Journal of Neonatal Nursing (2016) 22, 108e114

www.elsevier.com/jneo

ORIGINAL ARTICLE

Nurses’ experiences using conventional

overhead phototherapy versus fibreoptic
blankets for the treatment of neonatal
hyperbilirubinemia
Anne Marit Føreland, Master in, Pediatric Nursinga,*,
Lene Rosenberg, Master in, Intensive Care Nursinga,
Berit Johannessen, Ph.D, Associate Professorb

a
Sørlandet Hospital (SSHF), Postbox 416, 4604 Kristiansand S, Norway
b
Institute of Health and Nursing Science, University of Agder, Postbox 422, 4604
Kristiansand S, Norway

Available online 21 January 2016

KEYWORDS Abstract Background: In some neonatal intensive care units (NICUs), conven-
Phototherapy; tional overhead phototherapy is the only phototherapy available, whereas others
Fibre optic; use fibreoptic blankets only. Several NICUs use both treatments interchangeably.
Bilirubin; Aim: To explore how nurses experience the use of conventional versus fibreoptic
Family-centred care; phototherapy.
Bonding; Method: Six qualitative in-depth interviews involving nurses at three different NI-
Satisfied; CUs with experience in both treatments were conducted.
Harm; Results: Following experiences were revealed: i) Infants displayed discomfort
NICU while under phototherapy, whereas blanket use promoted infant satisfaction. ii)
Blankets increased parents’ satisfaction by facilitating bonding, breastfeeding
and kangaroo care. iii) The nurses disagreed as to whether fibreoptic blankets
and conventional treatment have similar effects. iv) Nurses were concerned about
the possible harm and discomfort to the eyes and skin of infants caused by photo-
therapy.

* Corresponding author. Tel.: þ47 98470410.

E-mail address: annemafo@hotmail.com (A.M. Føreland).

http://dx.doi.org/10.1016/j.jnn.2016.01.001
1355-1841/ª 2016 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.
Nurses’ experiences using conventional versus fibreoptic phototherapy
Conclusion: When the efficacy was considered sufficient, nurses preferred blankets
compared with conventional overhead, because of ability to facilitate infant com-
fort and parentechild interaction.
ª 2016 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.
Introduction
Phototherapy is the use of visible light for the
treatment of neonatal hyperbilirubinemia or
jaundice. It is a major strategy for the prevention
of bilirubin-induced brain damage and is consid-
ered a relatively harmless intervention (Wong
et al., 2006). Many different devices are avail-
able, but there is no international standardized
practice.
In conventional phototherapy, the infant is
placed in a bed or incubator with a light-source
placed 10e50 cm overhead. A new method that
delivers light from a high-intensity lamp to a
fibreoptic panel came into use around 1990
(Murphy and Oellrich, 1990). These devices take
the form of beds, pads and blankets of different
sizes and designs. Various studies have examined
the efficacy of conventional versus fibreoptic de-
vices, but the results vary widely because of dif-
ferences in the light source and configuration
(Bhutani, 2011; van Imhoff et al., 2013). Some
studies have focused on phototherapy and
maternal experiences but have not compared
conventional versus fibreoptic phototherapy.
Phototherapy is frequently a difficult and
emotionally stressful time for mothers (Brethauer
and Carey, 2010; Hannon et al., 2001), and it can
interfere with breastfeeding (Willis et al., 2002).
Modern neonatal intensive care units (NICUs)
emphasize the importance of the family, and
‘family-centred care’ (FCC) is considered the
best approach for providing paediatric care
(Shields et al., 2012). Szucs and Rosenman’s
(2013) case report focused on the challenge of
providing effective phototherapy within the
framework of FCC. A Cochrane review found that
research into the possible advantages of
fibreoptic over conventional phototherapy was
required (Mills and Tudehope, 2001). In some
NICUs, conventional overhead is still the only
phototherapy treatment available, whereas
others use fibreoptic blankets only. Several NICUs
use both treatments interchangeably. There is a
lack of studies concerning nurses’ experiences
using conventional versus fibreoptic phototherapy
in the NICU.
109
Aim
The aim of this study was to explore how nurses
experience the use of conventional versus
fibreoptic phototherapy in neonatal care.
Method
A qualitative research design using individual semi-
structured interviews was chosen (Malterud, 2012).
The study was conducted in three Norwegian NICUs
in October 2013: one regional and university hos-
pital, and two district general hospitals. Two of the
selected hospitals used both conventional and
fibreoptic phototherapy. One hospital had stopped
using conventional devices and used fibreoptic
blankets only. Two nurses in each hospital were
interviewed. The inclusion criteria were: (i) a
minimum of two years’ experience with photo-
therapy and (ii) experience with both conventional
overhead and fibreoptic blanket phototherapy.
Each interview lasted about 45 min. The in-
terviews followed a semi-structured interview guide
with four main themes: experiences using conven-
tional phototherapy, experiences using fibreoptic
blankets, perceived advantages and disadvantages,
and perceived differences between the methods.
The interviews were transcribed verbatim into
92 pages of transcript, and analysed by systematic
text condensation (STC) as developed by Malterud
(2011). STC is inspired by Giorgi’s phenomenolog-
ical method and includes four steps. 1) Obtain an
overview of the data and identify preliminary
themes. 2) Identify and code the meaning units
relevant to the study question. 3) Condense and
sort the content in each code group into subgroups.
4) Reconceptualise the data by synthesizing the
content of the condensates and develop de-
scriptions. This process resulted in nine pages of
text, which were divided into four main categories.
Ethical considerations
The study protocol was approved by the Faculty
Research Ethics Committee, the Norwegian Social
Science Data Service and the hospitals’ research
110 A.M. Føreland et al.

