BiliBed and BiliCombi
Newborn babies with hyperbilirubinaemia need more than just phototherapy treatment – they need to be close to their mum, too.
The BiliBed phototherapy system allows mums and babies to be together day and night. This frees up hospital staff for other duties.
The Bilicombi comfortably secures the baby to the BiliBed and keeps the baby protected and warm. Bilicombi comes in reusable and disposable versions in order to cover all hospital needs.
Benefits of BiliBed
The BiliBed fits into standard hospital cots, enabling mum and baby to be together, and allowing the mum to pay close attention to the baby during treatment.
The Bilicombi allows the light to be directed accurately at the baby, at the minimum distance.
Two displays monitor the therapy and the total time the BiliBed has been in use during treatment.
A single fluorescent tube with a life of 1,500 hours and a low power requirement (30W) keeps operating costs to a minimum.
- Baby-friendly treatment in mum's room
- Highly effective thanks to the short distance to the light source
- No eye protection needed as the baby is wrapped in a soft Bilicombi blanket
- Easy to use
- Low cost and efficient to run
How were the 1500 hours determined (necessary for tube change)?
According to tests we had done, at 1500 hours the irradiance drops to 75% of that of a new lamp.
Does the BiliBed meet the American Acadamy of Pediatrics requirements for Intensive Phototherapy?
The BiliBed does meet and exceeds the AAPs requirements for intensive phototherapy. The 2004 AAP guidelines state that intensive phototherapy implies the use of high levels of irradiance in the 430 to 490 nm band (usually 30 μW/cm2/nm or higher) delivered to as much of the infant’s surface area as possible.
Upon connecting the device to the voltage, it starts to operate automatically (without anybody turning it on). Is this normal?
The BiliBed was designed to turn on automatically when it is plugged in. Some hospitals put the Bilibed into a tight fitting cot. Then the start/stop switch can no longer be attached (or is no longer desired). Therefore, the BiliBed was designed to turn on when plugged in. In this manner, the start/stop switch is not necessary to turn on the light.
If the doctor chooses to place a baby on his stomach, does the baby need eye patches?
If the baby must be laid on his stomach and the washable Bilicombi is being used, eye patches are not needed, provided that the Bilicombi is properly secured around the baby’s neck. Eye patches are recommended if the baby is on its stomach and the disposable Bilicombi is used because a small amount of light can come through the material.
Do you think it is wrong to say that babies can only be treated on their back?
Dr. Sender, who wrote a study about using the BiliBed, did his tests with the baby positioned on his back (there are some doctors who prefer this, due to the possible risk of SIDS when the baby is positioned on his stomach). In this study he notes the duration of therapy is perfectly comparable with therapy with conventional phototherapy lamps. It is therefore not wrong if you say, the baby should only be treated on his back. We mention the possibility of treating the baby on both sides, because it is possible to do this (as in Switzerland). Some doctors consider the repositioning of the baby similar to intermittent phototherapy.
What can you tell me about the BiliBed bag?
The outer material is cordura in marine blue color. On the side is a zippered compartment for keeping the instructions for use. The bag comes with a shoulder strap and a carrying handle.
Is there a danger of the baby developing bedsores from pressure and/or would they develop rashes from wriggling on the gauze?
Bedsores and rashes are common among premature babies because they have no fat layers. This does not make a difference, if the baby is under phototherapy or not. The possibility of a baby getting rashes of bedsores on the BiliBed is not different. Our experience has shown that the baby support (very flexible, baby almost floats on bed) has a more likely positive effect. The cotton material is similar than normal bed sheets.
The bilirubin levels went up after using the BiliBed. What does this mean?
This can happen with any phototherapy. The levels can first rise and then the phototherapy actually starts working. The doctors performing phototherapy should be acquainted with this phenomenon if they used lamps earlier. Sometimes, the levels first rise and then start sinking, and sometimes the levels automatically start sinking.
Is there a possibility of low-temperature burn?
