How does sunlight compare to conventional phototherapy for treating neonatal jaundice. Is sunlight exposure a safe and effective method for preventing hyperbilirubinemia in newborns. What are the potential benefits and risks of using sunlight to manage neonatal jaundice.

Understanding Neonatal Jaundice and Hyperbilirubinemia

Neonatal jaundice is a common condition characterized by yellowing of a newborn’s skin and eyes. It occurs when there’s an excess of bilirubin, a yellow substance produced during the normal breakdown of red blood cells, in the baby’s blood. This condition is medically referred to as hyperbilirubinemia.

Why does jaundice occur in newborns. Newborn babies produce more bilirubin than adults due to their higher red blood cell turnover. Additionally, their immature livers may not be able to process and eliminate bilirubin efficiently. In most cases, neonatal jaundice is harmless and resolves on its own within a few weeks. However, in some instances, bilirubin levels can rise to dangerous levels, potentially leading to serious complications.

Risks Associated with Severe Hyperbilirubinemia

When bilirubin levels become excessively high, there’s a risk of acute bilirubin encephalopathy (ABE). This condition occurs when bilirubin crosses the blood-brain barrier and affects the central nervous system. If left untreated, ABE can lead to kernicterus, a form of permanent brain damage.

Which factors increase the risk of severe hyperbilirubinemia. Several factors can contribute to an increased risk:

• Premature birth
• Blood type incompatibility between mother and baby
• Certain genetic conditions
• Infections
• Bruising or internal bleeding during birth

It’s important to note that babies in low- and middle-income countries (LMIC) are at a higher risk for developing severe hyperbilirubinemia and its complications. This increased risk is due to factors such as limited access to maternal care during pregnancy, higher prevalence of blood disorders that can cause jaundice, and increased risk of infections or birth trauma.

Conventional Treatment Methods for Neonatal Jaundice

The primary treatment for neonatal jaundice is phototherapy. This involves exposing the baby’s skin to special blue-green light, which helps break down bilirubin into a form that can be more easily excreted from the body.

How Does Phototherapy Work?

Phototherapy lamps emit light in a specific spectrum that penetrates the baby’s skin. This light energy causes a chemical reaction that converts the bilirubin into a water-soluble form, allowing it to be eliminated through urine and stool. The effectiveness of phototherapy depends on several factors, including the intensity of the light, the amount of skin exposed, and the duration of treatment.

Are there any side effects of conventional phototherapy. While generally considered safe, phototherapy can have some minor side effects:

• Dehydration due to increased water loss through the skin
• Skin rashes
• Changes in bowel habits
• Interference with parent-child bonding due to the need for eye protection and limited physical contact during treatment

In severe cases of hyperbilirubinemia, or when phototherapy is not effective, exchange transfusion may be necessary. This procedure involves replacing the baby’s blood with donor blood to rapidly reduce bilirubin levels.

The Potential of Sunlight in Managing Neonatal Jaundice

Given that sunlight contains light in a similar spectrum to phototherapy lamps, researchers have been investigating its potential as a treatment or preventive measure for neonatal jaundice. This is particularly relevant in LMIC settings where access to conventional phototherapy equipment may be limited.

Advantages of Sunlight Exposure

Why might sunlight be a viable option for managing neonatal jaundice. There are several potential advantages:

• Readily available and cost-effective
• Does not require specialized equipment
• Can be used in home settings
• May allow for increased parent-child bonding compared to conventional phototherapy

However, the use of sunlight also raises concerns about potential risks, primarily related to ultraviolet (UV) radiation exposure and temperature regulation.

Research Findings on Sunlight for Neonatal Jaundice

A systematic review of clinical trials has been conducted to evaluate the safety and effectiveness of sunlight for treating or preventing jaundice in newborns. The review included three clinical trials involving a total of 1103 infants from two countries.

Study Characteristics

What were the key features of the included studies. The trials focused on:

• Infants born at or near their due date (35 weeks of gestation or later)
• Babies less than two weeks old
• Both healthy babies and those with jaundice
• Comparison of sunlight therapy to no treatment or to conventional phototherapy

One study evaluated sunlight for prevention or reduction of jaundice in healthy babies, while the other two focused on treating existing jaundice. In the treatment studies, sunlight was delivered through a light-filtering tent that blocked harmful UV light and infrared radiation.

Key Findings

What were the main results of these studies on sunlight therapy for neonatal jaundice.

1. Sunlight vs. No Treatment:
   • Reduced occurrence of jaundice
   • Fewer days of jaundice
   • No significant reduction in hospital readmissions for jaundice
2. Sunlight vs. Conventional Phototherapy:
   • Similar rate of decline in bilirubin levels
   • No increased rates of sunburn, dehydration, or hypothermia when using light-filtering films
   • Increased risk of hyperthermia in babies exposed to sunlight

The studies suggest that sunlight might not be inferior to conventional phototherapy if it can be delivered for at least four hours per day, with electric phototherapy used at night when needed.

Safety Considerations for Sunlight Therapy

While the potential benefits of sunlight therapy for neonatal jaundice are promising, it’s crucial to consider the safety aspects of this approach. The main concerns revolve around UV radiation exposure and temperature regulation.

UV Radiation Protection

How can babies be protected from harmful UV radiation during sunlight therapy. The studies addressed this concern by using light-filtering tents or films that block UV light while allowing the beneficial blue-green spectrum to pass through. This approach appears to be effective in preventing sunburn and other UV-related complications.

Temperature Regulation

Temperature control is a critical factor when exposing newborns to sunlight. The studies found an increased risk of hyperthermia (overheating) in babies exposed to sunlight. To mitigate this risk, frequent temperature checks are recommended.

What measures can be taken to ensure safe temperature regulation during sunlight therapy.

• Regular monitoring of the baby’s body temperature
• Providing adequate shade and ventilation
• Adjusting exposure time based on ambient temperature
• Ensuring proper hydration

Implications for Low- and Middle-Income Countries

The potential of sunlight therapy for neonatal jaundice has significant implications for LMIC, where access to conventional phototherapy equipment may be limited. Sunlight could provide a cost-effective and readily available alternative or supplement to traditional treatments.

