Newborn Center Point by Prof Kriangsak Jirapaet

The Newborn Instrument Production Project

The Newborn Instrument Production Project was established by Kriangsak Jirapaet, MD, Professor Emeritus
of Pediatrics (Neonatology), in 1984 with the support of the Faculty of Medicine Siriraj Hospital, Mahidol University.

Vision and mission

His vision has been that improving national neonatal care standards requires the ability to rely on inexpensive, independently produced, long-lasting, and high-quality medical equipment with low-cost maintenance.

The project addresses the shortage of medical equipment needed for the care of newborn infants in Thailand. It is a significant barrier to addressing the public health issues that contribute to high neonatal morbidity and mortality. The project has been carried out since 1995 without support from Siriraj Hospital, with the same policy, and the equipment has been either sold to hospitals or donated to those with limited budgets to improve neonatal care standards nationwide.

Research and development

All medical devices under this project have been researched and proven for their effectiveness, safety, and durability. Selling at a lower profit so the health service system can leverage its buying power for these vital medical devices. The devices have been sold to hospitals across the country at a price 2-4 times lower, with high durability and efficacy equivalent to or superior to imported devices.

The aim of production

The Siriraj phototherapy device (SPD) was first produced in 1996 using fluorescent tubes to solve the high rate of blood exchange transfusions from hyperbilirubinemia at Siriraj Hospital, approximately 500 cases per year. The Siriraj phototherapy device has evolved significantly through continuous improvement, from daylight fluorescent tubes to special blue fluorescent tubes,^1-4 and advanced to light-emitting diode (LED) tubes as a light source for intensive phototherapy. The advantage of SPD is that the traditional SPD using fluorescent tubes can be easily modified to use LED tubes by simply adding an LED conversion kit and replacing the fluorescent tubes with LED tubes, which helps the hospital save on the budget for purchasing a new LED phototherapy device. In addition, its T8-LED tube enclosure can also support the future development of LED tubes when compared to phototherapy machines using LED modules that may not be able to.

The 2026 model SPD upgrade

The latest SPD design has been upgraded to be modern for LED phototherapy for neonatal jaundice. The latest SPD design aligns with the American Academy of Pediatrics (AAP) recommendations for the most effective and safe phototherapy devices.⁵ These include: (1) incorporation of narrow band blue-to-green light-emitting diode lamps (∼460–490 nm wavelength range; 478 nm optimal), (2) emission of irradiance of at least 30 µW/cm²/nm in term infants, and (3) illumination of the exposed maximal body surface area of an infant (100%). The key improve-ment is using the blue-green wavelength of a peak ~478 nm, which has previously shown 31% more efficient for removing unconjugated bilirubin from circulation than blue LED light with a peak wavelength of ~452 nm⁶. This wavelength increases the safety profile by reducing photodynamic damage, minimizing heat generation, and limiting oxidative stress.^6,7

General specification

SPD is a floor-standing, mobile phototherapy device utilizing T8-LED tubes instead of integrated LED light modules. It offers significant advantages regarding maintenance costs and ease of repair. Users can replace the LED tubes themselves, and only the deteriorating tube needs to be replaced, rather than the complete integrated LED fixtures.

SPD provides high spectral irradiance that covers more than the entire body surface area of a full-term, 40-week gestational-age infant (1,925 cm² vs 1,500 cm²). The distance of the light enclosure can be adjusted as needed to reduce or increase the irradiance intensity; a closer proximity to the baby increases the intensity.

Key aspects of SPD's safety include:

The LED tubes of SPD do not emit significant light in the ultraviolet or infrared ranges, with a reduced risk of skin damage and a minimal increase in the air temperature surrounding the baby from the thermal energy dissipated into the surrounding air by the LED heat sink.

This more uniform distribution of and higher irradiance intensity across the infant surface area (ISA) reduces the length of phototherapy treatment and hospital stay. Furthermore, because of the wider ISA, the baby is still in the effective ISA when moving, which eliminates the need for nurses to position the baby frequently. These two factors, a reduction in length of stay and direct contact, reduce the risk of sepsis.Transitioning from blue fluorescent light to blue-green LED light (478 nm) aids in neonates’ exposure to less light in the 400–450 nm spectral range, potentially leading to less photo-oxidation and geno-/cytotoxicity, reduced risk of cancer, and decreased mortality in extremely low-birthweight neonates.⁶ In addition, the blue-green LED light facilitates shorter, less intensive treatment sessions.^6,7

SPD is available in both single and double phototherapy units.

Product specification

Spectrum

This SPD upgrade utilizes blue–green LED light with a peak emission of 478 nm, which has proven 31% more effective in removing unconjugated bilirubin from circulation than blue LED light with a peak wavelength of 452 nm.⁶

Intensity

The use of six T8-LED tubes provides more light energy and uniform distributions of light energy. SPD emits a light energy of 66.8 microwatts/cm²/nm in the center of the ISA, covering the head to toes, with an average light energy of 49.5 μW/cm²/nm calculated from an ISA for 40-week-gestational-term infants of 30x50 cm (the blue-green area).

The effectiveness of SPD for treating jaundice

Compared to the daylight fluorescent phototherapy device and the foreign LED device, the first SPD invented with special blue fluorescent tubes showed a faster bilirubin decrease in healthy infants (p-value < 0.015).^2,4 The rate of blood transfusions reduced by 75% within the first 6 months of use, from 15.4% to 4.3%.² The annual prevalence of exchange transfusions, which pose a risk to blood-transmitted diseases such as CMV, HIV, hepatitis B, C, etc., dropped to 19 cases per year after the double SPD was produced in 2003.

