Textile Research Journal OnlineFirst, published on October 15, 2009 as doi:10.

1177/0040517509349785

Textile Research Journal

Article

Light Protection Performance of Textile Phototherapy Eye-patch Protectors for Jaundiced Infants
In this paper we report on an experimental investigation into the performance of textile eye-patch protectors for jaundiced infants nursed in neonatal units which are routinely used to protect their eyes from strong light during phototherapy. With the view of practical application, the main factors affecting the light protection performance of an eye-patch protector, including the light transmission level of the fabric, the irradiance level, location of the light unit, the head directions of the infant, and the design components of eyepatch protectors, were examined in a simulated clinical environment of phototherapy light treatment. It was found that textile eye-patch protectors are able to shield the strong phototherapy light effectively. However, the light protection performance of the eye-patch protector is greatly affected by its fabrication and the level of the eye-patch displacement. Results from the current work confirmed that fabric constructional parameters and structure both had a significant impact on phototherapy light protection. Fabric that was black in color could give effective protection from different light sources. Results also revealed that the selection of light units, the positions and the head directions of the infant, and the infants distance from the light unit are major factors affecting the irradiance level and the efficacy of the treatment. Uniquely, non-linear regression models have been applied and demonstrated to predict the safety performance of eye-patch protectors.

Abstract

Yong-mei Deng, Kit-lun Yick1 and Yi-lin Kwok

Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong

Siu-chun Wong
Department of Paediatrics and Adolescent Medicine, The Hong Kong Queen Mary Hospital, Hong Kong

Long Wu
Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong

Key words eye-patch protector, phototherapy

treatment, light protection performance

Neonatal jaundice is the most common condition found in newborns. About 5060% of full-term infants and 80% of pre-term infants will have jaundice during the first week of their life because their livers are too immature to remove a waste product called bilirubin from the blood [1-3]. Typically, a naked infant is exposed to a fluorescent light for

several days. As the light is absorbed by the infants skin, the bilirubin in the infants body is changed into another

1 Corresponding author. Tel: +852 2766 6551; Fax: +852 2773 1432; Email: tcyick@inet.polyu.edu.hk

Textile Research Journal Vol 0(0): 112 DOI: 10.1177/0040517509349785 Figures 1, 7, 10 appear in color online: http://trj.sagepub.com

The Author(s), 2009. Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav

TRJ

Textile Research Journal 0(0)

form of bilirubin that can be easily excreted in stools or urine. The literature indicates that the wavelength and the irradiance of light are two essential parameters of phototherapy light affecting the required dosage for jaundice treatment [4]. Dicken et al. [4] also revealed that the most efficacious wavelength range for photo-degradation of bilirubin is between 450 and 460 nm (i.e. blue light). However, a study of animals revealed that intense blue fluorescent light can damage a newborn piglets retinas which are developed in a way similar to human infants [5]. Therefore, eye shields such as eye-patch protectors (EPs) are routinely used in neonatal units routinely to protect the infants eyes from strong light during phototherapy. The application of EPs to phototherapy treatment has a history of over 40 years. Various EPs have been developed and applied to phototherapy [68]. Since the essential function of an EP is photo-protection, the protection given by an EP must be evaluated. Much research has focused on evaluating light transmittance through EPs [911]. Robinson [6] and Porat et al. [7] emphasized that the evaluation of EPs should be conducted in a clinical light simulating environment. A spectroradiometer was used to measure the spectral distribution of irradiance which is an effective index for the dose of phototherapy in clinical practice. Porat et al. [7] and Davies [8] also used a luxmeter (or lightmeter) to measure illuminance and evaluate the intensity of incident light and wavelengths. As there are medical ethics restrictions on testing on the living human body, most of the research studies focused on the light transmission characteristics of the EPs materials [611]. Since the experiments did not mimic the clinical light conditions of phototherapy treatment, the performance of eye protection offered by EPs is still unknown. Some researchers also noticed that the transmission characteristic of materials is only one of the important factors for photo-protection of EPs. However, measurements taking other influencing factors into account, such as fitting and displacement, are still very scarce.

