I thought you may be interested in this - yes we do say to lay babies near a
window here too, avoiding overheating etc, however I always emphasis it's
the frequent and *effective* feeding that is more important :-)

http://www.mja.com.au/public/issues/178_08_210403/joh10652_fm.html

"Is sunlight an effective treatment for jaundice in term infants?" A women's
health educator at Southern Health wanted to know if there was any evidence
that sunlight helps to reduce physiological jaundice in healthy term
infants.

Search question
The formulated search question followed a standard
patients/interventions/comparisons/outcomes (PICO) format. Patients were
term newborn infants with physiological jaundice (see Box), and the
intervention was exposure to sunlight. Clinical outcomes of interest were
primarily a reduction of jaundice. A randomised controlled trial comparing
sunlight exposure to no treatment or another treatment would be the most
appropriate study design to answer this clinical question.

Search
The search terms "neonatal jaundice", "hyperbilirubin(a)emia" or "icterus"
were combined with the treatment search terms "sunlight", "heliotherapy" or
"phototherapy". We searched the following electronic databases: the Cochrane
Library, Best Evidence, MEDLINE, CINAHL (Cumulative Index to Nursing and
Allied Health Literature), Current Contents and Biological Abstracts.
MEDLINE indexes articles published since 1966, but a widely cited and
historically important article that provided the first English-language
report of an association between light and a reduction in neonatal jaundice
was published in 1958.2 In light of this, we hand-searched the print
versions of Index Medicus and Science Citation Index from 1958 to 1966. We
also searched the websites of a number of organisations: Bandolier,
University of Michigan Department of Pediatrics (Evidence-Based Pediatrics),
US National Guidelines Clearinghouse, National Health and Medical Research
Council of Australia (Publications Catalogue), Scottish Intercollegiate
Guidelines Network, and UK National Health Service (Institute of Health
Sciences Guideline Project).

Summary of findings
Our extensive search identified only the one, original study that examined
sunlight exposure as a treatment for neonatal jaundice.2 This was a case
series reporting the effect of sunlight in jaundiced preterm, rather than
term, infants. The same authors then reported a case series of artificial
light therapy for jaundiced preterm infants, which stimulated the subsequent
considerable volume of research articles on the effectiveness of
phototherapy for neonatal jaundice in both term and preterm infants. Current
recommendations for artificial phototherapy are summarised elsewhere.3 We
found no controlled trials comparing sunlight against either no treatment or
artificial light treatment for jaundice. The use of sunlight appears to have
resulted from anecdotal reports of its effectiveness rather than from
rigorous medical evidence. And if the effectiveness of sunlight exposure for
jaundice is unknown, so too is the incidence of potential risks to the
neonate - for example, sunburn or photosensitivity.

Outcome
There is insufficient evidence to support exposure to sunlight for the
treatment of jaundice. The persistence of this practice 40 years after
publication of a report on a single case series raises questions about the
influence of evidence on the beliefs of professional healthcare workers.
Based on our search results, a recommendation against using sunlight
exposure to treat jaundice was distributed to Southern Health staff and used
in an education program for midwives.

(Definition of physiological jaundice
Physiological jaundice is a diagnosis of exclusion. It should not fill any
of the following criteria:
Clinical jaundice in the first 24 hours of life;
Total serum bilirubin level > 300 ?mol/L in a term infant or > 255 ?mol/L in
a preterm infant;
Direct reacting serum bilirubin level > 30 ?mol/L, persisting more than 10
days in a term infant or 14 days in a preterm infant.)

References
Levene MI, Tudhope DI, Thearle MJ, editors. Essentials of neonatal medicine.
3rd ed. Massachusetts: Blackwell Science, 2000: 143.
Cremer RJ, Perryman PW, Richards DH. Influence of light on the
hyperbiliru-binaemia of infants. Lancet 1958; i: 1094-1097.
American Academy of Pediatrics. Practice parameter: management of
hyper-bilirubinaemia in the healthy term newborn. Pediatrics 1994; 94:
558-565. <PubMed>
Harrison SL, Buettner PG, MacLennan R. Why do mothers still sun their
infants? J Paediatr Child Health 1999; 35: 296-299. <PubMed>
(Received 3 Oct 2002, accepted 8 Dec 2002)

Centre for Clinical Effectiveness"


Cheers
Karen Clements
IBCLC
Melb Aust

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html