Since starting to sell the BiliBed (1994) we have not had any such cases. Normally the baby is treated for 2 max 4 days on the BiliBed. Occasional breaks for breastfeeding or changing diapers are taken. The safety tests of the TÜV and other certifiers have shown that the temperature on the perspex cover does not exceed 40°C. There are some countries that have a high room temperature. When the BiliBed is placed into a bassinet without ventilation holes and the air circulation is not as recommended in the instructions for use (20 cm2 around the BiliBed; the width of a regular pencil), a sweating baby may be the result (no burns). The Bilicombi has been designed to improve the air circulation. So far, no low-temperature- burns have been reported.
Must babies wear diapers on the BiliBed?
Medela recommends that the baby wears small diapers when undergoing phototherapy.
There are different studies about this topic:
The study “Phototherapy for neonates” from Graham Hart, Chris Day and Anne Hainsworth (published in the Journal of Neonatal Nursing) states: “Gonad protection: As long as all the UV radiation has been filtered from the phototherapy unit, there is no reason for gonad protection due to the treatment itself”. (The BiliBed does not emit any UV radiation)
In the study “Phototherapy for Neonatal Jaundice” from K.L. Tan (published in Clinics in Perinatology, September 1991) the author states: Maximal exposure is mandatory for maximal efficacy; therefore, our infants are unclothed completely during phototherapy. Experience in over 10,000 male infants has demonstrated no ill effects even at “saturation” dose, either in the immediate or long term. Some of these patients are already in their teens and are growing and developing normally. Chances of any complications occurring to the gonads during phototherapy would indeed seem to be highly unlikely because the period of exposure is relatively short and the gonads are shielded by the skin and subcutaneous tissue”.
The study “Hyperbilirubinemia and neonatal jaundice” from Susan Blackburn (Neonatal Network, October 1995) lists possible side effects of phototherapy. She concludes “However, most studies have failed to demonstrate significant long-term adverse effects in human infants treated with phototherapy and for whom interventions are initiated to reduce the impact of these side effects”.
What about the distance between the baby and the baby irradiation light source?
It is therefore a considerable advantage, that the baby lies so close to the light source. This way the therapeutic light that reaches the baby is at an optimum. There has been no case in the specialist literature or in talks with clinics, which report that someone had a too high phototherapy light transmission level. There are occasional people who state that as soon as the level of phototherapy light transmission reaches a certain point, that the therapeutic effect does not improve. However, the main opinion is that the more light, the better. Obviously the specialists aren’t of one mind. The specialists we contacted (Wiese, Sender, Lindgren) believe that there is no danger with higher levels of phototherapy light transmission.
Is there a danger of electrocution when the baby voids on the BiliBed?
We have several precautions against electrocution:
The baby does not lie directly on the glass surface, but on the baby support. If there is any dampness (urine), it stays on the baby support, because the weight of the baby will get it to form a little “puddle”, and so keep it from reaching the plexiglass surface.
The BiliBed is completely sealed. We have a rubber sealing separating the BiliBed from the plexiglass surface.
If the baby were to lie directly on the surface (operator fault #1) and if dampness would develop on the glass surface (operator fault # 2) and if the rubber sealing had been removed from underneath the plexiglass surface (operator fault #3), then there would still not be a chance of electrocution, because the electrical connections are all built in on a higher level than the base of the BiliBed. There is no danger of electrocution when using the BiliBed.
What do the numbers on the hour meter mean?
The first number before the dot is the hour (this means 1 = 1 hour). The highest digit shown on the hour meter would be: 99’999.9. The numbers behind the dot = 1/10th hour (this means, it changes every 6 minutes)
Does intermittent phototherapy make sense?
There is one study which explains the benefits of intermittent phototherapy - Intermittent phototherapy in the treatment of jaundice in the premature infant, Vogl, Thomas P et al. This study states that “intermittent phototherapy is as effective as continuous illumination in the treatment of hyperbilirubinemia in preterm infants”.
How long is the light tube good for and how often should it be checked?
