Biliblanket

A biliblanket is a portable phototherapy device used to treat neonatal jaundice (hyperbilirubinemia).[1] BiliBlanket is a trademark of General Electric's Datex-Ohmeda subsidiary, but its name has become the generic, colloquial term for a range of similar products and the term used in the medical professions. The name "biliblanket" combines the words bilirubin and blanket, and this device is also known as home phototherapy system, bilirubin blanket, or bidirectional fiber-optic phototherapy blanket.[2]

A baby being treated for jaundice with a BiliBlanket

Different types of phototherapy for jaundice involve a blue light of varying types of light, wavelengths, and degrees of irradiance to remove excess bilirubin from the body.[3] Compared to standard forms of phototherapy, a biliblanket utilizes a fiberoptic system, allowing them to be used in the hospital or at home for phototherapy treatment.[2] The baby is placed in direct contact with the pad, which is connected to a machine, and the parents can continue to hold or feed the baby.[4]

The biliblanket system consists of three components: an illuminator, fiberoptic pad, and disposable cover or vest.[2] The fiberoptic pad is used to transport blue or white light from the light source, the illuminator, directly onto the baby's skin.[5] The light waves are absorbed by the baby's skin and blood, which will promote breakdown of bilirubin and allow it to be eliminated.

Neonatal Jaundice (Hyperbilirubinemia)

Jaundice is not uncommon in newborn babies and presents itself as yellow discoloration of the skin and whites of the eyes (sclera). Jaundice occurs in roughly 60% to 84% of infants.[2] This condition also causes babies to appear sick, experience difficultly waking up, make high-pitch cries, or not be able to be fed or gain weight.[6] Bilirubin is an orange yellow bile pigment that is produced as a byproduct of hemoglobin as red blood cells break down (hemolysis). Bilirubin is then metabolized in the liver, recycled, and excreted in the bowel movements. When a baby has jaundice or hyperbilirubinemia, this can indicate that the baby's body is producing excess bilirubin or that the liver is too immature to be able to eliminate bilirubin fast enough.[7] Feeding, in particular breastfeeding, the baby often in the first few days of birth can help lower the chances of developing jaundice, since the baby will pass more stool and the milk provides energy to the liver to allow metabolism of bilirubin. Uncontrolled levels of bilirubin can be harmful to the baby.[8] Most neonatal jaundice shows during the first week after birth. Nevertheless, when bilirubin levels become exceedingly high, the substance may move out of the blood, cross the blood brain barrier, and collect in brain tissue, damaging the baby's brain cells, a condition known as acute bilirubin encephalopathy.[9] If acute bilirubin encephalopathy is not addressed promptly, Kernicterus syndrome can develop and cause permanent brain damage.[10] In rare situations, a baby may experience seizures, deafness, cerebral palsy or mental retardation.[3] Jaundice can be prevented and treated in the majority of cases. Jaundice is more dangerous in certain cases such as babies who are born prematurely (before 37 weeks of gestation), babies who are underweight (less than 2500 grams at birth), babies who are going through an infection, babies who experienced a difficult delivery or have bruises (since they are replacing and breaking down more red blood cells at a higher rate) and babies who have a blood group that is not compatible with their mothers.[8]

Mechanism

Jaundice in some babies can disappear within one to two weeks without treatment; however for babies with more severe jaundice, treatment is required. A biliblanket is a phototherapy home treatment that consists of a portable illuminator and fiber-optic pad. It uses a pad of woven fibers to transfer light to a baby in order to treat neonatal jaundice (hyperbilirubimia). It uses visible light to transform bilirubin into a more water-soluble form that allows it to dissolve easily in water and be eliminated. This therapy lowers the serum bilirubin level. The baby is placed on the fiber-optic pad, which has a disposable cover in direct contact with the baby's skin.[2] This fiber-optic pad exposes the skin to light, and bilirubin is eliminated when light is absorbed.[4] The biliblanket releases waves of blue or white light, when these are absorbed in the skin, bilirubin breaks down and is eliminated from the baby's blood stream.

This lowers the yellowing effect in the baby's eyes and skin.[1] Afterwards, blood needs to be tested to observe bilirubin levels and decide whether the biliblanket is still needed. Majority of babies that need a biliblanket use it for several days, but it depends on each baby's condition. Even though a biliblanket may cause loose stools and skin rashes, it is considered safe for the most part. This device is mostly used for 2 to 3 days only. In severe situations, intravenous fluids may be needed to be given to the patient. When a baby is receiving treatment, they only wear protective eye patches and a diaper so most of the skin and absorb the light.[11]

Phototherapy uses photons of energy that are infused and absorbed by bilirubin located in superficial capillaries and subcutaneous tissues and interstitial spaces of the skin. Photochemical reactions then transform bilirubin into nontoxic isomers that are more polar, water-soluble and therefore, can be excreted without being further metabolized by the liver. Urinary and gastrointestinal elimination remain important to the process of reducing the bilirubin load.[7]