Experimental Work
Fabric Samples
Keybus et al.s work [12] revealed that almost all structural indices of textile materials, especially fabric color, weight, and structure, have a direct impact on the transmittance of visible radiation and the light protection of fabric. In this work, the effects of fabric structural indices on fabric light transmittance during phototherapy treatment were examined. As suggested by the medical staff of neonatal intensive care unit and special care baby unit of a local hospital, cotton and/or cotton blended single jersey fabrics were first chosen for light protection performance examination due to their excellent comfort and softness for newborn infants. Blue light in the wavelength range of 400500 nm and white light in the wavelength range of 350800 nm, both of which are usually used in phototherapy treatment were used. The light transmittance of three single jersey fabric samples of various thicknesses and weights under the condition of no fabric extension were measured by a Cary UV/ Visible spectrophotometer using the ASTM 183-2004 method. Since fabric extension has a major effect on light transmission [13] and knitted fabrics have an inherent capacity to extend, while woven fabrics do not, test results in light transmittance were compared against a simple woven fabric. Samples are made from 100% cotton or cotton/spandex blended, some of their structures and contents are similar to the EP fabrics used. Specifications of the fabric samples are presented in Table 1. In this experiment, the light transmittance of different color fabrics was also examined. Six fabric samples of the same structure of Fabric D in white, yellow, green, blue, red, and black colors were used.

Table 1 Specifications of the fabric samples.

Fabric Content No. Color Construction Weight (g/m2) Thickness under pressure of 200 Pa (mm) 0.54 0.81 1.19 0.50 36.9 Yarn count Warp (tex) 14.5 14.5 18.0 36.9 Weft (tex) Fabric sett (per cm) Ends or wale 15.9 18.2 15.9 44.4 Picks or course 17.8 27.2 24.4 15.7

A B C D

100% cotton 95/5 cotton/ Spandex 95/5 cotton/ Spandex 96/4 cotton/ Spandex

White White White White

Single jersey Single jersey Single jersey Woven (1/2 twill)

100.8 207.6 258.0 240.8

Light Protection Performance of Textile Phototherapy Eye-patch Protectors Y.-mei Deng et al.

TRJ

Figure 1 Instrumentation for light protection performance evaluation.

Figure 2 Light units at simulated clinical environment: (a) fluorescent light; (b) halogen spotlight.

Data Acquisition Instrumentation for Light Protection Performance Evaluation in a Simulated Clinical Environment
To evaluate the level of light exposure and protection of EP in phototherapy treatment, a data acquisition instrumentation for indices of light, including spectral irradiance and illuminance, was developed. The instrument consists of an infants head model, a spectroradiometer with a small size diffuser installed at manikins eye location and a support stand, see Figure 1. A gear with a 15 interval was designed at the bottom of the head model to adjust the angle of the head model so as to simulate the head directions of the infants. An International Light ILT 900 wideband rapid portable spectroradiometer with a fiberoptic/ mini waterproof cosine diffuser having a diameter of 14 mm was used for investigating the spectral distribution of light irradiance. The diffuser of the spectroradiometer was

attached to the eye position in the head model to examine the level of light exposure to the infants eyes. A simulated clinical environment was set up in the hospital to mimic a clinical phototherapy environment with various assemblies of light source (i.e. light units, locations, directions and distances). A Medela fluorescent phototherapy unit and an Ohmeda halogen spotlight unit were used as light sources in this experiment, see Figure 2. The light units were located at the top of a standard Air Shields Isolette Incubator. The diffuser of the spectroradiometer used for the detection of light irradiance was located in six different locations to simulate the positions of the infants, see Figure 3. In view of the head directions of the infants, the light irradiance at seven different angles from 0 to 180 was measured, see Figure 4. All experiments were conducted with the indoor artificial lighting maintained over 24 hours in the neonatal unit. The measuring range of the spectroradiometer was regulated as the

TRJ

Textile Research Journal 0(0) visible light wavelength of 350800 nm because visible light may cause retinal damage and a variable degree of visual loss to infants [4].

EP Samples
Two EPs currently used in the neonatal unit of a local hospital in Hong Kong were selected for the experiment: the Posey eye-patch protector (EP1) and the Biliband eyepatch protector (EP2). A newly developed EP (EP3) was also evaluated in this study [14, 15]. Each EP included two panels: one eye-patch panel used to protect infants eyes from strong light and one fastening panel used to fix the eye-patch panel to an optimum position on the infants head, which varied in style, material composition and function to the other samples. The schematic diagrams of the samples are presented in Figure 5 and their fabrication of eye-patch panel is presented in Table 2. It is noteworthy that the eye-patch panel is a composite of a three-layer structure with an inner layer single jersey fabric, a middle layer of foam or woven material, and an outer layer of knitted fabric.

