peer-review article in Pediatrics moved a group of us to action at our center to buy or develop a TPN calculator. We did this because no stand-alone commercial calculators were available to us, and expensive electronic medical records typically do not include TPN calculators for neonatal patients. The new software includes decision support, and the orders are consistently legible. The physician performs fewer calculations, and there are no mathematical errors. This article examines the broader significance of providers having to write their own TPN software.