Advantages in LMIC Settings

Why might sunlight therapy be particularly beneficial in LMIC contexts.

• Reduced reliance on expensive phototherapy equipment
• Potential for home-based treatment, reducing hospital burden
• Increased accessibility for rural or remote populations
• Possibility of preventing severe hyperbilirubinemia through early intervention

However, it’s important to note that while sunlight may be an effective adjunct to conventional phototherapy in LMIC settings, it should not be considered a complete replacement for standard medical care. The sporadic availability of sunlight and the need for careful monitoring mean that it may not be suitable as a sole treatment for severe cases of hyperbilirubinemia.

Future Research Directions

While the current studies provide valuable insights into the potential of sunlight therapy for neonatal jaundice, there are still many questions that need to be addressed through further research.

Areas for Future Study

What aspects of sunlight therapy for neonatal jaundice require further investigation.

• Long-term safety and efficacy of sunlight exposure in newborns
• Optimal duration and timing of sunlight exposure
• Development of standardized protocols for sunlight therapy
• Comparison of different light-filtering methods
• Effects of sunlight therapy on different populations and in various climates
• Cost-effectiveness analysis in different healthcare settings

Future studies should also aim to increase the certainty of evidence, as the current research has been rated as very low to moderate certainty for most outcomes. Larger, well-designed clinical trials with longer follow-up periods could provide more definitive answers about the safety and effectiveness of sunlight therapy for neonatal jaundice.

Potential Technological Innovations

Are there any emerging technologies that could enhance the use of sunlight for treating neonatal jaundice. Some potential areas for innovation include:

• Advanced light-filtering materials that optimize beneficial light spectrum while blocking harmful radiation
• Portable devices that combine natural sunlight with supplemental therapeutic light
• Smart monitoring systems that track bilirubin levels, exposure time, and environmental conditions
• Telemedicine solutions for remote guidance and monitoring of home-based sunlight therapy

These technological advancements could help address some of the current limitations and safety concerns associated with sunlight therapy, potentially making it a more viable option for managing neonatal jaundice in various settings.

Practical Considerations for Implementing Sunlight Therapy

If sunlight therapy is to be considered as a treatment or preventive measure for neonatal jaundice, there are several practical aspects that need to be addressed to ensure its safe and effective implementation.

Guidelines for Safe Sunlight Exposure

What precautions should be taken when exposing newborns to sunlight for jaundice treatment.

• Use of light-filtering materials to block harmful UV and infrared radiation
• Limiting exposure time based on the baby’s age, skin type, and local climate conditions
• Ensuring proper eye protection for the baby
• Maintaining a comfortable ambient temperature
• Regular monitoring of the baby’s skin for signs of sunburn or overheating
• Adequate hydration to prevent dehydration

Healthcare providers would need to develop clear protocols and educate parents or caregivers on the proper techniques for safe sunlight exposure.

Integration with Existing Healthcare Systems

How can sunlight therapy be integrated into existing neonatal care practices. Some considerations include:

• Training healthcare workers on the proper administration of sunlight therapy
• Establishing guidelines for when to use sunlight therapy versus conventional phototherapy
• Developing systems for monitoring and follow-up of babies receiving sunlight therapy
• Creating educational materials for parents and caregivers
• Implementing quality control measures to ensure safe and effective treatment

The integration of sunlight therapy into healthcare systems would require careful planning and coordination among various stakeholders, including healthcare providers, policymakers, and community leaders.

Cultural and Social Considerations

It’s important to consider cultural and social factors that may influence the acceptance and implementation of sunlight therapy for neonatal jaundice. In some cultures, there may be traditional beliefs or practices related to sun exposure for newborns that could either facilitate or hinder the adoption of this treatment approach.

How can healthcare providers address cultural considerations when implementing sunlight therapy.

• Engage with community leaders and traditional healers to understand local beliefs and practices
• Develop culturally sensitive educational materials
• Incorporate traditional practices where appropriate and safe
• Address any misconceptions or concerns about sunlight exposure in newborns
• Emphasize the importance of medical supervision and monitoring during treatment

By taking these cultural and social factors into account, healthcare providers can increase the likelihood of successful implementation and acceptance of sunlight therapy in diverse communities.

Ethical Considerations in Sunlight Therapy Research

As research into sunlight therapy for neonatal jaundice continues, it’s crucial to address the ethical implications of such studies, particularly when conducted in low-resource settings.

Balancing Risks and Benefits

How can researchers ensure that the potential benefits of sunlight therapy outweigh the risks for study participants. Some key considerations include:

• Rigorous safety protocols to minimize the risk of harm to newborns
• Clear informed consent procedures for parents or guardians
• Provision of alternative treatment options for control groups
• Ongoing monitoring and early stopping rules for studies if safety concerns arise
• Long-term follow-up to assess potential delayed effects of sunlight exposure

Ethical review boards play a crucial role in evaluating the risk-benefit ratio of sunlight therapy studies and ensuring that appropriate safeguards are in place to protect vulnerable newborn participants.

Equity in Research and Treatment Access

Research into sunlight therapy for neonatal jaundice has significant implications for global health equity. While this approach may offer a low-cost alternative for LMIC, it’s important to ensure that it doesn’t become a substandard option for resource-limited settings while high-income countries continue to use more advanced technologies.

What steps can be taken to promote equity in jaundice treatment research and access.

• Conducting parallel studies in both high-income and low-income settings
• Ensuring that sunlight therapy research doesn’t divert resources from improving access to conventional phototherapy
• Developing guidelines for appropriate use of sunlight therapy alongside conventional treatments
• Promoting technology transfer and capacity building in LMIC for jaundice management
• Advocating for global policies that support equitable access to effective jaundice treatments

By addressing these ethical considerations, researchers and healthcare providers can work towards developing safe, effective, and equitable treatment options for neonatal jaundice across diverse global settings.

Sunlight for the prevention and treatment of hyperbilirubinemia in newborns

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Review question

How safe and effective is sunlight for treating or preventing jaundice (yellowing of the skin, called hyperbilirubinemia) in newborns?

Background

Babies with jaundice are often treated with phototherapy lamps, which emit blue-green light that alters the bilirubin (yellow substance found naturally in the baby’s blood) so that it can be more easily excreted.