Figure 3 Locations of diffuser for detection of light irradiance (unit: millimeters).

Prediction of Safety Performance using Nonlinear Regression Method

To predict the safety performance of EP in relation to its displacement, non-linear regression models using the Gauss Newton algorithm are used to calculate the light protection performance of EP [16]. As the diffuser of the spectroradiometer was shielded by the three EPs, the light illuminance values with distance and direction variations were firstly standardized using Equations (1), (2) and (3) below and Bartletts test was applied for significance of variables:

Figure 4 Directions of diffuser for detection of light irradiance (unit: degrees).

Table 2 Fabrication of the eye-patch panels of EP samples.

Sample code Composite Structure with three layers of material for each sample Construction Content/structure Color Weight of EP panel at three-layer composite structure (g/m2) Thickness of EP panel under pressure of 200 Pa (mm)

Inner-layer EP1 (Posey) Middle-layer Outer-layer Inner-layer EP2 (Biliband) Middle-layer Outer-layer EP3 (new design) Inner-layer Middle-layer Outer-layer

Cotton (single jersey) Polyurethane/polyester blended (foam) Nylon (tricot) Cotton (single jersey) Polyurethane/polyester (foam) Cotton (single jersey) Cotton/Modal blended (single jersey) Cotton (woven) Cotton (single jersey)

White Gray White Blue White Black White Black Pink 401.4 1.30 542.9 2.36 365.5 3.75

Light Protection Performance of Textile Phototherapy Eye-patch Protectors Y.-mei Deng et al.

TRJ

Figure 5 Schematic diagrams of the EP samples.

xi x z i = ----------s

(1)

s =

1 -n

(x x)
i

(3)

where zi is calculated as the standardized data of independent variable; xi is the corresponding independent variable; x and s are the mean and standard deviation of the independent variable which are calculated as follows: 1 x = -n

where n is the number of samples. The data was then calculated using Table Curve 3D by non-linear regression. The fitting procedure is based on the Gauss Elimination Algorithm.

(2)

TRJ

Textile Research Journal 0(0)

Figure 6 Light transmittance of fabrics in different structures and weights.

Results and Discussion

Effects of Fabric on Light Protection Performance of EP
The light transmittance results obtained from the four studied fabrics at the wavelength range of 350800 nm are presented in Figure 6. Amongst the three single jersey fabrics (A, B and C), Fabric C was the heaviest and thickest fabric sample and resulted in the lowest values of light transmittance and the best light protection during phototherapy treatment. Fabric weight and thickness had a significant impact on the value of light transmittance in both the wavelength ranges of 400500 nm (blue light) and 350 800 nm (white light). This could also be attributed to the variations in yarn fineness and density of the fabric samples [17, 18]. To some extent, the woven structure of Fabric D may be more desirable for EP development than single jersey structures since it also gave low values of light transmittance, even though its thickness is only half that of Fabric C. While one woven fabric was investigated in the current study, other processing variables differed among fabric types and were not controlled; further examination on woven samples for phototherapy light transmittance is recommended for EP development. For example, in the literature it has been reported that satin weave offered better ultraviolet protection than twill and plain weaves since it

can achieve higher warp/weft density than with twill and plain weaves, so the macropores are smaller and ultraviolet radiation has less free space to pass through than in twill or plain weaves [17]. Results of the six fabrics of the same structure but different colors are presented in Figure 7. It can be seen that the different colors of the fabrics had a major effect on light transmittance at the wavelength range of 350800 nm. The results revealed that white fabric had the highest values of light transmittance, while fabrics in yellow, green, blue, and red had low values of light transmittance in the wavelength range of 400500 nm, but high values of light transmittance in the wavelength range of 550800 nm. Black fabric, however, had the lowest values of light transmittance (with the mean value of 0.008%) and offer the best light protection from both blue and white lights during phototherapy treatment. It is noteworthy that the light transmission characteristic of materials would also be affected by several fabric parameters such as yarn structure, fabric texture, fabric extensibility, finishing treatment, etc. [13, 17, 18]. The light transmittance of knitted fabrics may also increase readily when fabrics were stretched at use and the light protection performance of the textile EPs would show more complex rules. Thus, the conclusion drawn from this experiment may be only suitable for single jersey and/or simple woven fabrics without tension applied such as the fabric samples used in this study. Owing to the above-mentioned draw-

Light Protection Performance of Textile Phototherapy Eye-patch Protectors Y.-mei Deng et al.