Proper Use

The biliblanket setup consists of the light generator, termed the light box, the fibre-optic cable through which the light is carried, and the fiberoptic pad, which is a 25cmx13cm (10"x5") pad that is attached to the baby. The light generator stores the source of light, which is a halogen bulb. The fiber-optic cable connects the light generator to the fiberoptic pad, which contains fiberoptic fibers and usually has a disposable cover.[2]

It is important to make sure that the light-source machine is placed on a flat, level, hard surface such as a table or nightstand to ensure proper ventilation. A disposable cover is placed onto the light pad and should be changed if the cover becomes soiled. For effective therapy, the baby’s skin should be directly exposed to the light pad as much as possible. The light pad should be on at all times except during baths. The light pad is usually placed on the undressed baby’s back with a diaper on. Clothing may be worn, but the clothing should be placed over the light pad, and the light pad should still be in direct contact with the baby’s skin. The light pad should never be placed on the baby's head.[4] The baby can sleep, eat, or be held while the light pad is on.

In some cases, it is recommended that the baby's eyes are covered with eye patches during phototherapy treatment to prevent the risk of retinal damage. In adults, it has been shown that prolonged exposure to blue or white light can cause retinal damage.[12]

The biliblanket is safe and can be used for 24 hours a day as long as therapy is required. However, the duration of phototherapy will vary from individual to individual based on the baby's current condition and disease state. It will also depend on the physician’s clinical judgement.[13]

Blood tests may be required daily during phototherapy to assess the bilirubin levels and determine if normal levels have been reached and whether or not phototherapy can be stopped. Once the bilirubin levels are normal, the baby's skin will return to its normal color.[4]

Side Effects

One common side effect that is experienced by babies who are receiving phototherapy treatment is more frequent and loose stools. The color of these stools are usually a greenish color; however, this is normal because that is the way bilirubin is removed from the body. As bilirubin levels return to normal and phototherapy is no longer needed, the frequency of bowel movements and the color of the stools will return back to normal.[3]

Short-term[3]
  • Skin lesions
  • Diarrhea due to thermal and hydroelectrolytic abnormalities
  • Bronze baby syndrome (grey and brown pigmentation of the skin in infants with cholestasis)[14]
  • Hematological changes
  • Paralytic ileus

Long-term[3]

Other side effects of phototherapy include effects on circadian cycle genes, patent ductus arteriosus, and possible retinal damage if the eyes are exposed to constant phototherapy.[3]

Efficacy

Comparison of biliblankets vs. conventional phototherapy

The efficacy of biliblankets is still being studied today. A trial compared the efficacy of Ohmeda Biliblanket (fiber-optic phototherapy) and daylight fluorescent lamps (conventional phototherapy) in full-term, healthy infants. The study also compared different intensities of fiber-optic phototherapy such as standard, large, and double phototherapy. In conclusion, the trial found that a decrease in bilirubin levels was greatest in the double-fiber optic and conventional daylight group. The double-fiber optic phototherapy demonstrated slightly better initial efficacy while the conventional daylight phototherapy demonstrated better overall efficacy.[15]

Breast-fed infants have a lower response to phototherapy

Another study compared the efficacy of phototherapy in formula-fed, breast-fed, and formula and breast-fed infants. They found that, although breast-fed infants still achieved adequate efficacy, they had a significantly reduced response to phototherapy. As a result, the addition of formula would enhance the efficacy of phototherapy and reduce phototherapy exposure time.[16][17]

Combining biliblankets and conventional phototherapy

When choosing between conventional phototherapy, fiberoptic Wallaby, and photo-optic biliblanket it has been shown that combining therapies shorten the duration of treatment.[18]

Ohmeda Biliblanket vs Wallaby Phototherapy System

The Ohmeda biliblanket is more effective in reducing bilirubin levels in the home-care environment. Although still effective, the Wallaby phototherapy system had similar efficacy as conventional therapy, This is due to the Ohmeda biliblanket's feature to control the intensity of therapeutic light.[19]

Advantages

Unlike conventional forms of phototherapy, which require eye protection, the baby does not need to have eye protection when using a biliblanket. Another advantage of the biliblanket is that it can be used at home. In some cases, if the baby’s condition is not too severe, the parents will be given a biliblanket to set up and use at home. This provides a more comfortable and convenient setting since the parents and baby do not have to stay in the hospital. Other advantages of the biliblanket are that it can be easily transported, can be used when the baby is sleeping, eating, and or being held, and promotes a relationship between parents and infants since they do not need to be separated during treatment.[2]

Disadvantages

The biliblanket is one of the many forms of phototherapy devices used for the treatment of neonatal jaundice. Other phototherapy devices include blue LEDs, halogen white light, and fluorescent tubes. Although biliblankets were made to be compact in size, they often cannot be used as monotherapy since they do not provide a large enough surface area for adequate treatment. Therefore, biliblankets are often used in combination with fluorescent or halogen lights.[3]