Sunlight emits light in a similar spectrum. However, sunlight also emits harmful ultraviolet rays and infrared radiation, which can cause sunburn and skin cancer. Further, exposing babies to sunlight might mean they could get too warm or too cold, depending on the climate.

In low- and middle-income countries (LMIC) phototherapy is not always available for babies who need it. Further, babies in these countries can be at increased risk for dangerous jaundice, where the bilirubin in their blood reaches levels that allow it to cross the blood-brain barrier and cause damage to the brain. Babies in LMIC are at increased risk for jaundice for a number of reasons, including poor access to maternal care during pregnancy, increased numbers of blood disorders causing jaundice, and increased risk of infection or birth trauma.

Given that sunlight is readily available, there is an urgent need to determine if sunlight is safe and effective at treating jaundice in babies in LMIC.

Study characteristics

We included three clinical trials containing 1103 infants from two countries. The trials included infants born at or near their due date (35 weeks of gestation or later) who were less than two weeks old. One study evaluated healthy babies, and the other two evaluated babies with jaundice. In one study, the babies received either sunlight therapy or no treatment to assess sunlight for the prevention or reduction of jaundice. In the other two studies, infants with jaundice were randomly assigned to receive treatment with phototherapy machines or to receive sunlight through a light-filtering tent that blocked ultraviolet light and infrared radiation, and these groups were compared for improvement in their jaundice. One study did not comment on funding. The other two studies were funded by the Thrasher Research Fund. Evidence is current to June 2020.

Key results

Sunlight versus no treatment: babies exposed to sunlight may have a reduced occurrence of jaundice and be jaundiced for fewer days compared to babies who have no preventive treatment for jaundice. There was no reduction in readmission to hospital for jaundice in babies exposed to sunlight compared to babies who were not treated.

Sunlight versus other sources of phototherapy: when compared to babies who were exposed to electric phototherapy treatment, babies exposed to sunlight had a similar rate of decline in bilirubin levels. Using light-filtering films, babies exposed to sunlight did not have increased rates of sunburn, dehydration, or hypothermia. Babies exposed to sunlight were at an increased risk of hyperthermia. The effectiveness of sunlight might not be inferior to phototherapy, if sunlight can be delivered for at least four hours per day, and electric phototherapy can be delivered at night when needed.

Certainty of the evidence

The certainty of the evidence for outcomes in all three studies was very low to moderate. It was very low for all the main outcomes in each study. We are uncertain whether sunlight is effective for the prevention or treatment of hyperbilirubinemia in term or late preterm neonates.

Authors’ conclusions: 

Sunlight may be an effective adjunct to conventional phototherapy in LMIC settings, may allow for rotational use of limited phototherapy machines, and may be preferable to families as it can allow for increased bonding. Filtration of sunlight to block harmful ultraviolet light and frequent temperature checks for babies under sunlight may be warranted for safety. Sunlight may be effective in preventing hyperbilirubinemia in some cases, but these studies have not demonstrated that sunlight alone is effective for the treatment of hyperbilirubinemia given its sporadic availability and the low or very low certainty of the evidence in these studies.

Read the full abstract…

Background: 

Acute bilirubin encephalopathy (ABE) and the other serious complications of severe hyperbilirubinemia in the neonate occur far more frequently in low- and middle-income countries (LMIC). This is due to several factors that place babies in LMIC at greater risk for hyperbilirubinemia, including increased prevalence of hematologic disorders leading to hemolysis, increased sepsis, less prenatal or postnatal care, and a lack of resources to treat jaundiced babies. Hospitals and clinics face frequent shortages of functioning phototherapy machines and inconsistent access to electricity to run the machines. Sunlight has the potential to treat hyperbilirubinemia: it contains the wavelengths of light that are produced by phototherapy machines. However, it contains harmful ultraviolet light and infrared radiation, and prolonged exposure has the potential to lead to sunburn, skin damage, and hyperthermia or hypothermia.

Objectives: 

To evaluate the efficacy of sunlight administered alone or with filtering or amplifying devices for the prevention and treatment of clinical jaundice or laboratory-diagnosed hyperbilirubinemia in term and late preterm neonates.

Search strategy: 

We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 5), MEDLINE, Embase, and CINAHL on 2 May 2019. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs.

We updated the searches on 1 June 2020.

Selection criteria: 

We included RCTs, quasi-RCTs, and cluster RCTs. We excluded crossover RCTs. Included studies must have evaluated sunlight (with or without filters or amplification) for the prevention and treatment of hyperbilirubinemia or jaundice in term or late preterm neonates. Neonates must have been enrolled in the study by one-week postnatal age.

Data collection and analysis: 

We used standard methodologic procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Our primary outcomes were: use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, chronic bilirubin encephalopathy, and death.

Main results: 

We included three RCTs (1103 infants). All three studies had small sample sizes, were unblinded, and were at high risk of bias. We planned to undertake four comparisons, but only found studies reporting on two.

Sunlight with or without filters or amplification compared to no treatment for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates

One study of twice-daily sunlight exposure (30 to 60 minutes) compared to no treatment reported the incidence of jaundice may be reduced (risk ratio [RR] 0. 61, 95% confidence interval [CI] 0.45 to 0.82; risk difference [RD] −0.14, 95% CI −0.22 to −0.06; number needed to treat for an additional beneficial outcome [NNTB] 7, 95% CI 5 to 17; 1 study, 482 infants; very low-certainty evidence) and the number of days that an infant was jaundiced may be reduced (mean difference [MD] −2.20 days, 95% CI −2.60 to −1.80; 1 study, 482 infants; very low-certainty evidence). There were no data on safety or potential harmful effects of the intervention. The study did not assess use of conventional phototherapy, treatment failure requiring exchange transfusion, ABE, and long-term consequences of hyperbilirubinemia. The study showed that sunlight therapy may reduce rehospitalization rates within seven days of discharge for treatment for hyperbilirubinemia, but the evidence was very uncertain (RR 0.55, 95% CI 0.27 to 1.11; RD −0.04, −0.08 to 0.01; 1 study, 482 infants; very low-certainty evidence).

