Sixty years of phototherapy for neonatal jaundice – from serendipitous observation to standardized treatment and rescue for millions

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A breakthrough discovery 60 years ago by Cremer et al. has since changed the way we treat infants with hyperbilirubinemia and saved the lives of millions from death and disabilities. “Photobiology” has evolved by inquiry of diverse light sources: fluorescent tubes (wavelength range of 400–520 nm; halogen spotlights that emit circular footprints of light; fiberoptic pads/blankets (mostly, 400–550 nm range) that can be placed in direct contact with skin; and the current narrow-band blue light-emitting diode (LED) light (450–470 nm), which overlaps the peak absorption wavelength (458 nm) for bilirubin photoisomerization. Excessive bombardment with photons has raised concerns for oxidative stress in very low birthweight versus term infants treated aggressively with phototherapy. Increased emphasis on prescribing phototherapy as a “drug” that is dosed cautiously and judiciously is needed. In this historical review, we chronicled the basic to the neurotoxic components of severe neonatal hyperbilirubinemia and the use of standardized interventions.

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