Table 1 Characteristics of the sample.

Participant NICU Auxiliary/ Choice of Experience Experience with
nurse experience postgraduate light source with conventional fibreoptic blanket
and unit (years) education in phototherapy phototherapy (years)
neonatal or (years)
intensive nursing
A, NICU 1 13 Yes Conventional and/ 13 3
or fibreoptic
B, NICU 1 17 Yes Conventional and/ 17 3
or fibreoptic
C, NICU 2 3 No Conventional and/ 3 <1 year in this NICU,
or fibreoptic 2e3 years in
another NICU
D, NICU 2 14 No Conventional; 14 1
fibreoptic when
multiple
therapy useda
E, NICU 3 22 Yes Fibreoptic 19 7
F, NICU 3 22 Yes Fibreoptic 19 7
a
Multiple phototherapy: when using more than one light source simultaneously (NICE, 2010).

departments. Written informed consent was ob-
tained from all the participants before inclusion in
the study.
There were no conflicts of interest that could
affect the results.
Results
The interviewed nurses’ NICU experiences and
choice of light sources are shown in Table 1.
The fibreoptic blanket was new to NICU 2 and
had not been incorporated into routine practice as
well as in NICUs 1 and 3. NICU 2 had only one
fibreoptic blanket available, whereas NICU 1 had
two and NICU 3 had several blankets. The most
frequently used types of equipment were BiliSoftª
(fibreoptic) and NeoBlueª or BiliCompactª (con-
ventional). The nurses did not comment on the
type of light (LED, fluorescent, halogen, etc.).
Uncertainty about the efficacy of fibreoptic
blankets
babies if she knew it was effective. Nurses A and B
had conducted a literature review and had found
that the fibreoptic blanket is effective if a suffi-
cient amount of the body surface is exposed to
light. They preferred fibreoptic blankets for pre-
term but not necessarily for full-term babies. For
treating full-term infants, the nurses considered
whether the blanket could cover the infant, the
bilirubin level and the infant’s comfort. Nurse D
expressed her opinion:
“Conventional is very effective, maybe even
more effective.”
Nurse C indicated:
“If the efficacy is better, the advantage is a
shorter time of the light treatment.”
The two nurses at NICU 3 believed the fibreoptic
blanket was as effective as conventional therapy,
and they no longer used conventional therapy.
Nurse F said:
“It does not take many days to lower bilirubin
level. The efficacy is fine.”

