Abyssinia Journal of Science and Technology Vol. 3, No.

1, 2018, 13-19

Abyss. J. Eng. Comput. Vol. 1, No. 1, 2021, 22-25

Abyssinia Journal of
© 2021 Kombolcha Institute of Technology, Wollo University
Engineering and Computing

Optimization of Phototherapy Machine for Advanced

Treatment of Neonatal Jaundice
*Hundessa Daba Nemomssa, Bheema Lingaiha & Wasihun Alemayehu
Jimma University, School of Biomedical Engineering, P.O Box 378, Jimma, Ethiopia

ABSTRACT
Neonatal Jaundice is a medical condition in which high number of unconjugated bilirubin exists in infant’s
blood resulting in yellowish colour of baby’s skin and whites of the eye. Unconjugated bilirubin is
potentially toxic to neural tissue both brain and spinal cord. Entry of unconjugated bilirubin into the brain
can cause both short-term and long-term neurological dysfunction, bilirubin encephalopathy, which needs
serious attention. Even though hospitals use phototherapy machine to treat jaundice, there are a number of
gaps on the machine related to its effectiveness. Among the gaps long hospitalization time, biological
hazards from strong optical radiation and limitation to higher hospitals are the major ones. The main
objective of this research was to optimize phototherapy machine for advanced treatment of neonatal
jaundice. Before optimization activities, necessary clinical study was performed and the results from the
clinical study were used as an input for optimization work. The optimization work included integration of
non-invasive bilirubin measurement, light intensity measurement, back treatment and different power supply
options to overcome the gaps. The actual device using 465 nm light emitting diode was developed and tested
against specifications. Non-invasive measurement system avoids invasive bilirubin measurement,
comfortable and makes tracking treatment progress easier. Addressing all skin surface of a baby by the
device improves treatment efficiency and plays vital role in baby to mother bond as it reduces treatment
time.

Keywords: Jaundice, Light intensity, Neonates, Non-invasive bilirubin meter, Phototherapy

INTRODUCTION jaundiced when the amount of bilirubin becomes

>7 mg/dl [1].
When the lifecycle of the red blood cell comes to
an end, the hemoglobin part of its composition Neonatal jaundice is a very common condition
breaks down into ‘heme’ and ‘globin’. The ‘heme’ worldwide occurring in up to 60% of term and
part of the dead cell is further decomposed into 80% of preterm newborns in the first week of life.
iron and bilirubin, illustrated on figure 1. Clinically As bilirubin begins to build up, it deposits on the
two types of bilirubin are known; conjugated and fatty tissue under the skin causing the baby's skin
unconjugated bilirubin. Unconjugated bilirubin to be white and the baby's eyes to appear yellow.
mostly circulates in the bloodstream bound to
albumin although some of it is 'free' and hence able It is one of the most common conditions requiring
to enter the brain. The color of bilirubin is an medical attention in newborn babies. According to
orange/ red pigment in the blood. The study done in Nigeria, the most common cause of
unconjugated bilirubin that circulates in the admission to this hospital and Children’s
bloodstream enters into the liver to be metabolized Emergency room within neonatal period was
and transformed into conjugated bilirubin. Then hyperbilirubinemia which accounts for 17% [2].
the metabolized (conjugated) bilirubin is largely According to this study hyperbilirubinemia was
excreted from the body as stool. When excretion among the cause of morbidity and mortality in
process is low, it does not work efficiently, or it is neonates.
overwhelmed by the amount of endogenously
produced bilirubin. When the amount of bilirubin Neonatal hyperbilirubinemia is a recognized cause
in the body increases, it results in of brain damage with unconjugated bilirubin
hyperbilirubinemia or jaundice. Newborns appear causing kernicterus, which results in long-term

