The present disclosure relates generally to medical devices, systems, and methods. More specifically, the present disclosure relates to medical devices, systems, and methods for phototherapy to treat disorders such as hyperbilirubinemia and jaundice in infants.
Phototherapy typically involves shining light onto a patient's skin and is a promising clinical tool for the treatment of many conditions including affective disorder, sleep disorders, and skin disorders such as herpes, psoriasis, acne, and even skin cancer. Phototherapy is particularly promising in the treatment of neonatal hyperbilirubinemia, also known as newborn jaundice.
Neonatal hyperbilirubinemia affects over 60% of newborns worldwide. Hyperbilirubinemia is caused by the accumulation of excess bilirubin in the blood, which can give the skin and sclera of the eye a characteristic yellow color. If left untreated, an infant with severe jaundice may sustain neurological damage or even die. The condition requires treatment in approximately 12% of all infants. Studies have estimated that over 6 million newborns with severe jaundice are not receiving adequate treatment.
Hyperbilirubinemia can be treated using phototherapy. In such phototherapy, an infant is exposed to light in a wavelength range corresponding to the peak absorption spectra for bilirubin (blue-green, 400 to 520 nm), Absorption of the light leads to the conformational and structural isomerization of bilirubin into soluble forms that can be easily eliminated through urine.
The effectiveness of such phototherapeutic treatment is contingent on several factors. These factors include the intensity and spectrum of the delivered light, the surface area coverage of the delivered light, and the duration of light delivery. Existing devices are typically expensive, difficult to maintain, and often ineffective in low-income countries where the unmet need for jaundice treatment is the greatest. Thus, there is a need for high-performance phototherapy devices that are designed for extreme affordability. Also, illumination sources such as fluorescent bulbs, incandescent bulbs, fiber optic emitters, and LEDs are typically found in conventional phototherapy devices. Many of these illumination sources are not optimized for intensity, surface area coverage, maintenance, and costs.
The following literature publications may be of interest: “Light-Emitting Diodes: A Novel Light Source for Phototherapy” by Vreman et al, (1998), “An Evaluation of the Characteristics and Performance of Neonatal Phototherapy Equipment” by Dicken et al. (2000), “Treatment of Jaundice in Low Birthweight Infants” by Maisels et al. (2003), “A Prospective Randomized Controlled Study of Phototherapy Using Blue and Blue-Green Light-Emitting Devices, and Conventional Halogen-Quartz Phototherapy” by Seidman et al. (2003), and “Phototherapy: Current Methods and Future Directions” by Vreman et al. (2004).
The following patents and patent publications may be of interest: PCT Publication Nos. WO2008/011885 and WO2009/050213; U.S. Patent Application Publication Nos. 2006/0089685, 2006/0100675, 2006/0217787, 2006/0278816, 2006/0:293727, 2007/0032842, 2007/0208395, 2007/0208397, 2007/0239232, 2008/0116401, 2008/0205033, 2008/0275533, 2009/0030490, 2009/0068613, 2010/0179469, 2012/0078328, 2012/0104277, and 2012/0280114; and, U.S. Pat. Nos. D639751, 3,877,437, 4,802,066, 5,339,223, 5,400,425, 5,698,866, 5,792,214, 6,045.575, 6,290,713, 6,402,681, 6,443,978, 6,464,714, 6,464,715, 6,596,016, 6,811,563, 6,866,678, 6,872,220, 6,955,684, 7,128,442, 7,131,990, 7,147,653, 7,210,817, 7,304,201, 7,305,163, 7,479,664, 8,026,528, 8,043,349, 8,048,136, 8,069,857, 8,202,307, 8,246,666, 8,267,922, 8,337,538, and 8,372,063.