The nurses from NICUs 1 and 2 agreed that the She also indicated that the treatment time had
decreased after the unit started using BiliSoftª,
combination of conventional and fibreoptic light
which is larger than the previously used
sources was a good option for delivering multiple
BiliBlanketª. When required, they used two
phototherapy. For single-light1 phototherapy, the
blankets; over and underneath the infant.
experiences varied between the four nurses. For
example, Nurse C stated: “Sometimes it seems to
work fine, other times it doesn’t”. She would use Differences in infant comfort
the blanket for most of the preterm and full-term
All six nurses reported that infants frequently
cried, were uncomfortable or were stressed under
1
Single-light phototherapy uses one light source. conventional phototherapy. Nurse E stated:
Nurses’ experiences using conventional versus fibreoptic phototherapy
“The babies are naked, unprotected and
alone.”
According to several nurses, the infants receive
a shorter period of phototherapy if breaks have to
be taken to comfort them. All six nurses found that
infants were more satisfied in blankets than under
conventional treatment because the baby can be
wrapped with the blanket, which forms a
comfortable nest around the baby, and the blanket
promotes the foetal position. Nurse F stated:
“When using the fibreoptic blanket, the infant is
satisfied and sleeps well in a comfortable
position.”
Nurse A gave an example of a baby who cried
constantly during conventional phototherapy. The
only place he was happy was in his mother’s arms
or when breastfeeding. The conventional treat-
ment was interrupted for a long time until a
fibreoptic blanket was placed under him as he lay
in his mother’s arms.
Differences in parent satisfaction
Several nurses described phototherapy as a situa-
tion that is difficult for parents; several had seen
parents crying. Nurse D said:
“Parents are really worried about their baby’s
situation, even if it is a situation we are not
concerned about! They often express their
worries more intensely than in other situations.”
She found this peculiar because phototherapy is
usually an uncomplicated treatment, and she
thought this distress might relate to the mother’s
hormonal imbalance or unmet expectations. Several
nurses described the parental feeling of distance or
a dramatic image of a naked child with eyes covered
under conventional light, and stated that these
feelings might harm the attachment process.
All six nurses believed that the fibreoptic
blanket allowed the infant to be closer to the
parent. Nurse E said: “I think the parents are
happy when the child is close to them.” She had
heard parents saying with surprise: “Is this really
possible?”
Two of the nurses (E and F) had seen infants
spend almost all day in kangaroo care (KC) com-
bined with phototherapy. They described this as
valuable for parenteinfant bonding and indicated
that it was in accordance with the Newborn Indi-
vidualized Developmental Care and Assessment
Program (NIDCAP). Nurses B, C and E felt that the
combination of KC and phototherapy was not
accomplished as often as it could be. Nurse E
111
suggested that letting the infant remain in bed or
the incubator may be more convenient for the
nurse. Some nurses were not aware of the possi-
bility that KC could be combined with photo-
therapy. Nurse C said:
“Regarding interaction and FCC, the fibreoptic
blanket is preferred. It’s not easy to provide
skin-to-skin contact, but at least the parents
can hold the baby in their arms.”
Possibility of harm from phototherapy
The nurses all described the blue light as uncom-
fortable, and they turned it off during in-
terventions. Eye protection for the infant was used
in both conventional and fibreoptic phototherapy.
Several nurses reported that the eye protection
fell off easily or slipped away from the eyes, but
the situation was better when using a fibreoptic
blanket.
Nurse B stated:
“The eye protection does not slide away from
the eyes as often as in conventional therapy,
because the infant is calmer.”
Some nurses explained that they used sheets or
curtains as shields, but none of the units provided
eye protection for the parents or nurses. Several
nurses described the conventional light as glaring
and stated that long-term exposure was “painful or
uncomfortable”. All agreed that light from blan-
kets is much more comfortable than conventional
light.
The blanket might be a challenge for the baby’s
skincare because the blanket is quite hard, and
some nurses noted that a baby’s skin can become
clammy. Nurses B and C chose the conventional
device for infants with immature skin. The nurses
sometimes discussed whether phototherapy might