Sunlight with or without filters or amplification compared to other sources of phototherapy for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia

Two studies (621 infants) compared the effect of filtered-sunlight exposure to other sources of phototherapy in infants with confirmed hyperbilirubinemia. Filtered-sunlight phototherapy (FSPT) and conventional or intensive electric phototherapy led to a similar number of days of effective treatment (broadly defined as a minimal increase of total serum bilirubin in infants less than 72 hours old and a decrease in total serum bilirubin in infants more than 72 hours old on any day that at least four to five hours of sunlight therapy was available). There may be little or no difference in treatment failure requiring exchange transfusion (typical RR 1.00, 95% CI 0.06 to 15.73; typical RD 0.00, 95% CI −0.01 to 0.01; 2 studies, 621 infants; low-certainty evidence). One study reported ABE, and no infants developed this outcome (RR not estimable; RD 0.00, 95% CI −0.02 to 0.02; 1 study, 174 infants; low-certainty evidence). One study reported death as a reason for study withdrawal; no infants were withdrawn due to death (RR not estimable; typical RD 0.00, 95% CI −0.01 to 0.01; 1 study, 447 infants; low-certainty evidence). Neither study assessed long-term outcomes.

Possible harms: both studies showed a probable increased risk for hyperthermia (body temperature greater than 37.5 °C) with FSPT (typical RR 4.39, 95% CI 2.98 to 6.47; typical RD 0.30, 95% CI 0.23 to 0.36; number needed to treat for an additional harmful outcome [NNTH] 3, 95% CI 2 to 4; 2 studies, 621 infants; moderate-certainty evidence). There was probably no difference in hypothermia (body temperature less than 35.5 °C) (typical RR 1.06, 95% CI 0.55 to 2.03; typical RD 0.00, 95% CI −0.03 to 0.04; 2 studies, 621 infants; moderate-certainty evidence).

Health topics: 

Child health > Neonatal care > Neonatal jaundice

Neonatal care > Neonatal jaundice

Filtered sunlight a safe, low-tech treatment for newborn jaundice | News Center

Safe sunlight exposure under canopies that remove harmful rays is a low-cost, effective way to give phototherapy to jaundiced infants in impoverished settings, according to a new study.

September 16, 2015
– By Erin Digitale

Newborn jaundice can be treated with filtered sunlight, providing a safe, inexpensive, low-tech solution to a health problem that now causes permanent brain damage or death in more than 150,000 babies in developing countries each year.

That’s the finding of a new study by researchers at the Stanford University School of Medicine and their colleagues that will be published Sept.17 in The New England Journal of Medicine. In the study, conducted in Nigeria, some mothers and babies sat under outdoor canopies that filtered out harmful wavelengths from sunlight, but still allowed jaundice-treating blue wavelengths to reach the babies’ skin. The filtered-sunlight treatment was as safe and effective as the blue-light lamps traditionally used to treat infant jaundice, the study found.

“This research has the potential for global impact,” said the study’s senior author, David Stevenson, MD, the Harold K. Faber Professor in Pediatrics and senior associate dean for maternal and child health at Stanford. “All babies can get jaundice. In settings with no access to modern devices, we’ve shown we can use something that’s available all around the planet — sunlight — to treat this dangerous condition.” Stevenson also directs the Johnson Center for Pregnancy and Newborn Services at Lucile Packard Children’s Hospital Stanford.

Jaundice is extremely common in newborns, whose bodies need a few days after birth to develop the enzymes that enable excretion of bilirubin, a compound released during the normal breakdown of red blood cells. If too much bilirubin builds up in the blood, the skin and eyes acquire the hallmark yellow tinge of jaundice. Worse, high bilirubin levels can cause lasting brain damage or infant death.

Filtering out ultraviolet, infrared rays

Phototherapy with lamps that emit blue wavelengths has been the most prevalent newborn jaundice treatment since the 1960s. But hospitals and health clinics in developing countries often lack the funds, expertise and reliable electricity needed to use the equipment.

The research team built and tested outdoor canopies that used commercially available plastic films to filter out sunburn-causing ultraviolet rays and infrared rays that could make infants overheat. Jaundice-treating blue wavelengths could pass through the filters. The team used different canopies for sunny and overcast days.

“Even with an overcast sky, we still get good light transmission and phototherapy,” said study author Hendrik Vreman, PhD, a senior research scientist in pediatrics at Stanford, who developed, built and tested the canopies.

For a clinical trial, the scientists enrolled 447 infants with jaundice at a large, inner-city hospital in Lagos, Nigeria, of whom 224 were randomly assigned to treatment with filtered sunlight and 223 to conventional phototherapy. Infants received at least five hours per day of their assigned treatment, and were evaluated hourly during treatment for signs of hypothermia, overheating, dehydration and sunburn. Infants treated with filtered sunlight were held in their mothers’ laps under the canopies and could breastfeed while receiving treatment.

New, conventional methods similarly effective

The two therapies worked similarly well: Filtered sunlight was effective on 93 percent of treatment days, and conventional phototherapy on 90 percent of treatment days. The treatments were also similarly safe.

The team is now studying  greenhouse-like structures that incorporate the filters. Such structures will allow for filtered-sunlight therapy in locations that are windy, rainy or have colder climates than Nigeria’s.

“We’re excited that we can use our understanding of the biology of jaundice and adapt treatment to the local context of a developing country, and the resources that exist there,” said Stevenson, who is a member of the Stanford Child Health Research Institute.

The study’s lead author is Tina Slusher, MD, associate professor of pediatrics at the University of Minnesota. Another Stanford-affiliated author of the study is Ronald Wong, senior research scientist in pediatrics.

Researchers at the University of Minnesota, Massey Street Children’s Hospital in Lagos and the University of California-San Diego also contributed to the study.

The study was funded by the Thrasher Research Fund and by the National Center for Advancing Translational Sciences of the National Institutes of Health (grant UL1TR000114.)

Stanford’s Department of Pediatrics also supported the work.