BiliBed light tubes are guaranteed if changed every 1'500 hours of use. As long as they are changed every 1'500 hours of use there is no need to check their irradiation unless your organization requires it.
How do you measure the BiliBed's irradiance level?
You need a meter capable of measuring high intensity (40+ μW/cm2/nm) light in the 425 - 475 nm light spectrum. Medela recommends the Olympic Medical Bili-meter Model 22 with type B-22 sensor. The B-22 sensor is specifically for fluorescent light, which Bilibed has. Press the button on the sensor and place it on the bed with or without the Bilicombi therapy blanket. Make sure the eye of the sensor is facing down towards the light source and in the center of the bed. Press down slightly to replicate the weight of the baby on the bed. A good light tube will read in the range of 40 ñ 60 μW/cm2/nm. The higher reading will be directly above the light tube and decreasing as you move away from it. With a new light tube it is common to have reading as high as the low 100 μW/cm2/nm. Before using other meters on the BiliBed make sure they meet the above requirement.
Is there a protection against power surges?
The electronics of the BiliBed are protected against damage through voltage spikes in the electricity supply. If there is an excessive voltage surge in the power network, your BiliBed will switch off automatically. It can be turned on again for further use by pressing the START/STOP switch.
Is there a safety circuit that switches the lamp off in order to protect the system from overheating?
Regarding the electronic safety circuit: the lamp is turned off when the fan is not running at the proper speed or is blocked. This means, the circuit is not measuring the temperature. Only when a problem with the fan occurs, does the lamp switch off. This is a protection measure, to keep the BiliBed from overheating. If the fan works properly, there should be no overheating.
Is vacuum extraction a contraindication for the use of the BiliBed when phototherapy is needed?
No, this is no contraindication to use the BiliBed. Exposing the head is not necessary since phototherapy does not act locally but all over the skin
What are minimum and maximum baby weights when using the BiliBed?
The ideal weight is ~>2.5kgs (~5.5lbs). Caution should be exercised for babies below 1.5 - 2.0kgs (~3.3 - 4.4lbs) as their skin surface may be too small. The maximum baby weight is 10kgs (~22lbs).
How should the Bilicombi be cleaned?
Remove Bilicombi from BiliBed Zipper Bilicombi and attach under-chin Velcro fastener.
Wash for Standard Machine cycle. Minimum wash cycle of 10 minutes is recommended.
Machine wash in hot water. We recommend temperature of 140 degrees F (60°C). The maximum temperature is 210 degrees F (95°C). Standard cleaning detergent to be used. Refer to washing machine manufacturer for instructions. Use of Chlorine Bleach can cause color to bleach and/or fade and can reduce life of Bilicombi. Tumble dry low heat. If any of the Velcro fasteners shows decreased adherence, a new Bilicombi should be used.
What does μW/cm2/nm mean?
μW/cm2/nm is pronounced: micro watts per square centimeter per nanometer. This is measurement of spectral irradiance that is taken within an area equal to 1 square centimeter. Spectral irradiance is the power output of light. When we measure the BiliBed's irradiance we are measuring the light power output in a specific light wavelength (425 - 475 nm).
To be more specific:
- μW (micro watt), micro is the prefix for one millionth (0.000001) & watt is a measurement of power, so 1 μW is equal to one millionth (0.000001) of a watt.
-cm2 (square centimeter), is a measurement of area. 1 cm2 is equal to 0.155 square inches or you can look at is as 1 square foot is equal to 929 cm2. So when you use the Bilimeter to take a measurement, the sensor you lay on the bed is calculating this measurement within an area equal to 1 square centimeter.
- nm (nanometer), is a unit of measurement that is used to determine a light's wavelength. Different colors of light have different wavelengths. When you see a rainbow the wavelengths of all the colors range from approximately 400 - 700 nm.
The reddish colors you see in a rainbow have longer wavelengths (around 650 - 700 nm) where the BiliBed’s blue colored light has shorter wavelengths of 425 - 475 nm. For reference, the length of 1 nanometer is equal to 1billionth of a meter or a thousand millionth of a meter or can also be stated at 0.0000000001 meters.