The present disclosure provides devices, systems, and methods for treating neonatal hyperbilirubinemia with phototherapy using LEDs configured to optimize such phototherapy. A phototherapy device according to many embodiments may comprise a plurality of LEDs configured to provide a uniform intensity light at a specified distance range. The specific number of LEDs used may be minimized to a number sufficient to provide such uniform intensity. One or more lenses or filters may be provided for the phototherapy devices. The LED(s) may be provided on a light source or lamp head mounted on a stand or mounting structure, which may be coupled to a support for an infant patient to rest on. The LED(s) will typically have a long lifespan, such as 7.6 years assuming 18 hours of usage per day such that bulb replacement for the phototherapy device is often unnecessary. Thus, a single phototherapy device can treat up to 1,042 infants assuming an average treatment time of 48 hours. The effectiveness of the LED(s) through this long lifespan can be maintained by discretely increasing one or more of current and power supplied to the one or more LEDs as their total light hours increase and the LEDs naturally decay. The power or current supplied to the LED(s) can also be adjusted in response to changes in the tilt or orientation of the phototherapy device or lamp head. The LED(s) are typically coupled to a heat dissipating base or support structure to minimize overheating without requiring the use of a fan, thus lowering the need for additional parts. The disclosure therefore provides cost-effective (e.g., less than 400 USD per device) and long-lasting devices, systems, and methods for phototherapy.
Aspects of the disclosure provide a phototherapy device for the treatment of a subject. The device comprises one or more LEDs and a base or support structure for coupling to and supporting the one or more LEDs. The one or more LEDs are configured to provide a uniform dose of radiation on a treatment surface of the subject over a distance range. The support structure is configured to absorb and dissipate heat generated by the one or more LEDs to minimize overheating generally without requiring the use of a fan. The power supplied to the one or more LEDs may be adjustable by one or more of resistor placement and pulse-width modulation (PWM). The one or more LEDs may comprise a plurality of LEDs distributed over the support structure, where the power supplied to each LED may be independently adjustable. The support structure may comprise a heat-conductive metal plate.
The desired distance range over which the uniform dose of radiation produced may be a range from 20 cm to 50 cm. The distance range may be from about 10 cm to 30 cm, 20 cm to 30 cm, or 20 cm to 45 cm, for example. The one or more LEDs may have an emission range of 400 nm to 520 nm, preferably 430 nm to 490 nm or 475 nm to 500 nm, more preferably 445 nm to 470 nm or 450 nm to 470 nm, and even more preferably 450 nm to 465 nm. The one or more LEDs may be configured to output one or more of at least 30 μW/cm2/nm, preferably at least 35 μW/cm2/nm, and at most 65 μW/cm2/nm over the distance range and across an emission range, e.g., 400 nm to 520 nm. The treatment surface may have an area of about 25 cm by 50 cm.
The phototherapy device may have additional components. The phototherapy device may further comprise a processor for controlling the power supplied to the one or more LEDs and/or their output. The phototherapy device may further comprise a display coupled to the processor for displaying one or more treatment parameters such as an intensity of the one or more LEDs, a wavelength of the one or more LEDs, a treatment time, a time of total use of the one or wore LEDs, a light meter reading, an accelerometer reading, and a checksum. The phototherapy device may further comprise a light meter for detecting an intensity of light from the one or more LEDs. The phototherapy device may further comprise one or more of an accelerometer for detecting an orientation of the phototherapy device and a distance meter to measure the distance between the LEDs and the treatment surface. Power supplied to the one or more LEDs can be adjusted in response to one or more of the detected orientation of the phototherapy device and the distance between the LEDs and the treatment surface. The phototherapy device may further comprise a timer or a memory to measure the total number of hours of use of the LEDs, and the power supplied to the LEDs can be increased as the total number of hours of use increases. As the total number of hours of use of an LED increases, the LED may become dimmer and so current and therefore power supplied to the LEDs may need to be gradually increased to maintain the light output intensity of the LEDs, increasing the effective lifespan of the phototherapy device. The phototherapy device may further comprise one or more focusing lenses coupled to each of the one or more LEDs. The phototherapy device may further comprise one or more filters coupled to each of the one or more LEDs. The one or more filters may be configured to have a transmission spectrum corresponding to an absorption spectrum of bilirubin. The phototherapy device may further comprise one or more LEDs having an emission range of about 550 nm to 650 nm, configured to illuminate the patient. These LEDs can be switched on together with or independently of the LEDs configured to provide the treatment radiation, and may be configured to automatically power off after a specified length of time.