not be as safe as assumed:
“How harmless is the light for the fragile,
transparent skin and the cells?” (Nurse F)
Discussion
The nurses described their positive experiences
with fibreoptic devices, such as the promotion of
infant comfort, parent satisfaction, bonding,
breastfeeding, KC, and NIDCAP. However, some
nurses had concerns about the efficacy of fibreoptic
blankets and the possibility of harm from both
fibreoptic and conventional phototherapy.
112
The present study revealed that one of the ad-
vantages of fibreoptic phototherapy is that infants
seem to be satisfied. All six nurses had experience
with crying, stressed or uncomfortable infants
during conventional phototherapy. This has been
shown in research on mothers’ experiences
(Hannon et al., 2001). However, infant behaviour is
rarely the focus of research on phototherapy,
despite the short- and long-term importance.
Stressed preterm infants have an increased risk of
haemorrhage in the first days after birth (Volpe,
2008), which is often concurrent with beginning
phototherapy.
Several nurses perceived phototherapy as being
traumatic for parents. Previous studies have re-
ported similar results; for example, mothers have
reported the first days of having an infant with
neonatal jaundice as “very frustrating”, “torture”,
“gruelling”, “draining”, “brutal”, “awful” and
“overwhelming” (Brethauer and Carey, 2010). The
nurses in our study proposed that unmet expecta-
tions, maternal hormonal imbalance, a feeling of
distance, worries about hazards and the image of a
naked baby might explain the reactions of parents.
This is consistent with previous studies that have
described mothers’ struggles with guilt, distress,
breastfeeding problems, misunderstanding and
lack of information (Hannon et al., 2001). The
feeling of distance and lack of parentechild
bonding are emphasized in several studies (Hannon
et al., 2001; Truman, 2003). These feelings and
reactions highlight the importance of the finding in
our study that the fibreoptic blanket helps to
promote the parentechild interaction, breast-
feeding and parent satisfaction. Some nurses also
noted that KC is possible and is favourable during
phototherapy, although Nurses C and D did not use
KC with fibreoptic phototherapy. As indicated by
Nurse C, this may be because of uncertainty and
lack of knowledge, which have been shown to be
barriers to the delivery of KC (Flynn and Leahy-
Warren, 2010). Nurse B suggested that not using
KC with fibreoptic phototherapy might reflect a
general lack of KC implementation in the unit. This
is a well-known challenge in NICUs (Jesney, 2015).
Nurses may feel that it is more convenient or feel
more in control by keeping the infant in a bed or
incubator (Ludington-Hoe, 2011).
The nurses had different views on the duration
needed for treatment. Some nurses indicated that
conventional phototherapy may be more effective
and has the advantage of requiring a shorter period
of light treatment. Infants who receive fibreoptic
treatment may need prolonged treatment (Mills
and Tudehope, 2001). On the other hand, several
nurses experienced that crying infants received
A.M. Føreland et al.
many breaks from conventional phototherapy and
that the bilirubin level did not decrease to the
extent desired. Treatment was seldom interrupted
when using fibreoptic blankets because the baby
was satisfied or easier to calm. This is not shown in
previous research. The nurses in NICU 3 had found
that the blankets worked well enough to enable
them to discontinue the use of conventional de-
vices. All nurses highlighted the ability to lower
bilirubin level as the most important quality of a
phototherapy device; however, this goal could be
achieved in different ways.
Nurses described the blue light from photo-
therapy as causing discomfort. The eye protection
slipped off easily, and they worried about harm to
the infants’ eyes. This problem is discussed by
recent studies that have focused on the adverse
effects of blue light (Xiong et al., 2011; Csoma
et al., 2011). Phototherapy might not be as
harmless as previously thought. None of the three
NICUs used eye shields for parents or nurses, even
though this is recommended by device manufac-
turers. Protective glasses for parents and nurses
might be made available in all NICUs. However,
this is of minor importance when using fibreoptic
blankets. According to the findings of our study,
light from a fibreoptic blanket is less uncomfort-
able and is easier to block. Eye shields are still
needed for the infant, but they do not slip away as
often when fibreoptic blankets are used because
the infant is calmer. Nurses were also concerned
about the use of phototherapy for preterm infants