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How much Sun is enough for your child? – Magazine

Bone health is essential for upright posture and stable walking. Only sunlight, more precisely, ultraviolet radiation, allows the children’s skeleton to develop. Most of the bones of a newborn are made up of cartilage, which undergoes gradual ossification. Bone mineralization itself begins when children receive calcium and phosphorus from their diet: both trace elements are then incorporated into bone development under the influence of vitamin D.

Most foods contain only small amounts of vitamin D, although fish oils and oily fish contain quite a lot. But thanks to UV radiation, we can produce the necessary amount of vitamin D ourselves: this happens when enough sunlight hits the skin.

If there is a lack of vitamin D, the bones cannot develop properly. In infants, acute vitamin D deficiency can lead to rickets, so taking this vitamin, for example, is recommended for babies in Germany. While breast milk, the best food for infants, contains relatively little vitamin D, commercial infant formula should be fortified with vitamin D (up to 15 micrograms or 600 IU/litre).

To ensure sufficient vitamin D in the skin, infants and older toddlers should be exposed to the sun for 30-60 minutes a day: enough if only the face is exposed and facing a clear sky. Babies don’t need direct sunlight, and they certainly shouldn’t be out in the open without clothes, losing body heat.

But too much sunlight can be harmful, especially for babies and young children. At a tender age, a baby’s skin is thin and has few melanocytes (skin cells that produce the protective pigment melanin). This means that even a relatively short period of sun exposure can cause sunburn. Like any other burn, it is manifested by reddening of the skin, and in severe cases leads to the formation of blisters. Sun exposure during childhood can greatly increase the risk of developing skin cancer. This is partly because the child’s immune system is not yet fully developed, so it cannot repair the cell damage caused by the sun’s rays.

Use a sunscreen with a high SPF of at least 20 and up to 50 for your child. avoidable sun exposure.

• The younger the child, the more important it is not to stay under the scorching rays of the sun (especially during the daytime from 11:00 to 16:00).
• The child’s skin should always be covered with light cotton clothing and the head covering should shade the skin of the neck.
• Use a sunscreen factor of 20 or higher without fragrance or preservatives.
• Sun lotion or cream should be used with extreme caution on the ears, nose and tops of the feet.

Even if sunscreen is applied, it does not mean that children can be exposed to direct sunlight for longer periods of time. If exposure to the sun, despite the precautions mentioned above, has resulted in sunburn, this condition requires immediate effective treatment.

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II. Basic rules of conception hygiene. What to do and what not to do to conceive a healthy child (rule 4 and 5). – “How to conceive a healthy child.” Book Nikitin A.I. – Articles and books

4.

Healthy lifestyle. (rule 4)

(From chapter II: Basic rules for conception hygiene. Do’s and don’ts to conceive a healthy child).

A healthy lifestyle is something that spouses must adhere to especially strictly during the period of preparation for pregnancy and during it. Unfortunately, we begin to pay attention to this factor, which seems to be easily achievable in everyday life, only when we become seriously ill. At the same time, as observations and special studies show, maintaining a healthy lifestyle is the most effective means of maintaining not only reproductive health, but health in general. Following the rules of a healthy lifestyle in itself can ensure the restoration of the lost ability to conceive.

The general principles of a healthy lifestyle are quite simple and well known. This is a reasonable alternation of work and rest, proper sleep, proper nutrition, regular physical education, the maximum elimination of stressful situations and the complete rejection of bad habits (more (more on this in section P (6). Granting a woman pregnancy leave and childbirth creates additional conditions for maintaining a healthy lifestyle.However, it is necessary to start strict adherence to these rules from the moment you plan pregnancy.0003

A woman’s ability to conceive is also determined by such an important factor as body weight, which also largely depends on her lifestyle. It has long been noted that excess weight is accompanied by a decrease in fertility. This is due to the fact that the increased fat content in the body leads to disorders in the endocrine system. In addition, obesity can cause diabetes, cardiovascular disorders and other diseases, which in themselves can become an obstacle to pregnancy. Therefore, a woman should lead an active lifestyle and avoid overeating (more on this below).

Regular hardening of the body is an important element of a healthy lifestyle. It is especially necessary in the period preceding pregnancy. Within reasonable limits, hardening is useful during pregnancy. One of the most effective ways of hardening is the impact on the body of fresh air – aerotherapy. It includes outdoor procedures – long walks, best of all in a forested area or on the shore of a reservoir. In addition to enriching the body with clean air, the beneficial effect of aerotherapy lies in the training of thermoregulation mechanisms. It is useful to combine aerotherapy procedures with physical exercises. In summer, air baths are of great importance for hardening and increasing the adaptive capabilities of the body, which are carried out at an air temperature of at least 18 degrees in places protected from the wind.

Heliotherapy – sunbathing – is of great healing importance. We emphasize, however, that this influence becomes useful only with the correct (metered) exposure to sunlight. Exposing your body to ultraviolet radiation for hours is very harmful. Burns, skin aging, tumors (melanoma) are the result of frequent and prolonged exposure to direct sunlight. The use of sunscreens should not be misleading – a lot depends on their quality, method and frequency of use. In autumn and winter, solariums are used for dosed ultraviolet irradiation. Sunbathing and solarium visits during pregnancy should be significantly limited and carried out only after consulting a doctor.

A number of hardening procedures are based on the use of low temperature effects on the body. In this regard, water procedures have the most effective effect. Experts have been talking about their benefits for a long time. One of the founders of Russian medicine, S.G. Zybelin, in 1773 published the work “A word about the harm arising from keeping oneself in excessive heat”, where for the first time the benefits of hardening using water procedures were substantiated at the scientific level corresponding to that time. Beginners are advised to start hardening with daily wiping the body in the morning with a damp towel. You can use contrast baths for hands and feet with a change in 10-15 seconds. hot water to cool. In the autumn-winter period and in March-April, an effective method of hardening is regular dousing with water, the temperature of which is gradually reduced from 30o to 200C. A contrast shower is an excellent tool for hardening and training the body’s adaptive mechanisms.

Experts point out the positive value of visiting the Russian steam bath both for a woman’s health in general and for ensuring the normal course of pregnancy. However, you should not “sit out” in the steam room, cover your head with a felt hat, it is recommended to drink more during breaks, best of all – mineral water. You must also be careful, move carefully in the steam room so as not to get injured. To do this, put on rubber slippers on your feet. On the shelves in the steam room you should sit on a towel or a special bedding.