TRJ

Figure 7 Light transmittance of fabrics in different colors.

backs, the dimensions of the final EPs, the size or head circumference of the infant and the finishing treatment of the protecting fabric are not considered when examining the light protection performance of the EPs.

irradiance (in wavelength ranges of 350800 nm and 400 500 nm) and the total illuminance (of various settings of light conditions typically used in hospital) were calculated and are summarized in Table 3.

Influence of Light Conditions and Settings of Phototherapy Treatment

When considering the end-use of the textile EP, the influence of light conditions and settings of phototherapy treatment are examined. As suggested by the medical staff, three light settings for the fluorescent light unit and halogen light unit frequently used in hospital were adopted in this work. Owing to the invasive medical treatment and/or physiological needs, infants move from time to time. It is a persistent problem that the EPs are displaced very quickly. Therefore, the light environment of various typical locations which mimic the sleeping positions and head directions of the infants during phototherapy treatment was also measured. Even though the optimum light quality for the most efficient use of phototherapy is still under active investigation and discussion, the yellow bilirubin absorption spectrum in plasma and buffer/human serum albumin has been well established. The most effective light sources for degrading bilirubin in the skin are those that emit light in a relatively narrow wavelength range of 400500 nm and center around a peak of 46010 nm, which closely matches the bilirubin absorption spectrum [19, 20]. In this respect, the spectral distributions of light irradiance with various settings of light conditions were measured, and the total

Types of light unit

Figure 8 presents the effects of the fluorescent light with four blue tubes (4B), with two white and two blue tubes (2W2B) and the halogen light (H) with the diffuser located at point E of the mattress, which is the typical head location of infants. Results indicated that light irradiance from the fluorescent light unit with 4B was higher than that with 2W2B in the wavelength range of 390530 nm, but lower than that with 2W2B in other wavelength ranges. The peak of spectral irradiance of halogen light was at 640 nm approximately and reduced slowly from the peak. Results demonstrated that fluorescent light with 4B is the most effective light source for jaundice treatment amongst the three light units studied. In this experiment, halogen light is less effective for bilirubin reduction since only about 15% of halogen light irradiance was in the wavelength range of 400500 nm. The strong light illuminance of halogen light (65,270 lux), far exceeding the safety illuminance magnitude and 10 times higher than that of the fluorescent light settings, may also result in a higher degree of potential retina damage to infants.

TRJ

Textile Research Journal 0(0)

Figure 8 Spectral distribution of light from various types of light unit (4B, 2B2W, H).

Location of the Diffuser

When the 4B fluorescent light unit was put over the center of the incubator with a vertical distance of 350 mm between the unit and the diffuser, the spectral distribution of light irradiance was measured at points A, B, C, D, E, and F, illustrating the moving range of the infants head on the mattress. As shown in Table 3, the values of total irradiance obtained from different positions on the mattress were different obviously. The further the distance between the diffuser and the light unit is, the smaller the values of total irradiance and illuminance. The highest values of light irradiance within the wavelength of 400 500 nm (56 W/m2) and illuminance (6365 lux) was obtained at point F, as it has the shortest distance from the fluorescent light unit amongst the six locations studied. Point A resulted in the lowest values of light irradiance (8.6 W/m2 within 400500 nm) and illuminance (1466 lux). It is obvious that the position of the diffuser and its distance from the light unit are major factors affecting light irradiance and light illuminance.

diffuser from 0 to 90, the values of irradiance within the wavelength of 400500 nm and illuminance were reduced sharply. When the angle moved continuously from 90 to 180, the low values of light irradiance and illuminance were obtained. The measured values of light irradiance and illuminance obtained from diffuser angles of 120 to 150 were higher than those obtained from diffuser angles of 90 to 180. The results can be explained by the increased light reflection of the white bedding sheet on the mattress. Thus, the direction between the diffuser and the light unit is another major factor in affecting the light irradiance and illuminance.