References:

1. Jirapaet K, Jirapaet V. Measurements of the irradiance and the effect on environment temperature of the Siriraj      Phototherapy Lamp. Siriraj Hospital Gazette, 1997:49:323-9.
2. Jirapaet K, Jirapaet V. The efficacy of Siriraj phototherapy lamp. Thai Journal of Pediatrics.1997;36:284-91.
3. Sittanomai N, Jirapaet K. The effect of lining the phototherapy lamp with white cloth, blue cloth, and aluminum foil
     on the irradiance. Thai Journal of Pediatrics. 2009; 48:71-76.
4. Ngerncham S, Jirapaet K, Suvonachai R, Chaweerat R, Wongsiridej P, Kolatat T. Effectiveness of conventional     phototherapy versus super light-emitting diodes phototherapy in neonatal hyperbilirubinemia. J Med Assoc
    Thailand. 2012: 95(7):884--9. PMID: 22919982
5. Bhutani VK, Wong RJ, Turkewitz D, et al; American Academy of Pediatrics, Committee on Fetus & Newborn.
    Phototherapy to Prevent Severe Neonatal Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of
    Gestation: Technical Report. Pediatrics. 2024;154(3):e202406802
6. Ebbesen F, Vreman HJ, Hansen TWR. Blue-Green (~480 nm) versus Blue (~460 nm) Light for Newborn
    Phototherapy-Safety Considerations. Int J Mol Sci. 2022;27;24(1):461. doi: 10.3390/ijms24010461.
7. Ebbesen, F., Madsen, P.H., Rodrigo-Domingo, M. et al. Bilirubin isomers during LED phototherapy
    of hyperbilirubinemic neonates, blue–green (~478 nm) vs blue. Pediatr Res 2025;97, 1623–8.
8. Dam-Vervloet, A.J., Bosschaart, N., van Straaten, H.L.M. et al. Irradiance footprint of phototherapy devices:
    a comparative study. Pediatr Res 92, 453–8 (2022).

The Newborn Instrument Production Project

Vision and mission

His vision has been that improving national neonatal care standards requires the ability to rely on inexpensive, independently produced, long-lasting, and high-quality medical equipment with low-cost maintenance.

The project addresses the shortage of medical equipment needed for the care of newborn infants in Thailand. It is a significant barrier to addressing the public health issues that contribute to high neonatal morbidity and mortality. The project has been carried out since 1995 without support from Siriraj Hospital but with the same policy, and the equipment has been either sold to hospitals or donated to those with a limited budget to support the improvement of neonatal care standards on a nationwide level.

Research and development

All project medical devices have been researched and proven for their effectiveness, safety, and durability. Selling with less profit so the health service system can leverage their buying power for these vital medical devices. The device has been sold to hospitals across the country at a price that is 4-5 times cheaper than those imported from abroad.

The aim of production

SRW was first produced in 1986 to tackle the problem of neonatal hypothermia in the delivery room (DR) and neonatal wards due to a lack of infant warming devices (infant warmer, infant incubator, etc.). The prevalence of hypothermia was 52% for infants transferred from the DR to the well newborn nursery for 24-hour observation and 100% for those transferred to the sick newborn wards for treatment.1 It was intended as a simple and easy-to-use therapy warmer that provides warmth for preterm and term infants.

SRW was awarded the Mahidol University Award for Invention by His Majesty King Bhumibol in 1991. It was one of the major achievements listed in the 120 Memorabilia of Siriraj book published in 2003 when the Faculty of Medicine Siriraj Hospital commemorated its 120-year anniversary.2

General product information

The SRW is a floor-standing and moveable warmer and has been designed to be used with infants lying in open beds or with babies in incubators who need to open the cabinet for procedures (the concept design of a hybrid incubator nowadays).

Heating element

The enclosure, with a 1000-wat heater rod inside, can provide even heat distribution over the entire bed area. It is made of stainless steel and is located on a pole with a caster base, which makes it easy to move the device. The base can be inserted under the open bed and an incubator.

The ambient temperature around an infant can be adjusted by setting the thermostat button in accordance with the required neutral thermal environment (NTE) temperature appropriate to its birthweight and age. NTE is an environment in which an infant maintains a normal body temperature while minimizing energy expenditure and oxygen consumption. Following is the relationship between the set temperature and ambient temperature when the lower edge of the enclosure is 90 cm above the infant and drafts are avoided.

The efficiency of SRW on Infants’ temperatures

Long-term temperature maintenance

The SRW has the capability to operate continuously. By using an adjustable thermostat in conjunction with a thermocouple, the device can be switched on and off intermittently. It can be used as a substitute for an incubator for preterm and term infants if one is lacking. But it must be free from drafts in the room environment to prevent hypothermia.1 The core temperatures can be maintained within the normal range of 36.5 °C to 37.5 °C.1

Short-term warming

SRW can effectively treat hypothermia in preterm and term infants within two hours of warming.1

References:

Jirapaet K, Jirapaet V. Rewarming hypothermic newborn infants with Siriraj radiant warmer-model 2.
Siriraj Hospital Gazette 1991; 43:299-305.
Faculty of Medicine Siriraj Hospital. 120 Memorabilia of Siriraj. Bangkok: Plan Printing; 2008. p. 381-3.

©Copyright Professor Kriangsak Jirapaet
Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University.Tel. +66 2419 5935
E-mail: kriang-sak@hotmail.com