Aspects of the disclosure also provide a light meter for measuring the intensity of radiation provided by a light source. The light meter may comprise one or more filters, a light sensor, and a circuit board. The one or more filters may be configured to have a transmission spectrum corresponding to a target range of wavelengths, for example an absorption spectrum of bilirubin. The light sensor is configured to detect radiation within a target range of wavelengths, and/or output a voltage corresponding to the detected radiation. The circuit board may have a calibration curve stored thereon, and the circuit board may use the calibration curve to convert the voltage output of the light sensor into an irradiance value. The light meter may be used as an independent unit, having its own display so that the irradiance value may be displayed. The light meter may also be connected to a mobile control device such as a cell phone via a connector port, such that the irradiance value is communicated to and displayed by the mobile device.
Aspects of the disclosure also provide a phototherapy system comprising a mounting structure and the phototherapy device discussed above which is coupled to the mounting structure. The phototherapy device may be adjustably coupled to the mounting structure. For example, the angle of the phototherapy device relative to the mounting structure may be adjusted. The mounting structure will typically be mobile, for example, by comprising a mounting structure base having one or more wheels for mobility. The mounting structure may comprise a height adjustable stand. The mounting structure may further comprise a height indicator that indicates the distance between the LEDs and the treatment surface. The height indicator may comprise a treatment height indicator to indicate the distance range, for example 20 cm-50 cm, of the phototherapy device. The height indicator may also comprise a distance meter having a distance sensor, such as an optical range finder, that may be configured to measure the distance between the LEDs and the treatment surface. The measured distance may be communicated to the processor of the phototherapy device to adjust the power supplied to the LEDs correspondingly. The system may further comprise a light intensity monitor or light meter, configured to measure the intensity of the radiation provided by the LED.
Aspects of the disclosure also provide a phototherapy system for the treatment of a subject. The system may comprise a phototherapy device comprising one or more LEDs configured to provide a uniform dose of radiation on a treatment surface of the subject over a distance range. The system may also comprise a light meter as discussed above, configured to measure the intensity of the radiation provided by the LEDs of the phototherapy device. The light meter may be stored with the phototherapy device in many ways. The phototherapy device may comprise a hook which may be engaged with an opening on the handle portion of the light meter, and/or a holster which may hold the light meter. The light meter may also be magnetically couplable with a surface of the phototherapy device. The light meter may be connected to the phototherapy device via a connector port, so the irradiance value from the light meter may be communicated to a processor of the phototherapy device and displayed by a display of the phototherapy device.
Aspects of the disclosure also provide a phototherapy device for the treatment of a subject. The device comprises one or more LEDs, a support structure, and a processor. The one or more LEDs are configured to provide a uniform dose of radiation on a treatment surface of the subject over a distance range. The support structure couples to and supports the one or more LEDs. The processor is configured to adjust the power supplied to the one or more LEDs, in response to one or more of a detected tilt or orientation of the phototherapy device, a distance between the LEDs and the treatment surface, and a total number of hours of use of the one or more LEDs. The orientation of the phototherapy device may be provided by an accelerometer of the phototherapy device. The distance between the LEDs and the treatment surface may be provided by a distance meter of the phototherapy device or of a mounting structure coupled to the phototherapy device. The phototherapy device may further comprise a display coupled to the processor, and the distance measured by the distance meter may be displayed by the display, The total number of hours of use of the LEDs may be provided by a timer or a memory of the phototherapy device. The support structure can be configured to absorb and dissipate heat generated by the one or more LEDs to minimize overheating without requiring the use of a fan.
Aspects of the disclosure also provide a phototherapy system comprising a phototherapy device having a processor to adjust the power supplied to the LEDs as described above, and a light meter as described above. The processor of the device can calculate the dose of radiation provided to a patient, based on one or more of the size of the exposed treatment surface, the distance between the LEDs and the treatment surface, the total number of hours of use of the LEDs, and the intensity of the radiation provided by the LEDs.
All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.
The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:
The present disclosure provides devices, systems, and methods for treating neonatal hyperbilirubinemia with phototherapy using LEDs configured to optimize such phototherapy. A phototherapy device according to many embodiments may comprise a plurality of LEDs configured to provide a uniform intensity light at a specified distance range. The specific number of LEDs used may be minimized to a number sufficient to provide such uniform intensity. One or more lenses or filters may be provided for the phototherapy devices. The LED(s) may be provided on a light source mounted on a stand or mounting structure which may be coupled to a support for an infant patient to rest on.