Particular importance should be attached to adequate sleep in terms of duration and depth. The condition for its usefulness is: dinner 3-4 hours before bedtime, before going to bed – walks in the fresh air, the exclusion of physical and strenuous mental work, including stopping watching TV at least an hour before going to bed.

Although there is no need to drastically change the usual way of life upon the onset of pregnancy, however, from that moment on, a woman should subordinate her life as much as possible to caring for the health of the unborn child, eliminate bad habits and everything that causes an overstrain of the body: attending noisy parties, discos, long feasts with drinking alcohol, including beer, etc. 5.

Refusal of “bad habits”. (rule 5)

For the period of pregnancy planning and for all its subsequent stages, it is necessary to abandon “bad habits”. Although we call them politely harmful, in some people they turn into real serious illnesses. The main unhealthy habits include, first of all, ethyl alcohol (vodka), substances that enter the body during smoking, and drugs that have long been used by humans as stimulating and anti-stress agents. However, since the regular consumption of these substances has a peculiar effect in the peculiar conditions of consumption, experts have identified them in a group of so-called socio-cultural factors. Such phenomena, characteristic of modern civilization, as psycho-emotional stress (stress) caused by violation of work, rest, sleep regimes, information overload, the need to solve acute social and domestic problems, etc., can also be attributed to the adversely affecting the human body. The existence of a person under the influence of these factors increasingly leads to the disruption of the genetically programmed adaptive capabilities of the body, the emergence of “chronic fatigue syndrome”, stress conditions and other pathologies.

Among these factors, alcohol, smoking and drugs have become constant companions of a significant part of humanity. The behavior of groups of people prone to these bad habits is proposed to be designated as a special “mutagenic lifestyle”.

Alcohol.

Domestic drunkenness and alcoholism are one of the most acute medical and social problems throughout the world. In Russia, with the cessation at the end of “perestroika” of broad anti-alcohol measures, by the way, highly appreciated, in contrast to our own country, in the West, as having saved hundreds of thousands of lives, alcohol consumption per capita increased sharply. In 2013, it was about 14 liters. per year (at 1987 g. – 3.9 l). At the same time, according to the conclusion of the World Health Organization, a level of 8 liters or more should be considered dangerous for the health of the nation.

The adverse effect of alcohol on the human body and offspring has long been known. “Children of a merry day”, “children of a carnival” – the name of children with severe mental disabilities and congenital malformations that was common in medieval Europe, who were born after the appropriate time after traditional carnivals, accompanied by abundant consumption of alcoholic beverages. Therefore, already centuries ago there were prohibitions aimed at preventing conception while intoxicated. In Rus’ and among a number of other peoples, there was a custom that forbade the bride and groom to drink alcohol at the wedding. In ancient Greece, Rome and Sparta, laws were passed prohibiting the use of wine until the age of 30. Regardless of religious beliefs, drunkenness among women was considered a great sin among all peoples. This contributed to the development of a certain “psychological immunity” to alcohol in them. However, the active involvement of women in industrial production, the “winning” of equal rights with men, and the socio-economic crises of recent years have contributed to the growth of women’s regular consumption of alcoholic beverages. It was found that the ratio of “male” and “female” alcoholism has changed from 9:1 at the beginning of the 19th century. up to 4:1 in recent decades.

Ethyl alcohol (ethanol) belongs to the class of narcotic substances. Absorbed in the intestines and delivered with blood to various organs, it exerts its influence primarily on the cerebral cortex, causing disturbances in the functions responsible for the state of the intellectual, emotional and motor spheres. The neutralization of alcohol that has entered the body occurs in the liver. First, up to 98% of alcohol is converted into acetaldehyde, a toxic compound with mutagenic properties. Its further biotransformation leads to the formation of end products – carbon dioxide and water. Up to 10% of alcohol is excreted unchanged from the body with exhaled air, urine and sweat.

It is noted that the excretion of ethanol from the body in women is slowed down. This leads to its higher and longer than in men, the concentration in the organs. Therefore, the development of addiction to alcohol in women occurs more quickly, and the course of alcoholism in them often becomes malignant. The increasing concentration of ethanol in the brain causes disturbances in the activity of the hypothalamic-pituitary system and sex glands, which leads to disruption of menstrual and ovulatory functions, resulting in problems with conception. It has been established that the frequency of infertility in “drinking” women is 3-4 times higher than in “non-drinking” ones.

In chronic alcoholism, atrophic processes in the ovaries develop more quickly, leading to premature menopause. According to some data, chronic alcoholism increases the risk of developing breast cancer by 30%.

Problems with conception can also be observed in “drinking” men. It has been established that ethanol that easily penetrates the testicles can cause a violation of spermatogenesis. The death of a significant number of spermatozoa sometimes leads to the emergence of the so-called. syndrome “only Sertoli cells”, in which spermatozoa in the ejaculate are absent or found in an extremely small amount (azoospermia). The degree of structural changes in the testicles depends on the dose and duration of the introduction of alcohol into the body. According to Finnish researchers, pronounced violations of spermatogenesis are observed with regular consumption of more than 40 g of ethanol per day by a man.

Particular attention should be paid to issues related to the influence of alcohol on the development of the embryo and fetus. It is important to emphasize that this influence can be realized not only when a woman takes alcoholic beverages during pregnancy, but also before it occurs through the action of alcohol on germ cells. Drinking alcohol during the periovulatory period is especially dangerous. Thus, studies conducted in our country and abroad have shown that the introduction of ethanol into the body of female experimental animals at this time causes an increase (by 3-5 times) in the frequency of chromosomal abnormalities in eggs. After fertilization of such eggs, embryos with an altered chromosome set are formed, which causes their death in the early stages of pregnancy or the occurrence of developmental disorders (malformations) in the fetus.

Easily soluble in water and fat, ethanol quickly overcomes the placental barrier and within a minute after the introduction into the body of a pregnant woman is found in the umbilical blood, and after 15 minutes. – in the amniotic fluid. Therefore, the threat of abortion, spontaneous abortions, fetal development disorders in women who abuse alcohol are 4-5 times higher, and stillbirths are 6-7 times higher than among non-drinkers. Increased in drinking mothers is the mortality of children in the first two years of life.

