Do phototherapy hoods really protect the neonate?

The objective of the current study was to evaluate the protection given to the eyes of neonates by an Amber 300 phototherapy hood during blue-light phototherapy from Drager Phototherapie 800 units, and to make recommendations for clinical practice. Hazard-weighted blue-light radiance of phototherapy lamps was measured inside neonatal incubators, with and without the use of a protective phototherapy hood. The study was carried out in a tertiary referral neonatal unit. No patients were involved. A mannequin was used as model of a jaundiced neonate being treated with blue-light phototherapy. The study shows that hazard-weighted blue-light radiance levels detectable from within the space enclosed by the hood may be several times greater than accepted industrial threshold limits for adults. Conclusions: Nursing and medical staff must ensure meticulous care in the positioning of infants,so that the caudal edge of the shadow cast by the hood is always at least 30 mm inferior to the infants' lower eyelids. The vulnerability of the neonatal retina and the relatively high levels of blue-light radiance visible from within the shadow of the hood may make it advisable to use more effective eye protection. Triple phototherapy using lamps at the foot-end of the incubator is clearly hazardous and should not be carried out unless the infant's eyes are protected by eye-patches.