The height of the mounting structure 120 may be adjustable. As shown in
As shown in
As shown in
Each individual LED 133 may have a lens coupled thereto to focus, contour, diffuse, attenuate, alter, or otherwise manage the light emitted from the LED 133. These lenses may be fixed to each individual LED 133 or may be detachable from the individual LEDs 133. The individual LEDs 133 may emit light at the same wavelengths or different wavelengths from one another. The LEDs 133 will typically emit blue-green light at a range of 400 nm to 520 nm, preferably 430 to 490 nm, more preferably 445 nm to 470 nm, and even more preferably 450 nm to 465 nm, to isomerize bilirubin in a subject into soluble forms that can be easily eliminated through urine. Other wavelengths of light may instead be used as well. The LEDs 133 may also comprise LEDs emitting white or amber light in the range of about 550 nm to 650 nm, for use in observing the patient. The white-amber LEDs may be switched on together with or independently of the blue-green LEDs for treatment, and may be programmed to power off automatically after a specified length of time. The optimal distance between the subject, in particular the subject's chest and abdomen area, and the LED arrangement 130 may be in a range of about 20 cm to 45 cm. In some embodiments, a distance of about 20 cm is preferred. The arrangement of the individual LEDs 133 in combination with the lenses for the individual LEDs can form a light source array that achieves maximum coverage area of the subject using the minimum number of individual LEDs 133. Alternatively or in combination, a common lens may be provided for the individual lenses 133 of the LED arrangement 130. Combination of lenses may be provided to provide multiple treatment options.
The light emitting head unit or phototherapy device 210 may be used in conjunction with the mounting structure 120 described above. The light emitting head unit or phototherapy device 210 may be attached to the movable stand or mounting structure 120 via a tilt-mechanism 215 that can allow one-handed operation and automatically locks in place with a range of motion from 0 to 90 degrees, with a mechanical stop at 0 degrees.
The phototherapy device 210 comprises at least one high intensity light emitting diode (LED) 220 to emit a range of light wavelengths that corresponds to the peak absorption spectra for bilirubin (400 nm to 520 nm and preferably 430 nm to 490 nm and more preferably 445 nm to 475 nm). LEDs 220 that emit other light wavelengths useful in treating jaundice can also be used. The phototherapy device 210 may also comprise LEDs having an emission range of about 550 nm to 650 nm for use in observing the patient, wherein the LEDs may be operable together with or independently of the LEDs configured to provide the phototherapy.
The LEDs 220 may comprise high intensity LEDs. High intensity LEDs can use less power and have a longer lifespan than compact fluorescent and incandescent lights found in typical phototherapy devices in low-income countries. In areas with inconsistent electricity, the phototherapy devices 210 and 110 may be powered with a battery backup. The increased intensity and efficiency of the LEDs used in the devices 210 and 110 often mean that only a small number of LEDs are necessary to provide irradiance levels that meet American Academy of Pediatrics guidelines (>30 W/cm2/nm).
Within the housing assembly and as illustrated in
The array of LEDs 225 is typically fixed and mounted on a support structure comprising a heat-conductive metal plate 230, which can act as an external backing, mechanical infrastructure, and passive heat sink. The support structure may be made of one or more of copper, aluminum, ceramic, or other highly heat conductive material. In preferred embodiments, the support structure is a metal plate 230 made of aluminum. Because the heat-conductive metal plate 230 can eliminate the need for a fan to cool the light source, noise can be decreased and internal dust buildup minimized. Thus, these preferred embodiments can be easy to clean in low-resource environments. The elimination of the fan can also remove one of the most likely components to fail during a phototherapy unit's lifetime and can remove the need to purchase replaceable air filters. As illustrated in
The phototherapy device 210 can also comprise a programmable control system or processor 250 that outputs characters to a display 235, which may comprise a contrast-adjustable liquid-crystal (LCD) display. A power supply 245 may provide power to one or more of the processor 250, the display 235, and the array of LEDs 225. A microcontroller in the processor 250 can allow the user to fluidly move through multiple intensity settings and reset the patient treatment time at any moment. The microcontroller can also run two semi-hidden modes: data mode and setup mode. The data mode can allow the user to scroll through the following: the device serial number, the number of patient therapy time resets, the total hours the unit has been on, the most recent light meter reading, and a checksum that can be used to verify whether the previous data points were correctly interpreted when input into a peripheral data collection form. As shown in
The setup mode can allow a repair technician or a manufacturing employee to adjust the baseline PWM for the LED strings at each power setting, to erase the stored data, to input the serial number, to set the time and date, to adjust the contrast of the LCD display 235, and to view the five most recent events. Every event may be stored on internal memory on the circuit board of the processor 250 and can be accessed through an internal connector or through an external SD card slot. These events can all be time-stamped and may include turning the unit on/off, plugging the unit into wall power, unplugging the unit from the wall power, the tilted angle of the unit taken at pre-programmed time intervals, the internal temperature of the unit at pre-programmed time intervals, readings from the peripheral light meter, resets to the patient therapy time, and the duration of brown-outs.