History

In 1956, Sister Ward, a nurse at Rochford General Hospital in Essex, England, discovered that a jaundiced infant's body had regained its normal skin color after exposure to the sun. One small region, which had not been exposed to the sun, remained yellow in color. This discovery, along with findings that blood tubes exposed to the sun showed a decrease in bilirubin concentrations, drove research and development of the first phototherapy device for treatment of neonatal jaundice.[7]

Phototherapy has been used to treat neonatal jaundice since the early 1970's. The conventional form of phototherapy has been performed in the hospital for more than thirty years and requires the presence of multiple overhead light sources, such as halogen or fluorescent lamps, shining directly on the baby.[2] With advances in technology, novel forms of phototherapy emerged using optical fibers and a light source. Clinical testing for fiberoptic phototherapy devices began in 1988, which led to the development of the Wallaby Phototherapy System and biliblanket.[13]

References
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  2. Donel J (2019). "Bili Blanket Phototherapy". International Journal of Contemporary Pediatrics. 6 (5): 2231–2234. doi:10.18203/2349-3291.ijcp20193760.
  3. Faulhaber FR, Procianoy RS, Silveira RC (February 2019). "Side Effects of Phototherapy on Neonates". American Journal of Perinatology. 36 (3): 252–257. doi:10.1055/s-0038-1667379. PMID 30081405.
  4. "Your Baby, Jaundice and Phototherapy". www.med.umich.edu. Retrieved 2020-07-30.
  5. Chang YS, Hwang JH, Kwon HN, Choi CW, Ko SY, Park WS, et al. (February 2005). "In vitro and in vivo efficacy of new blue light emitting diode phototherapy compared to conventional halogen quartz phototherapy for neonatal jaundice". Journal of Korean Medical Science. 20 (1): 61–4. doi:10.3346/jkms.2005.20.1.61. PMC 2808577. PMID 15716604.
  6. "Newborn Jaundice: Causes, Symptoms, Treatment, and Prevention". Healthline. 2017-07-26. Retrieved 2020-07-31.
  7. Stokowski LA (October 2011). "Fundamentals of phototherapy for neonatal jaundice". Advances in Neonatal Care. 11 (5 Suppl): S10-21. doi:10.1097/ANC.0b013e31822ee62c. PMID 22123449. S2CID 23883586.
  8. "Jaundice in newborns". Paediatrics & Child Health. 12 (5): 409–20. May 2007. doi:10.1093/pch/12.5.409. PMC 2528723. PMID 19030401.
  9. "Bilirubin encephalopathy: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2020-07-31.
  10. "Kernicterus". NORD (National Organization for Rare Disorders). Retrieved 2020-07-31.
  11. "Infant jaundice - Symptoms and causes". Mayo Clinic. Retrieved 2020-07-31.
  12. "FAQs About Phototherapy". Newborn Nursery. Retrieved 2020-07-31.
  13. Mills JF, Tudehope D, et al. (Cochrane Neonatal Group) (2001). "Fibreoptic phototherapy for neonatal jaundice". The Cochrane Database of Systematic Reviews (1): CD002060. doi:10.1002/14651858.CD002060. PMC 7025799. PMID 11279748.
  14. Onishi S, Itoh S, Isobe K, Togari H, Kitoh H, Nishimura Y (March 1982). "Mechanism of development of bronze baby syndrome in neonates treated with phototherapy". Pediatrics. 69 (3): 273–6. PMID 7063284.
  15. Tan KL (October 1994). "Comparison of the efficacy of fiberoptic and conventional phototherapy for neonatal hyperbilirubinemia". The Journal of Pediatrics. 125 (4): 607–12. doi:10.1016/s0022-3476(94)70019-2. PMID 7931883.
  16. Watkinson M (June 1999). "Formula for jaundiced breast-fed infants". Archives of Pediatrics & Adolescent Medicine. 153 (6): 657–8. PMID 10357315.
  17. Newman J (June 1999). "Breast-feeding, jaundice, and formula". Archives of Pediatrics & Adolescent Medicine. 153 (6): 656–7. PMID 10357314.
  18. Romagnoli C, Zecca E, Papacci P, Vento G, Girlando P, Latella C (2006). "Which phototherapy system is most effective in lowering serum bilirubin in very preterm infants?". Fetal Diagnosis and Therapy. 21 (2): 204–9. doi:10.1159/000089304. PMID 16491004. S2CID 11662145.
  19. George P, Lynch M (March 1994). "Ohmeda Biliblanket vs Wallaby Phototherapy System for the reduction of bilirubin levels in the home-care setting". Clinical Pediatrics. 33 (3): 178–80. doi:10.1177/000992289403300313. PMID 8194298. S2CID 934223.
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