It is important to note that the process of neutralization and excretion of ethanol from the fetal body is 2 times slower than from the mother’s body. Therefore, the fetus is exposed to ethanol for a longer time, and its content in the organs of the fetus may exceed (!) Its concentration in the mother’s body.

The most severe consequence of “drunken conception” is the appearance of congenital developmental disorders in the offspring. In the middle of the last century, peculiar changes were first described in children born to women who regularly consumed alcohol during pregnancy. This special type of combination of malformations with physical and mental retardation has been called “fetal alcohol syndrome” or “alcoholic embryopathy”. Its most typical manifestations are violations of the structure of the facial skull: a narrow forehead, a small saddle nose, underdevelopment of the chin, flattening of the occiput, microcephaly (small brain), strabismus, etc. Violations of the development of the genital organs are often detected: in girls – malformations of the vagina, in boys – changes “feminizing” type: cryptorchidism (undescended testicles into the scrotum), hypospadias (underdevelopment of the urethra), structural changes in the testicles. A severe manifestation of alcoholic embryopathy is the defeat of the child’s nervous system. Such newborns, even in the absence of obvious signs of alcohol syndrome, are characterized by: a slowdown in the processes of adaptation to extrauterine life, hyperreactions to various influences, sleep disturbances, difficulties in sucking and swallowing, at a later age – mental developmental disorders according to the type of mental retardation of varying severity (oligophrenia), the tendency of children and adolescents to illegal actions, subsequently – frequent (4-5 times more often than in the offspring of non-drinking parents) the development of alcoholism. It is noted that alcohol syndrome can also occur when a pregnant woman consumes dry wines and even beer. There are observations about the occurrence of this syndrome in the offspring of parents who stopped taking alcohol during pregnancy.

The effect of alcohol on the fetus is aggravated by such “companions” of alcoholism as poor nutrition, lack of vitamins in the body of a pregnant woman, especially group B, microelements (zinc, magnesium), chronic diseases and other factors. The effect of alcohol on the fetus is also enhanced under the influence of various harmful impurities contained in low-quality alcoholic beverages. Therefore, children with fetal alcohol syndrome are more often born in low-income families of alcoholics.

If a woman consumes alcoholic beverages after childbirth, they may have harmful effects while breastfeeding a newborn. It has been established that in a nursing mother, alcohol is found in breast milk within a few minutes after taking it. Due to the low activity of ethanol-cleaving enzymes in newborns, alcohol that has entered their body is retained in the blood and organs for a longer time. As a result, the child may develop typical alcohol intoxication, and with regular consumption of alcohol by the mother, symptoms of real alcoholism, including addiction and craving for alcohol. Thus, an alcoholic breastfeeding mother is actually drugging her child, making him an alcoholic of infancy or a potential alcoholic in the future. Therefore, in chronic alcoholism of the mother, artificial feeding is recommended.

The combination of mother’s alcoholism with father’s alcoholism has a very unfavorable effect on the offspring. Violations during pregnancy, the development of the fetus and the condition of the newborn in these cases are especially significant. In addition to the pathology described above, convulsive conditions are often observed in newborns, and in later life – the development of neuroses, psychogenic disorders, and mental retardation. Half of the children begin to walk and talk late.

The consequences for offspring are also unfavorable in cases where only the father abuses alcohol. It has been established that in case of alcoholism of the father, the wife’s pregnancy often ends in spontaneous miscarriage and premature birth, the frequency of fetal malformations is increased, the mortality rate of newborns is higher, their weight is reduced. Therefore, drinking parents planning a pregnancy should postpone pregnancy until the moment when they can give up alcohol, and even better, get rid of alcohol addiction forever.

Tobacco smoking.

Despite the fact that “the Ministry of Health warns…”, the problem of smoking and its impact on health, including the health of offspring, continues to be very acute. Currently, about 60% of men and about 20% of women smoke in Russia. As worrisome, as with alcohol, is the increasing prevalence of smoking among adolescents and young women. An unpleasant feature of tobacco smoking is that the smoking of one of the family members can also affect non-smokers through the so-called “passive” smoking.

According to the latest research, more than 4,000 chemical compounds have been found in tobacco smoke, including highly toxic methyl isocyanide, benzene, acetone, ammonium, arsenic, DDT, halogenated hydrocarbons, formaldehyde, lead, cadmium, nicotine. Most of them have reproductive toxicity. A number of them, primarily nicotine, affect the secretion of hypothalamic neurohormones. Therefore, women who smoke, including “passive” smokers, often experience menstrual dysfunction, which underlies the development of infertility in them.

The possibility of a direct effect of smoking on the gonads is due to the ability of a number of components of tobacco smoke to overcome tissue barriers, including tissue barriers of the ovary. This is evidenced by the detection of nicotine in the fluid of ovarian follicles in women who smoke, which can lead to a violation of their function. Harmful compounds formed during smoking can also overcome the blood-testicular barrier, penetrating directly into the testicles. A study of spermograms of smokers, including adolescents, revealed a decrease in sperm concentration and motility, as well as a significant increase in the number of morphologically abnormal forms. Spermatozoa of smokers are also characterized by a significant (4 times) increase in the level of chromosomal abnormalities. It is clear that this can lead to a decrease in their fertilizing ability and the occurrence of chromosomal pathology in the embryo. Smoking adversely affects the “sexual status” of men. Compared to non-smokers, smokers have reduced libido (sexual desire), frequency and “quality” of sexual intercourse.

It has been established that the pregnancy rate when using assisted reproduction methods (“test-tube babies”) is significantly lower both in women who smoke and in families where only the father smokes. In smoking mothers, an increase in the frequency of preterm birth and the birth of children with low birth weight was noted. The problem of low birth weight should be specifically highlighted when discussing the harmful effects of tobacco smoking on the fetus. This is due to the fact that birth weight will largely determine the health of a person during later life. Prematurely leaving the mother’s body, premature (low birth weight) babies end up in living conditions – an ecological environment that does not correspond to the anatomical and functional maturity of their organs, which are forced to urgently restructure their work in accordance with the conditions of extrauterine life. As a result, newborns are observed: respiratory disorders, infectious lesions of organs, disorders of the nervous system, neonatal jaundice and other pathologies. To this should be added the earlier and more frequent development of cardiovascular diseases, cerebral atherosclerosis, hypertension, chronic lung diseases, metabolic syndrome, diabetes mellitus, obesity, allergic conditions and other pathologies in such offspring in adulthood.