When a brown-out occurs, the microcontroller of processor 250 may measure the duration of each brown-out, and if the power outage duration is less than the programmed cut-off time, the unit may return to its previous status without user input required. The processor can detect loss of power and back up operating state, usage data, and other information.
An accelerometer on the processor can detect the tilt angle of the light emitting head unit. Using PWM, software on the processor can use a customized curve to increase or decrease the power or current supplied to the array of LEDs 225 based on the accelerometer inputs, in order to maintain a constant irradiance footprint at the treatment surface.
Since light output of the LEDs will likely diminish over time, the software on the processor can adjust the PWM of the current driver to discretely increase the power or current supplied to the array of LEDs 225 as the total light hours increase. This can compensate for the natural decay of the LED output and can enable the phototherapy unit 210 to provide more constant light output and maintain effective treatment irradiance over a longer lifetime.
Operational parameters from the processor are communicated to the user via a display screen 235. In its preferred embodiment and as illustrated in
On a lateral side of the device 210 may be a connector for a light meter accessory 260. The light meter 260 can be used to measure the irradiance of the array of LEDs 225. In preferred embodiments and as illustrated in
The detachable light meter 260 can store its own calibration data but may require an external LCD and circuit to display its measurements. The light meter 260 can be integrated with the processor 250 and LCD display 235 of the phototherapy unit 210 with a connector port 280, but can be moved and used on multiple devices. The outputs of the light meter 260 can be read by the processor 250 of the phototherapy unit 210 and can be translated to a character value displayed on the LCD 235. These values are then stored on the internal memory of the phototherapy unit 210.
When not in use, the light meter 260 can be stored in a vertical position on the lateral side of the phototherapy unit 210. In some embodiments, the phototherapy unit 210 may comprise a holster for storing the light meter, and/or a hook for placement of the light meter 260 which may have a hole in its handle portion for such a placement on the hook. Alternately or in combination, the light meter may be magnetically coupled to a surface of the phototherapy unit 210. An accelerometer sensor may be provided in the light meter 260 to detect when the meter 260 is in a horizontal position for measurements or vertical position for storage or other tilt or orientation of the light meter 260 or phototherapy unit 210. In the phototherapy unit 210, the processor 250 can auto-switch display modes to show measured irradiance when the light meter accessory 260 is horizontal, and can switch to normal operation when the light meter accessory 260 is vertical. Measurement and collection of usage data can be retrieved with a removable memory card through a compatible slot on a lateral side of the phototherapy unit 210.
In addition to interfacing with the display screen 235 on the phototherapy unit 210, the light meter accessory 260 can integrate with a smartphone and use a customized application to display its measurements. The light meter 260 may also have an option to be a standalone device that contains the circuitry to translate the sensor's voltage to an irradiance value displayed on an integrated LCD.
The processor of the phototherapy device may be programmed to calculate the dose of radiation provided to a patient during one or more treatments. The calculation may be based on one or more of the treatment parameters, including the area of the exposed treatment surface, the distance between the LEDs and the treatment surface, the total number of hours of use of the LEDs, and the intensity of the radiation provided. The calculated dose may be displayed on the LCD display screen.
While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.
This PCT application claims priority to U.S. Provisional Patent Application Ser. No. 61/879,619, filed on Sep. 18, 2013, entitled “PHOTOTHERAPY DEVICE FOR THE TREATMENT OF HYPERBILIRUBINEMIA” [attorney docket number 40929-703.101], the entire disclosures of which are incorporated herein by reference.
Number | Date | Country | |
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61879619 | Sep 2013 | US |
Number | Date | Country | |
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Parent | PCT/US2014/055125 | Sep 2014 | US |
Child | 15074568 | US |