Uniform national guidelines do not prevent wide variations in the clinical application of phototherapy for neonatal jaundice

Aim: This study compared the use of phototherapy for neonatal jaundice in all 21 Norwegian neonatal intensive care units (NICUs) from 2013-2014 to improve practice. Methods: Information on all types of phototherapy devices was collected, and irradiance was measured from random units at 20 cm and 50 cm from the light source. We gathered information on local practice rules, including the use of single, double or triple phototherapy, how infants were positioned, the frequency of blood sampling, rules for using reflective surfaces and interrupting phototherapy. In every NICU, we asked one nurse with more than five years of experience and one with less than one year to set up phototherapy equipment, then measured the irradiance and distance. Results: Photodiodes were the most common of the eight types of phototherapy devices used. Rules for the distance from the device to the infant varied from 10 to 40 cm and in practice they varied from 15 to 48 cm, with irradiance ranging from 11.1-56.1 W/m(2). There were significant variations between NICUs with regard to the overall treatment duration and duration in most birthweight categories. Conclusion: There were considerable variations in phototherapy practices among Norwegian NICUs. In particular, the significant variations in duration need to be addressed.