Recently, a group of German scientists led by Professor S. Rückiger conducted a study of the health status of tens of thousands of children whose mothers smoked during pregnancy. It was found that the chemical components of tobacco smoke when smoking a pregnant woman penetrate to the fetus. To describe these cases, scientists even used a special term – smoking “in utero”, i.e. in the uterus. In addition to the violations described above, the authors noted in children during their school years a more frequent manifestation of elements of deviant behavior, including: a tendency to lie, petty theft, unmotivated excitability, manifestations of violence, etc. Therefore, smoking parents should understand that if they smoke during pregnancy, then their unborn children “smoke” with them and all the above-mentioned tobacco toxicants enter their body. In male offspring of smoking fathers, such a congenital defect as hypospadias (underdevelopment of the urethra) is more common. In the offspring of smoking women, a decrease in fertility was found in later life. There is evidence that lung cancer occurs more often not only in adult smokers, but also in their children. Therefore, experts recommend that spouses planning a pregnancy at least 6 months before its possible onset stop smoking.

Parental smoking has a harmful effect on the growing body of the child. It has been established that the lungs of young children are not mature enough to effectively resist various adverse effects, and smoking of parents further reduces their protective functions. Diseases of the upper respiratory tract in children of smoking parents are observed 2 times more often. Parental smoking may be associated with asthma in children. Some authors associate cases of so-called smoking with parents. “sudden death” of newborns.

Drugs.

It has been established that taking drugs (marijuana, cocaine, heroin, etc.) inhibits the secretion of gonadotropic hormones. In women, this leads to violations of the menstrual cycle and the process of ovulation. As a result, fertility decreases and infertility occurs. Hormonal disorders resulting from drug use predetermine the presence of a pathological course of pregnancy and fetal pathology in drug addicts. Drugs can pass through the placenta or (in breastfeeding mothers) through breast milk. Pregnancy in this group of women often ends in spontaneous abortions or premature births.

Studies by English doctors have shown that newborns born to women who took drugs (cocaine, LSD, ecstasy, and others) in the first trimester of pregnancy were underweight, areas of hemorrhage and necrosis were detected in their brain 7 times more often. In this group, the incidence of birth defects was 4-5 times higher than in the United Kingdom as a whole. According to studies conducted in Ukraine, half of the pregnancies of female drug addicts end in spontaneous abortions, and perinatal mortality is 10 times higher than the national average.

In newborns born to mothers who used drugs, already in the first hours after birth, signs resembling withdrawal symptoms are often observed: anxiety, insomnia, tremor of the limbs, sometimes symptoms of a typical “withdrawal”. Thus, from all that has been said above, the only conclusion can be drawn – drugs and pregnancy are incompatible.

In recent years, excessive consumption of the stimulant caffeine has been shown to adversely affect fertility. It was found that in women who regularly drink more than 5 cups of coffee a day, this ability is reduced by 2.5 times.

Stress.

Modern man lives in conditions of increasing pressure of stress on his body. Social and domestic problems, the acceleration of the pace of life, disruption of sleep and rest patterns, information overload have made stress a constant companion of our lives. The founder of the doctrine of stress, Canadian scientist Hans Selye, defined stress as a non-specific response of the body to a variety of influences, giving rise to a number of general, sequentially occurring reactions (stages): anxiety, adaptation and failure of adaptation (exhaustion). The severity of these reactions does not depend, as a rule, on the qualitative characteristics of the stimulus, i.e. stress-causing factor.

It should be said, however, that to a certain extent, stressful situations contribute to the training of the body’s adaptive mechanisms and increase its resistance to adverse effects. Life without stress, said Selye, means death. Already at birth, a person experiences stress associated with the need to adapt to extrauterine existence. The state of a newly born newborn is compared with the state of an astronaut who has returned to Earth. In later life, a person is subjected to periodically occurring, often excessive, actions of natural, professional, social and other factors. Extreme stress, as well as repetitive stressful situations (chronic stress) have an adverse effect on the body.

With regard to the harmful effects of stress on reproductive function, some forms of psycho-emotional stress should first be mentioned. Specialists have long described a number of reproductive disorders associated with excessive psycho-emotional stress: amenorrhea (cessation of menstruation) of “wartime”, “concentration camp”, “imprisonment”, anovulation of “fear of pregnancy”, “career infertility” of business women, etc. .P. They are based on stress-induced disturbances in reproductive function, leading to temporary infertility. According to domestic researchers V.N. Serov and A.A. Kozhin, stressors of various nature lead to excessive excitation of the hypothalamic-pituitary link of endocrine regulation with increased secretion of gonadotropins, increased estrogen production, hyperfunction of the adrenal glands and the thyroid gland. The consequence of this is the occurrence of anovulatory conditions, infertility, the development of precancerous processes in the organs of the reproductive system.

As a consequence of chronic stress, hypogalactia (lack of breast milk) is considered to be widespread in modern women. It is also known that stress, especially in women, plays a significant role in introducing them to bad habits, including alcohol and smoking. According to a number of authors, chronic stress in men can be accompanied by changes in the neuroendocrine system, leading to a decrease in testosterone secretion, impaired spermatogenesis, and decreased fertility.

Stressful conditions of a pregnant woman also have an adverse effect on the fetus. This was found out, in particular, when studying the consequences of the September 11, 2001 terrorist attack in New York. Children born to women who lived within a one mile radius of the World Trade Center towers during pregnancy were diagnosed with mental retardation, determined by special tests.

The pathogenic effect of prolonged (chronic) stress stress, leading to a disruption of the body’s adaptive capabilities, is especially often manifested in conditions of recurring economic crises, man-made disasters and their consequences, “environmental crises”, under the influence of climatic and meteorological factors of an extreme nature on the body, etc.