Effects of Design Components on Light Protection Performance of EPs

In view of clinical application, the light protection performance of phototherapy EPs is not only affected by the conditions and settings of the light unit, but also influenced by the design and fabrication of the EP. Design components refer to the fabrication of the eye-patch panel which is generally a composite structure to shield the infants eyes, as well as the fitting of the EP to infants head while the light gap and its frequency of displacement should be minimized. In this study, the light protection performance of the eye-patch panel of three EP samples was first examined. The typical phototherapy setting of a 4B fluorescent light unit and halogen light were used. The diffuser of the spectroradiometer was then shielded by EP1, EP2, and EP3, and the level of spectral irradiance and the light illuminance were measured respectively. The results in Table 4 show that the illuminance values obtained from the three

Directions of Diffuser
The spectral distribution of light irradiance was also measured in directions of 0, 30, 60, 90, 120, 150, and 180 to simulate the infants head positions. As shown in Table 3, of all of the directions of the diffuser, the highest values of light irradiance and illuminance were obtained when the direction of the diffuser was at 0 (40 W/m2 within 400500 nm and 4925 lux), which is where the diffuser has the shortest vertical distance from the light source. When turning the

Light Protection Performance of Textile Phototherapy Eye-patch Protectors Y.-mei Deng et al.

TRJ

Table 3 Light irradiance and illuminance measured at various settings of light conditions.
Settings of light conditions Light units Variables Irradiance (W/m2) at 350800 nm 146.7 130.4 230.4 A B Fluorescent light (4B) with diffuser at six locations C D E F 0 30 60 Fluorescent light (4B) with diffuser at seven directions 90 120 150 180 110.9 128.7 142.5 118.2 146.7 164.3 146.7 132.8 119.8 113.5 117.2 115.7 113.2 at 400500 nm 40.4 18.0 33.8 18.6 24.6 37.0 14.9 40.4 56.2 40.4 27.9 17.7 12.5 15.8 14.5 12.4 4925 6453 65,270 1466 3044 4248 2264 4926 6365 4926 3508 1235 517 889 739 459 Illuminance (lux)

Fluorescent light unit with 4 blue tubes (4B) Fluorescent light unit with 2 blue and 2 white tubes (2B2W) Halogen light unit (H)

Table 4 Light protection performance of EPs

Irradiance (W/m2) at 350800 nm Ambient light at hospital Fluorescent light (4B) without EP Shielded by EP1 Shielded by EP2 Shielded by EP3 Halogen light (H) without EP Shielded by EP1 Shielded by EP2 Shielded by EP3 1.41 46.7 0.51 0.35 0.18 230.4 4.01 0.86 0.55 at 400500nm 0.27 40.4 0.32 0.10 0.06 33.8 0.41 0.10 0.05 Illuminance (lux) 491 4926 59.3 27.0 12.7 65,270 1122 225 155 Illuminance Residual (%) 1.2% 0.6% 0.3% 1.7% 0.4% 0.2%

EPs studied were reduced. The EPs can shield the infants eyes from both fluorescent light unit and strong halogen light unit effectively and safely, where the safety light level in terms of illuminance magnitude was defined as less than 600 lux [8]. Amongst the three EP samples, EP3 resulted in the lowest irradiance and illuminance values which can provide the best light protection from phototherapy light.

As the infant moves, the EP may become displaced very quickly, allowing light to shine directly onto the infants eyes. An ill-fitting EP results in light gaps and exposing the infants eyes to the bright light. As far as fitting aspect is concerned, the frequency and the level of light protection in relation to the displaced positions of EPs were also measured. The illuminance magnitude of EP3 with distance and direction variation was mapped, see Figure 9.

TRJ

10

Textile Research Journal 0(0)

Figure 9 The relationship between light illuminance and displacement position of EP3.

Based on the 600-lux illuminance threshold, over which the risk of the retinopathy of prematurity increased significantly [8], a safety region was marked on the illuminance magnitude map. EP3 resulted in the largest safety region (2000 mm2) as compared with EP1 (800 mm2) and EP2 (400 mm2), referring to a more comprehensive EP design which reduces accidental light exposure and minimizes EP repositioning. When the EP was displaced, the level of eye protection was determined by the covered area of eyes and the light gaps since the light transmittance of the eye-patch panel was consistent in all positions. Eyes were covered completely when the EP was displaced within a safety region where only the light gaps could affect the level of eye protection. The illuminance magnitude map therefore reveals that the light gaps were changed by the interaction of the EP and the face of the infant. When the edge of the EP approached the eyelid, the strong phototherapy light could still reach the eye through the light gaps and, thus, the illuminance value increased sharply and exceeded the safety threshold. As shown in Figure 9, the light gaps in bottom directions affected eye protection significantly because light usually came in upper front directions when the infants were in a supine position.