*Corresponding author: hundedb@gmail.com

22
 Abyssinia Journal of Engineering and Computing Vol. 1, No. 1, 2021, 13-19

sequel like sensory-neuronal hearing loss [3]. One

study conducted on neonatal hyperbilirubinemia Clinical study
estimates that about 1.1 million babies would Clinical study was needed to identify the core
develop hyperbilirubinemia with or without problems on the current jaundice management
bilirubin encephalopathy worldwide yearly. systems across health institutions. The main points
Among those neonates, 481,000 were term under clinical study includes side effects from
neonates of whom 114,000 die annually and more exposure to light, availability of treatment progress
than 63,000 survive with moderate or severe indicator, need for extra phototherapy device,
disability. The vast majority, 75% of affected action taken for overflow of patient,
neonates, reside in sub-Saharan Africa, the region recommendation of phototherapy for health centers
where Ethiopia is located, and South Asia [4]. and drawbacks of the existing systems. The
outcomes of this clinical study were taken as key
Mortality rate of neonates in Ethiopia was 37 in input for optimization work done on the
1000 live births according to Ethiopian phototherapy machine.
demographic health survey of 2011 [5].
Hyperbilirubinemia was among the causes of Optimization
neonatal admission and death in Gondar Teaching Non-invasive bilirubin measurement technique is
Hospital. Among neonates admitted to neonatal less painful and gives fast result compared to
unit 31.7% of them were due to invasive measurement technique. By using the
hyperbilirubinemia. Among all neonates admitted concept of optical reflection and absorption,
to the hospital 23.1% were died [6]. bilirubin concentration can be monitored in early
stage. The bilirubin concentration will absorb
Even though hospitals use phototherapy machine wavelength of light between 457nm until 473nm.
to treat hyperbilirubinemia, there are a number of In order to achieve this, the system was designed
gaps on the machine related to its effectiveness. according to the following block diagram.
Among the gaps long hospitalization time,
biological hazards from strong optical radiation,
invasive measurement of bilirubin and limitation to
Light Source
higher hospitals are the major ones. (LED 465nm) LCD Display
Skin
Surf-
ace Microcontroller
(Arduino Uno)
MATERIALS AND METHODS Detector
LDR
Materials
Research Design
Clinical study was done and the results from the Fig.2. Block diagram of Non-invasive bilirubin
study were taken as input for the optimization meter
work done on the machine. Optimization and
efficiency improvement work focuses on covering In order to get uniform distribution of light
the maximum skin surface with required level of intensity, LED light was used as light source.
irradiance to reduce treatment time, providing Blue LED devices emit a narrow spectrum that
treatment progress indicator and multiple power overlaps the absorption spectrum of bilirubin. They
supply options to extend the service of device in are power-efficient, portable devices with low heat
lower-level health institutions. The overall production that can be kept close to the baby. They
procedure for this study was according to the are durable and long lasting with low power
following flow chart. consumption. Light intensity is monitored by Pulse
width modulation instead of monitoring distance.
The light from the device pass though blue light
Clinical Study filter before reaching the light sensor. Blue light
filter is needed to block the interference of another
Design of Bilimeter Optimization Design of Radiometer visible light spectrum from the surrounding. The
blue light reaching light sensor (photodiode
Exposure Area Power Supply
Bpw34) will be converted to electrical energy and
sent to microcontroller (Arduino Uno R3). Then
the proportional light intensity will be displayed on
Actual Implementation and Test LCD screen.

Output

Fig.1. Flow of research work

23
 Abyssinia Journal of Engineering and Computing Vol. 1, No. 1, 2021, 13-19

RESULT AND DISCUSSION wavelength of 465nm was used since this is

appropriate wavelength of light absorbed by
Non-invasive bilirubin meter
bilirubin. The board for lighting assembly was
Transcutaneous measurement of bilirubin through prepared by researcher and the wiring and
non-invasive technique was implemented for the soldering of the circuit was done in lab by
intervention of the current invasive measurement researcher. The prototype of the device was
of bilirubin. The test was performed on mock skin carefully assembled as shown below. The
as shown below with different concentration of dimension of the device considered the treatment
yellow pigment. Variation in skin color of baby is of one baby at a time. Therefore, the base
considered as the main source of noise, but dimension of the device was 50cm by 40cm; this
according to the study done on the influence of means the height is 50cm while the width is 40cm.
skin color on diagnostic accuracy of The gap between overhead light and baby is 20cm
transcutaneous bilirubin meter, the variation is which can be adjusted.
insignificant. The study was done in three
categories such as light skin, medium skin and
dark skin infant by comparing the result of
transcutaneous bilirubin meter with total serum
bilirubin measurement in laboratory. The result
indicated 95%, 94% and 96% correlation for light,
medium and dark skin neonates compared with
total serum bilirubin measurement [7].