because of their immature skin and the possibility
of causing cell injury. Research indicates that
phototherapy may increase mortality among the
most immature infants (Tyson et al., 2012), and
this finding may be related to the thin skin through
which the light penetrates readily and more deeply
(Maisels et al., 2012). Extremely low birth weight
infants treated with fibreoptic blankets are at
lower risk of patent ductus arteriosus or death
(Morris et al., 2013). Experts are discussing adverse
effects (Hansen, 2012), and it might influence
future recommendations for the use of fibreoptic
versus conventional light sources.
There are many types of conventional and
fibreoptic devices and differences in their use and
guidelines for use around the world. The Norwegian
guidelines recommend fibreoptic devices for mul-
tiple phototherapy treatment but not for use as a
single device (Bratlid et al., 2011). Only one of the
nurses (Nurse D) acted in accordance with this
guideline. NICU 3 used a fibreoptic device as the
only choice and used two blankets for infants with a
high bilirubin level. The guidelines of the American
Academy of Pediatrics (2004) for newborns 35
Nurses’ experiences using conventional versus fibreoptic phototherapy
weeks state that fibreoptic devices deliver enough
output to be effective for standard phototherapy
but not when the bilirubin level requires “inten-
sive”2 phototherapy. These guidelines also state
that two or three pads may be needed because the
pads cover only a small surface area. The British
guidelines state that babies <37 weeks may receive
fibreoptic phototherapy unless the serum bilirubin
level increases rapidly (NICE, 2010).
The guidelines differ between countries despite
being based on research. Mills and Tudehope (2001)
concluded that fibreoptic phototherapy was equally
as effective as conventional phototherapy in pre-
term infants but less effective in full-term infants,
and the combined use of both device is most
effective. A study of preterm babies <31 weeks
(Romagnoli et al., 2006) confirmed these results.
However, according to Morris et al. (2013),
fibreoptic blankets have the highest mean irradi-
ance level but are not effective for extremely low-
birthweight infants. The differences in the use of
devices between the nurses in our study reflect the
diversity in guidelines and research findings.
The use of six informants may limit how repre-
sentative this study is; however, the findings
represent practice from three different NICUs and
91 years of experience from nurses using photo-
therapy. Our findings indicate a need for more
research on and discussion about phototherapy.
Questions remain about whether fibreoptic blan-
kets will be the only devices and, if not, how
caregivers should make the best choice about the
configuration and use of conventional and
fibreoptic equipment. The importance of infant
satisfaction and parent bonding in conjunction
with the choice of light source should also be
investigated.
Conclusion
This study describes the perceptions of six nurses
from three different NICUs about their experiences
with conventional overhead versus fibreoptic
blanket phototherapy. Positive experiences with
fibreoptic devices were found, such as the pro-
motion of infant comfort, parent satisfaction,
bonding, breastfeeding, KC and NIDCAP. However,
some nurses and their colleagues had concerns
about the efficacy of fibreoptic blankets and the
2
Intensive phototherapy is defined as irradiance of at least
30 mW/cm2 per nm in the 430e490 nm band to deliver light to as
much of the infant’s surface area as possible (AAP, 2004).
113
possibility of harm caused by both fibreoptic and
conventional phototherapy.
When decrease in bilirubin level was considered
sufficient, blankets were the nurses’ preferred
light source, compared with conventional over-
head phototherapy because of the ability to
facilitate infant comfort and parentechild
interaction.
Conflicts of interest
None.
Acknowledgements
We are indebted to the nurses and their leaders
who agreed to take part in this study.
References
American Academy of Pediatrics, AAP, 2004. Management of
hyperbilirubinemia in the newborn infant 35 or more weeks
of gestation. Pediatrics 114 (1), 297e316.
Bhutani, V.K., 2011. Phototherapy to prevent severe neonatal
hyperbilirubinemia in the newborn infant 35 or more weeks
of gestation. Pediatrics 128 (4), e1046ee1052. http://dx.
doi.org/10.1542/peds.2011-1494.
Bratlid, D., Nakstad, B., Hansen, T., 2011. National guidelines
for treatment of jaundice in the newborn. Acta Paediatr.
Oslo Nor. 1992 100 (4), 499e505. http://dx.doi.org/10.
1111/j.1651-2227.2010.02104.x.
Brethauer, M., Carey, L., 2010. Maternal experience with
