Effectiveness of a locally made eye protector for neonates treated with phototherapy at Queen Elizabeth Central Hospital (QECH), Malawi: a bench study.

backgroundThe highest incidence of severe neonatal jaundice occurs in Africa at 667.8 per 10,000 live births. At the Queen Elizabeth Central Hospital (QECH), approximately 75% of neonates have clinical jaundice, with up to 15% requiring treatment. While phototherapy is the standard treatment, the intense blue light poses the risk of retinal damage, which has led to the routine practice of eye protection for neonates receiving this therapy. Nonetheless, QECH, like other low-resource settings, lacks standard eye shields, forcing staff to improvise with different materials to shield the neonate's eyes. Whether these improvised methods are effective in that function is unknown, however. This study aims to develop a reusable eye shield and evaluate the effectiveness of the various eye protectors used for neonates receiving phototherapy at QECH.

methodsIn this bench study, improvised eye shields used between May and December 2023 were collected and compared to the newly developed eye shield using a gold-standard material. Twenty samples from each type of eye shield were measured using a light metre placed immediately beneath the material to measure the intensity of light irradiance at 10 cm, 15 cm, 25 cm, and 35 cm from the light source. Data were analysed using non-parametric statistical methods.

resultsOwing to the lack of standard eye care, nurses at QECH improvised eye protection for neonates using makeshift materials such as folded gauze, plaster, and surgical face masks. Among these, surgical masks were the least protective, with an average light irradiance of 12.78 µW/cm²/nm (95% CI 12.00-13.56) at the farthest distance. The shielding capacity of gauze and plaster materials was dependent on the thickness of the gauze used, which was determined by the available resources in the ward. The most protective gauze-based shields had an irradiance of 2.0 µW/cm²/nm, with an overall average of 5.96 µW/cm²/nm (95% CI 4.66-7.26). In comparison, the reusable cotton shield and the reference eye shield had no detectable light across all distances, registering a zero µW/cm²/nm light irradiance.

conclusionFor settings like QECH, where resources are limited and standard eye protection is unavailable for neonates undergoing phototherapy, the reusable cotton eye shield presents a viable alternative to improvised materials.