Neonatal hyperbilirubinemia affects approximately 60% of healthy term infants and 80% of preterm infants. Although mostly physiological and transient, it can progress to acute bilirubin encephalopathy and kernicterus if the unconjugated fraction reaches elevated levels. Since the late 1950s, phototherapy has served as the first-line treatment: blue-green light converts bilirubin into water-soluble photoisomers that can be eliminated without hepatic conjugation. This work examines light sources for phototherapy and their clinical efficacy through a comparative analysis of recent scientific literature, evaluating lighting, clinical, and technical-operational parameters. From this comparison, summarized in a table, three generations of devices emerge: fluorescent and halogen lamps, limited by a broad spectrum, rapid irradiance decay, heat generation, and flicker; narrow-band gallium nitride LEDs, which represent the current standard for intensive phototherapy due to their high and stable irradiance, minimal thermal emission and long lifespan; and finally, a new generation based on switchable blue/green spectrums, hexagonal grid LED arrays, and smart platforms equipped with IoT sensors and artificial intelligence. Furthermore, the work addresses the limitation of reduced effective body surface area irradiated, the long-term risks of light exposure (which mandate avoiding overtreatment), and solutions for de-hospitalization and low and middle-income countries, including filtered sunlight phototherapy,bshown to be non-inferior to conventional electrical phototherapy, wearable devices and home phototherapy. The conclusions outline a trajectory toward personalized, closed-loop adaptive dosimetry capable of combining efficacy, safety, equitable access to care, and the preservation of the maternal-infant bond.
L'iperbilirubinemia neonatale interessa circa il 60% dei nati a termine sani e l'80% dei pretermine: per lo più fisiologica e transitoria, può tuttavia evolvere in encefalopatia acuta da bilirubina e kernicterus se la frazione non coniugata raggiunge livelli elevati. Dalla fine degli anni Cinquanta il trattamento di prima linea è la fototerapia: la luce blu-verde converte la bilirubina in fotoisomeri idrosolubili, eliminabili senza coniugazione epatica. Il lavoro esamina le sorgenti luminose per fototerapia e la loro efficacia clinica mediante un'analisi comparativa della letteratura scientifica recente, valutando parametri illuminotecnici, clinici e tecnico-operativi. Dal confronto, sintetizzato in tabella, emergono tre generazioni di dispositivi: le lampade fluorescenti e alogene, limitate da spettro ampio, rapido decadimento dell'irradianza, produzione di calore e sfarfallio; i LED a banda stretta al nitruro di gallio, oggi standard per la fototerapia intensiva grazie a irradianza elevata e stabile, minima emissione termica e lunga vita utile; infine una nuova generazione basata su spettro commutabile blu/verde, matrici LED a griglia esagonale e piattaforme intelligenti con sensori IoT e intelligenza artificiale. Sono inoltre discussi il limite della ridotta superficie corporea realmente irradiata, i rischi a lungo termine dell'esposizione luminosa, che impongono di evitare il sovratrattamento, e le soluzioni per la deospedalizzazione e per i paesi a medio e basso reddito: fototerapia solare filtrata, non inferiore a quella elettrica convenzionale, dispositivi indossabili e fototerapia domiciliare. Le conclusioni delineano una traiettoria verso una dosimetria personalizzata e adattiva a ciclo chiuso, capace di coniugare efficacia, sicurezza, equità di accesso alle cure e tutela del legame madre-neonato.
ANALISI DI SORGENTI LUMINOSE PER IL TRATTAMENTO DELL'ITTERO NEONATALE
NOBILI, BEATRICE
2025/2026
Abstract
Neonatal hyperbilirubinemia affects approximately 60% of healthy term infants and 80% of preterm infants. Although mostly physiological and transient, it can progress to acute bilirubin encephalopathy and kernicterus if the unconjugated fraction reaches elevated levels. Since the late 1950s, phototherapy has served as the first-line treatment: blue-green light converts bilirubin into water-soluble photoisomers that can be eliminated without hepatic conjugation. This work examines light sources for phototherapy and their clinical efficacy through a comparative analysis of recent scientific literature, evaluating lighting, clinical, and technical-operational parameters. From this comparison, summarized in a table, three generations of devices emerge: fluorescent and halogen lamps, limited by a broad spectrum, rapid irradiance decay, heat generation, and flicker; narrow-band gallium nitride LEDs, which represent the current standard for intensive phototherapy due to their high and stable irradiance, minimal thermal emission and long lifespan; and finally, a new generation based on switchable blue/green spectrums, hexagonal grid LED arrays, and smart platforms equipped with IoT sensors and artificial intelligence. Furthermore, the work addresses the limitation of reduced effective body surface area irradiated, the long-term risks of light exposure (which mandate avoiding overtreatment), and solutions for de-hospitalization and low and middle-income countries, including filtered sunlight phototherapy,bshown to be non-inferior to conventional electrical phototherapy, wearable devices and home phototherapy. The conclusions outline a trajectory toward personalized, closed-loop adaptive dosimetry capable of combining efficacy, safety, equitable access to care, and the preservation of the maternal-infant bond.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12075/29567