Fig.5. Functional prototype of the device

Fig.3. Non-invasive bilirubin meter test on
With existing phototherapy machines care givers
mock skin
need to turn the infant every two hours to cover all
Light intensity
skin surfaces, but with this system the maximum
Light intensity measurement at various distances
skin surface will get treatment with provision of
from light source is compared with the actual
back side treatment option. The other advantage of
radiometer and the result is shown below. The
back side treatment is reduction of treatment time
mean accuracy of the developed system is 96%
which increases mother to baby bond.
compared to actual radiometer.
CONCLUSION

This research work addresses the major gaps

identified on phototherapy machine. The non-
invasive bilirubin measurement system developed
for the intervention of the existing invasive
bilirubin measurement system demonstrates high
efficiency during test on mock skin and it can be
used for measurement of bilirubin from dark
skinned babies as it demonstrates 94% to 96%
accuracy when compared with invasive bilirubin
measurement system in laboratory. This solves the
issue with treatment progress indicator and device
Fig.4. Light intensity control system use in health center level as the existing system is
tedious for clinicians and baby under treatment. On
Prototype of the device the other hand, the implemented light intensity
The overall system is implemented having the measurement system in this research gives
features; Non-invasive bilirubin meter, light accuracy of 96% when compared with actual
intensity indicator, modified power supply options radiometer which makes it ideal for continuous
and back treatment. For light source LED with monitoring. Beside this the implemented light

24
 Abyssinia Journal of Engineering and Computing Vol. 1, No. 1, 2021, 13-19

intensity measurement system is monitored using [4] V. K. Bhutani, A. Zipursky, H. Blencowe, R.

pulse width modulation system to help clinicians Khanna, M. sgro, F. Ebbesen , J. Bell, R.
deliver the required amount of light based on the Mori, T. M. Slusher, N. Fahmy, V. K. Paul, L.
bilirubin content without moving the overhead Du, A. A. Okolo, M.-F. De Almeida, B. O.
light. The added back treatment option reduces the Olusanya, P. Kumar, S. Cousens and J. E.
treatment time by 32 to 44% based on the bilirubin Lawn, "Neonatal hyperbilirubinemia and
amount. This increases baby to mother bond as the Rhesus disease of the newborn: incidence and
time taken for baby to stay under phototherapy impairment estimates for 2010 at regional and
machine is reduced. The overall system was global levels," Pediatrics Research, vol. 74,
implemented with different power supply options pp. 86-100, 2013.
i.e., AC power, Solar power and battery. This S. Tarekegn, L. Lieberman and V. Giedraitis,
makes the device very appropriate in areas where
[5]
"Determinants of maternal health service
power supply from main AC is limited. In general, utilization in Ethiopia: analysis of the 2011
the outcome of this research work produces a Ethiopian Demographic and Health Survey.,"
phototherapy machine equipped with non-invasive BMC pregnancy and childbirth., vol. 14, no.
bilirubin measurement system which continuously 1, p. 161, 2014.
monitor the bilirubin amount of baby under
treatment, digital light intensity monitoring system [6] M. Kokeb and T. Desta, "Institution Based
that monitors amount of light reaching neonates Prospective Cross-Sectional Study on Patterns
skin, back treatment system which allow treatment of Neonatal Morbidity at Gondar University
from front and back side at the same time and Hospital Neonatal Unit, North-West
multiple power supply options. Finally, since the Ethiopia.," Ethiopian journal of health
need for phototherapy machine is very high even in sciences, vol. 26, no. 1, pp. 73-90, 2016.
higher hospitals in our country, the concerned [7] S. Samiee-Zafarghandy , j. Feberova, J.
bodies have to facilitate the manufacturing of the Williams J, A. S. Yassen, S. L. Perkins and B.
device in our country to address the need since it Lemye, "Infl uence of skin colour on
could be easily implemented. diagnostic accuracy," Arch Dis Child Fetal
Neonatal, vol. 99, pp. 480-484, 2014.
CONFLICT OF INTEREST
The authors declare that there are no conflicts of
interest regarding the publication of this paper

ACKNOWLEDGMENT
Finally, the researchers would like to thank Tikur
Anbesa specialized hospital, JUMC, Agaro
General hospital, Shenen Gibe hospital and Seka
Hospitals with their pediatrics department staffs for
giving me valuable information during clinical
study. The researchers are also thankful to
Dr.Timothy Kwa, Sr. Yemisrach Getachew, Mr.
Lealem Yitayew, Mr. Muluken Gerbi, Mr. Lema
Kumbi, Mr. Zelalem Adbar, Mr. Dame Bulcha, my
family, my lovely fiancée and other people who
were with me during this work.

REFERENCES
[1] J. P. Cloherty , E. C. Eichenwald and A. R.
Stark, in Manual of Neonatal Care, USA,
Lippincott williams and Wilkins, 2008, p.
181.
[2] U. Ekwochi, I. Ndu, I. Nwokoye , O.
Ezenwosu , O. Amadi and D. Osuorah,
"Pattern of morbidity," Nigerian journal of
clinical practice, vol. 17, no. 3, pp. 346-351,
2014.
[3] J. Volpe, Neurology of the newborn, 4th ed.,
Saunders W, 2000.

25