analysis was carried out. The values of light illuminance in relation to the displacement distance and direction of the 3 EPs studied were analyzed. The data of independent variables was firstly standardized using Equations (1)(3), all with significance of 0.001. Non-linear regression was then undertaken and the light illuminance can be derived as follows: IEP = a + b x + c y + d x2 + e y2 + f xy + g x3 + h y3 + i xy2 + j x2y (4)

A Safety Performance Prediction Model for Phototherapy Eye-Patch Protectors

To predict the effects of EP displacement on light protection performance of the textile EPs, non-linear regression

where I EP is calculated as the light illuminance (lux) as the diffuser of the spectroradiometer was shielded by EP; x is the horizontal displacement of EP from optimum position (millimeters); y is the vertical displacement of EP from optimum position (millimeters); and a to j are the corresponding coefficient of variables derived from x and/or y. Using the Gauss Elimination Algorithm method, the magnitude of light illuminance could be predicted according to the position of EPs. In all cases, the regression coefficients obtained from each EP are higher than 0.900. The regression models for EP1, EP2, and EP3 were formulated using light illuminance as the dependent variable and the displacement position and direction as the independent variables with significance level of 0.000: IEP1 = 336.96 3.94x + 62.54y + 1.95x2 + 4.75y2 1.22xy 0.03x3 + 0.06y3 0.02xy2 0.04x2y (5)

Light Protection Performance of Textile Phototherapy Eye-patch Protectors Y.-mei Deng et al.

11

TRJ

Figure 10 Prediction of light illuminance of (a) EP1 and (b) EP2 by 3D fitting model.

IEP2 = 289.84 7.81x 21.19y + 0.87x2 + 6.58y2 + 0.77xy 0.01x3 + 0.30y3 + 0.07xy2 0.03x2y IEP3 = 677.6 + 6.20x + 58.45y + 1.19x2 + 4.04y2 + 1.38xy 0.02x3 0.003y3 + 0.05xy2 + 0.02x2y (7) (6)

Conclusion
In assessing the light protection performance of phototherapy EPs, the fabric structure and color were identified as the important variables affecting light transmittance. Even though cotton single jersey fabrics offer excellent comfort to infants, the differences in light transmittance amongst the fabrics examined were significant. This may be associated with the constructional parameters of the fabrics such as weight, thickness, yarn fineness, density, etc. While the simple woven fabric with lowest light transmittance was also the thinnest, woven structures may be more desirable for phototherapy light blocking as compared with single jersey structure. Results from the current work also confirmed that fabric color had a significant impact on the value of light transmittance. Black fabric offered the best light protection from both white and blue lights during phototherapy treatment for degrading bilirubin in newborn infants. Textile phototherapy EPs are able to shield fluorescent and halogen lights and protect the infants eyes safely. Nevertheless, differences in light illuminance as a result of EP displacement also illustrated the importance of understanding the relationship between EP design and protection. For example, EP3 offers the largest safety region which reduces accidental light exposure and light gaps against EP displacement. Light condition variables such as the selection of light unit, location and direction of the diffuser had great effects on the level of light irradiance and illuminance. Such differences may have implications that light conditions must be taken into consideration when evaluating the efficacy of the treatment. The non-linear regression models have demonstrated the influence of distance and direction variation on the safety performance of

Figure 10 shows the 3D surface fitting models of EP1 and EP2, where the level of light illuminance is correlated with their X and Y displacement positions, respectively. The figures clearly show that moving the EPs would undoubtedly increase the light exposure at phototherapy treatment. The distribution of light illuminance varied with the distances and directions of EP displacement. The plots indicate that the vertical and/or diagonal displacements of EP had a more radical effect on illuminance magnitudes than the horizontal displacements of EP. In EP2, an upward vertical displacement of 5 mm resulted in light exposure immediately, exceeding the 600 lux illuminance safety threshold. With further increase of the vertical displacement to 1520 mm, the illuminance magnitude reached a 4000 lux level. This indicates that the strong fluorescent light leaked through the light gaps and reached the infants eyes directly as without EP shielding. Comparatively, EP2 resulted in the poorest light protection performance amongst the three EPs studied when it was displaced. The results revealed that the increase of illuminance magnitude was mainly caused by the design of the EP, the concave shape of the nose, and the interaction of the materials and design.

