When pediatrician Tina Slusher, MD, began caring for newborns in Nigeria in 1989, she saw two big threats to the babies' health: severe jaundice and tetanus.
"I thought, 'Tetanus will go away with immunization, but nobody really seems to understand this jaundice problem,'" Slusher, a global pediatrics expert at the University of Minnesota, told me recently. In developing countries, well over 150,000 babies a year currently die or suffer severe brain damage from jaundice. "They still aren't getting treated," Slusher says.
But now, thanks to Slusher and her colleagues, that is set to change. She is the lead author on a scientific paper in the New England Journal of Medicine that evaluated a low-tech, inexpensive method for treating jaundice with filtered sunlight. The technology was conceived and built at Stanford, by a team led by neonatal jaundice expert David Stevenson, MD.
Newborn jaundice is caused by a delay after birth in development of the baby's ability to metabolize compounds released in the breakdown of red blood cells. In the U.S. and other developed countries, most cases are treated with phototherapy. But putting a baby under a blue-light-emitting lamp isn't feasible in places that lack steady electricity. The team members, who also included doctors and researchers at the Massey Street Children's Hospital in Lagos, Nigeria, wondered if they could safely use filtered sunshine instead.
From our press release about the new study:
Some mothers and babies sat under outdoor canopies that filtered out harmful wavelengths from sunlight, but still allowed jaundice-treating blue wavelengths to reach the babies’ skin. The filtered-sunlight treatment was as safe and effective as the blue-light lamps traditionally used to treat infant jaundice.
“This research has the potential for global impact,” said the study’s senior author, David Stevenson, MD, the Harold K. Faber Professor in Pediatrics and senior associate dean for maternal and child health at Stanford. “All babies can get jaundice. In settings with no access to modern devices, we’ve shown we can use something that’s available all around the planet — sunlight — to treat this dangerous condition.” Stevenson also directs the Johnson Center for Pregnancy and Newborn Services at Lucile Packard Children’s Hospital Stanford.
There's an appealingly MacGyver-ish back story to this work. Before building the sun-filtering canopies, Stanford researcher Hendrik Vreman, PhD, climbed out on the roof of a building on campus to test the UV- and infrared-blocking ability of commercially available plastic filters under the steady California sunshine. In the lab, he also used a heat lamp - the kind sometimes found in bathroom ceilings - to double-check whether the filters blocked infrared rays, which could make babies overheat. He eventually selected two filters, one for use in overcast conditions and one for sunny days, both of which let jaundice-treating blue light through. He then figured out how to incorporate the filters into canopies that moms and babies could sit under, doing much of the initial construction in his own backyard.
The next steps, Slusher said, are to test the technique for babies with more severe jaundice, and to launch a public health campaign that will help new mothers and other caregivers recognize jaundice in time to treat it. Vreman has also introduced commercially-available greenhouse kits that incorporate the filters, so that babies in rainy and windy locations can benefit, too.
“We’re excited that we can use our understanding of the biology of jaundice and adapt treatment to the local context of a developing country, and the resources that exist there,” said Stevenson.
Previously: Global health and precision medicine: Highlights from day two of Stanford's Childx conference, Countdown to Childx: Global health expert Gary Darmstadt on ensuring newborn survival and Stanford alums develop way to review maternal and child health products used in developing nations
Photo by Hendrik Vreman