Sister Ward, a bright nurse at the Premature Unit at Rochford General Hospital in Essex, England, was used to expose the newborns outdoor despite the resistance of the doctors at this practice. One sunny summer day in 1956 she noticed that the portion of the skin exposed to the sun was much paler than the yellow color of the skin covered by the sheets. Subsequently, researchers at Rochford Hospital convincingly showed that the level of bilirubin was much lower in tubes exposed to light leading to the idea of phototherapy for neonatal jaundice which they then developed with the first phototherapy unit with an artificial light source.1

Despite the decades of use of phototherapy for the management of severe neonatal jaundice, the optimum wavelength range for bilirubin photodegradation is still a matter of controversy. The standard phototherapy approach is based on the 460-nm concept, i.e., the light wavelength corresponding to the absorption maximum of bilirubin. Although used worldwide, a few studies suggested that the use of blue-green light with higher wavelengths above 490 nm might be of therapeutic value.2,3 In this issue of Pediatric Research, Vreman et al. report a detailed in vitro study on the efficacy of the bilirubin photodegradation at various wavelengths.4 Contrary to the general thinking, the 510-nm wavelength was found to be more efficient compared to the standard and clinically used wavelength of 460 nm. The authors demonstrated that the lumirubin production is enhanced at higher wavelengths because of the complex photophysical properties of bilirubin, the 4E,15Z-isomer of which is responsible for lumirubin formation.

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