What is transcutaneous bilirubin measurement?
Because serum bilirubin measurement via heelstick is invasive and expensive (although it is considered a reliable and accurate measure) an alternative, noninvasive method of screening for bilirubin levels in infants can be used: a transcutaneous bilirubinometer, or jaundice meter. The bilirubin meter is a noninvasive instrument which is pressed against the baby’s skin (usually on the forehead). The instrument produces an electro flash. The reflected light from the skin is analyzed and electronically evaluated. The bilirubin meter shows either an index number or the level. Because measurements can be affected by race, gestational age and birth weight, this type of device is more useful with a homogenous population. Once phototherapy is initiated, these devices are less reliable; if they are used, a small area of skin needs to be kept patched for use in testing.
Does blue light affect the infants or care givers?
This is not scientifically proven. Nevertheless, it is commonly known that blue light can hurt the baby’s eyes (which is why the baby needs eye patches when conventional phototherapy lamps are used). Caregivers often complain about headaches and eye irritation due to the blue light. It is very important that the phototherapy equipment focuses the light on the baby. Therefore, again the advantage of the BiliBed: the light is focused directly on the baby. No disturbing light reaches the caregivers. The phototherapy lamp from Medela also focuses the light on the patient. However, the IEC Standard requires that we write about possible side-effects: for the nursing staff: This lamp emits blue light in the wavelength of 425-475 which may harm the retina in some cases. You may want to avoid prolonged use/exposition if:
- you have a pre-existing ocular condition such as macular degeneration
- you are diabetic or otherwise at risk for retinal damage
- you are taking photosensitizing medication
- you are 55+ years.
What is the difference between blue and white light?
Blue light, in the range of about 425-475 nm has the best therapeutical effect. White light has a proportion of blue light in it. This means that white light not as beneficial as blue light (like used in the Medela phototherapy lamp or BiliBed) itself. Due to some disadvantages of blue light (blue light may mask skin colour changes of the patient, general discomfort to the caregivers) some phototherapy lamps are equipped with blue and white light tubes. We would like to give you some statements out of studies that were made on this subject. Why Use Homeopathic Doses of Phototherapy?, from M. Jeffrey Maisels, Dept. of Pediatrics, Royal Oak, MI USA First of all, the efficacy of phototherapy depends mainly on 3 factors: the spectrum of light, the power output of the light and the surface area of the infant exposed. Maisels states that: “ Because of the optical properties of bilirubin and skin, the most effective wavelengths are in the blue-green spectrum...
“Special blue” fluorescent tubes provide much more irradiance in the blue spectrum than other tubes and are the most effective light source currently available in the United States for phototherapy. Blue Light, Green Light, White Light, More Light: Treatment of Neonatal Jaundice, John F. Ennever, Clinics in Perinatology, Vol 17, No. 2, June 1990.
“The reason that color is important is that the first event in phototherapy is a bilirubin molecule absorbing a photon of light. Only light of certain colors (or wavelengths) can be absorbed by bilirubin... the blue light at approximately 450 nm is the most absorbed.... “Phototherapy for Neonatal Jaundice, K.L. Tan, Clinics in Perinatology, Vol. 18, No. 3, Sept 1991 Tan states “Our study comparing the efficacy of blue, daylight and green lamps demonstrated quite clearly that blue light was significantly more effective than either daylight or green light in reducing bilirubin values in comparable groups of healthy babies, as well as smaller infants under intensive care.”
Efficacy of “high intensity” blue-light and “standard” daylight phototherapy for nonhaemolytic hyperbilirubinaemia, KL Tan et al, Acta Paediatr 81, 1992 On page 873 the graphs show more than words can tell. The bottom graph is the decrease of the bilirubin levels when blue lights are used. Thus, Tan states “high intensity phototherapy using double-bank blue lamps with an emission spectrum similar to the absorption of bilirubin was more effective than daylight lamps, resulting in a decrement rate that was about twice that of daylight lamps”.