TRJ

12

Textile Research Journal 0(0)

8. Davies, V.A., The Effectiveness of Various Eye masks (EM'S) in Reducing Light Intensity (LT) During Phototherapy (PT), Pediatric Res., 20, 346A (1986). Moseley, H., and Marshall, J., Protective Light Shields for Neonatal Phototherapy, Lancet, October 8, 854855 (1988). Chin, K.C., Moseley, M.J., and Bayliss, S.C., Light Transmission of Phototherapy Eyeshields, Arch. Disease Childhood, 62, 970971 (1987). Levene, M.I., Uneven Distribution of Light in Standard Phototherapy, Arch Disease Childhood, 55, 398408 (1980). 12. Keybus, C.V., Laperre, J., and Roelandts, R., Protection from Visible Light by Commonly Used Textiles is not Predicted by Ultraviolet Protection, J. Am. Acad. Dermatol., 54(1), 8693 (2006). Wilson, C.A., Bevin, N.K., and Laing, R.M., Solar ProtectionEffect of Selected Fabric and Use Characteristics on Ultraviolet Transmission, Textil. Res. J., 78(2), 95104 (2008). Deng, Y.M., Yick, K.L., Kwok, Y.L., and Wong, S.C., Eyepatch Protector Design for Neonates in Hong Kong Used in Phototherapy Treatment, in The 85th Textile Institute World Conference, Colombo, Sri Lanka, March 2007. Deng, Y.M., Yick, K.L., Kwok, Y.L., and Wong, S.C., Development of Eye-patch Protector for Neonates Used in Phototherapy Treatment, in The Fibre Society 2007 Fall Annual Meeting and Technical Conference, Davis, CA, October 2007. Xue, S.Y., and Yang, S.X., Power System Frequency Estimation using Supervised GaussNewton Algorithm, Measurement, 42, 2837 (2009). Chen, M.Y., Sun, R.J., Dong, X.Y., and Lai, K., Visual Masking Performance of a Fabric, Textil. Res. J., 78(7), 625630 (2008). Dubrovski, P.D., and Golob, D., Effects of Woven Fabric Construction and Color on Ultraviolet Protection, Textil. Res. J., 79(4), 351359 (2009). Verman, J.J., Wong, R.J., and Stevenson, D.K., Phototherapy: Current Methods and Future Directions, Seminars Perinatol., (2004). Tan, K.L., The Pattern of Bilirubin Response to Phototherapy for Neonatal Hyperbilirubinaemia. Pediatric Res., 16, 5961 (1982).

EPs. As a consequence, commercial EPs which use materials of light transmittance cannot present its actual protection performance in a clinical phototherapy condition accurately. The safety performance of EP should also be evaluated in a simulated clinical condition, including both optimum and displaced positions to ensure that the EP is maximally effective to protect the infants eyes during phototherapy treatment.

9. 10.

11. 12.

Acknowledgement
The research is supported by a grant from the Research Grant Council of the Hong Kong Special Administrative Region, China (No.: POLYU 5299/04E)

13.

14.

Literature Cited
1. 2. 3. Kelnar, C.J.H., Harvey, D., and Simpson, C., The Sick Newborn Baby, 3rd edn, Bailliere Tindall, London, 1995. Melton, K., and Akinbi, H.T., Neonatal Jaundice, Postgrad. Med., 106(6), 167178 (1999). Levene, M.I., Tudehope, D.I., and Thearle, M.J., Essentials of Neonatal Medicine, 3rd edn, Blackwell Science, Oxford, 2000. Dicken, P., Grant, L.J., and Jones, S., An Evaluation of the Characteristics and Performance of Neonatal Phototherapy Equipment, Physiol. Meas., 21, 493503 (2000). Sisson, T.R.C., Retinal Changes Produced by Phototherapy, J. Pediatrics, 77(2), 221227 (1970). Robinson, J., Light Transmission Measurements and Phototherapy Eyepatches, Arch. Disease Childhood, 66, 5961 (1991). Porat, R., Brodsky, N., and Hurt, H., Efficacy of Phototherapy Eye Shields: Tubular Stockinette versus Bili-mask, Pediatric Res., 20, 358A (1986). 15.

16.

4.

17.

5. 6. 7.

18.

19.

20.