neonatal jaundice. MCN Am. J. Matern. Child Nurs. 35 (1),
8e16. http://dx.doi.org/10.1097/01.NMC.0000366803.
88540.1d.
Csoma, Z., Tóth-Molnár, E., Balogh, K., Polyánka, H., Orvos, H.,
Ocsai, H., Kemény, L., Széll, M., Oláh, J., 2011. Neonatal
blue light phototherapy and melanocytic nevi: a twin study.
Pediatrics 128 (4), e856ee864. http://dx.doi.org/10.1542/
peds.2011-0292.
Flynn, A., Leahy-Warren, P., 2010. Neonatal nurses’ knowledge
and beliefs regarding kangaroo care with preterm infants in
an Irish neonatal unit. J. Neonatal Nurs. 16 (5), 221e228.
http://dx.doi.org/10.1016/j.jnn.2010.05.008.
Hannon, P.R., Willis, S.K., Scrimshaw, S.C., 2001. Persistence of
maternal concerns surrounding neonatal jaundice: an
exploratory study. Arch. Pediatr. Adolesc. Med. 155 (12),
1357e1363. http://dx.doi.org/10.1001/archpedi.155.12.
1357.
Hansen, T.W.R., 2012. Let there be lightebut should there be
less? J. Perinatol. 32 (9), 649e651. http://dx.doi.org/10.
1038/jp.2012.80.
Jesney, S., 2015. A critical analysis of the role of the nurse in
the implementation of skin-to-skin on the neonatal unit. J.
Neonatal Nurs 22 (2), 68e73. http://dx.doi.org/10.1016/j.
jnn.2015.04.008.
Ludington-Hoe, S.M., 2011. Thirty years of kangaroo care sci-
ence and practice. Neonatal Netw. 30 (5), 357e362. http://
dx.doi.org/10.1111/j.1651-2227.2009.01597.
114
Maisels, M.J., Watchko, J.F., Bhutani, V.K., Stevenson, D.K.,
2012. An approach to the management of hyper-
bilirubinemia in the preterm infant less than 35 weeks of
gestation. J. Perinatol. 32 (9), 660e664. http://dx.doi.org/
10.1038/jp.2012.71.
Malterud, K., 2011. Kvalitative metoder i medisinsk forskning:
en innføring. Universitetsforlaget, Oslo.
Malterud, K., 2012. Systematic text condensation: a strategy for
qualitative analysis. Scand. J. Public Health 40 (8), 795e805.
http://dx.doi.org/10.1177/1403494812465030.
Mills, J.F., Tudehope, D., 2001. Fibreoptic phototherapy for
neonatal jaundice. Cochrane Database Syst. Rev. (1).
http://dx.doi.org/10.1002/14651858.CD002060.
Morris, B.H., Tyson, J.E., Stevenson, D.K., Oh, W., Phelps, D.L.,
O’Shea, T.M., Higgins, R.D., 2013. Efficacy of phototherapy
devices and outcomes among extremely low birth weight
infants: multi-center observational study. J. Perinatol. 33
(2), 126e133. http://dx.doi.org/10.1038/jp.2012.39.
Murphy, M.R., Oellrich, R.G., 1990. A new method of photo-
therapy: nursing perspectives. J. Perinatol. 10 (3), 249e251.
NICE, 2010. Neonatal Jaundice. Retrieved 20.10.2015 from.
http://www.nice.org.uk/CG98.
Romagnoli, C., Zecca, E., Papacci, P., Vento, G., Girlando, P.,
Latella, C., 2006. Which phototherapy system is most
effective in lowering serum bilirubin in very preterm infants?
Fetal Diagn. Ther. 21 (2), 204e209. http://dx.doi.org/10.
1159/000089304.
Shields, L., Zhou, H., Pratt, J., Taylor, M., Hunter, J., Pascoe, E.
, 2012. Family-centred care for hospitalised children aged
0e12 years. Cochrane Database Syst. Rev. (10). http://dx.
doi.org/10.1002/14651858.CD004811.pub3.
Available online at www.sciencedirect.com
ScienceDirect
A.M. Føreland et al.
Szucs, K.A., Rosenman, M.B., 2013. Family-centered, evidence-
based phototherapy delivery. Pediatrics 131 (6),
e1982ee1985. http://dx.doi.org/10.1542/peds.2012-3479.
Truman, P., 2003. Jaundice in the preterm infant: effective
management. J. Neonatal Nurs. 9 (1), 22.
Tyson, J.E., Pedroza, C., Langer, J., Green, C., Morris, B.,
Stevenson, D., Higgins, R., 2012. Does aggressive photo-
therapy increase mortality while decreasing profound
impairment among the smallest and sickest newborns? J.
Perinatol. 32 (9), 677e684. http://dx.doi.org/10.1038/jp.
2012.64.
van Imhoff, D.E., Hulzebos, C.V., van der Heide, M., van den
Belt, V.W., Vreman, H.J., Dijk, P.H., 2013. High variability
and low irradiance of phototherapy devices in Dutch NICUs.
Arch. Dis. Child. Fetal Neonatal Ed. 98 (2), F112eF116.
http://dx.doi.org/10.1136/archdischild-2011-301486.
Volpe, J.J., 2008. Neurology of the Newborn. Saunders,
Philadelphia.
Willis, S.K., Hannon, P.R., Scrimshaw, S.C., 2002. The impact
of the maternal experience with a jaundiced newborn on
the breastfeeding relationship. J. Fam. Pract. 51 (5),
465e465.
Wong, R.J., DeSandre, G.H., Sibley, E., Stevenson, D.K., 2006.
Neonatal jaundice and liver disease. In: Fanaroff, A.A.,
Martin, R.J., Walsh, M.C. (Eds.), Fanaroff and Martin’s
Neonatal-Perinatal Medicine: Diseases of the Fetus and In-
fant. Mosby Elsevier, Philadelphia, pp. 1429e1465.
Xiong, T., Qu, Y., Cambier, S., Mu, D., 2011. The side effects of
phototherapy for neonatal jaundice: what do we know? what
should we do? Eur. J. Pediatr. 170 (10), 1247e1255. http://
dx.doi.org/10.1007/s00431-011-1454-1.