Solar-powered phototherapy for severe neonatal hyperbilirubinemia in low-resource settings: a multicentre implementation study in Nigeria

Astratt

Background Progress in neonatal care in low- and middle-income countries (LMICs) remains constrained by inequitable access to effective interventions, particularly in remote settings where unreliable electricity, limited specialist availability, and household poverty restrict treatment. Severe neonatal hyperbilirubinemia (SNH) exemplifies this challenge. We evaluated whether a fully solar-powered total-body phototherapy system could maintain effective treatment while progressively decentralising care from specialist tertiary practice to resource-poor grassroots facilities. Methods A multicentre staged implementation study was conducted in Nigeria between February 2024 and January 2026. Implementation progressed through three phases: specialist-controlled deployment at a tertiary neonatal centre; corroborative deployment across additional tertiary centres in different geographic and climatic settings; and task-shifted implementation in grassroots hospitals. The PoliteUltraLumen system combines photovoltaic power generation, battery storage, and dual-surface total-body phototherapy. Grassroots implementation incorporated supplementary phototherapy devices, simplified operating procedures, community bilirubin screening, and treatment delivered predominantly by junior clinicians, nurses, and health assistants. Outcomes included bilirubin reduction to predefined treatment thresholds, treatment duration, safety, operational continuity, and feasibility of decentralised delivery. Results More than 2,000 neonates underwent community bilirubin surveillance and 663 received phototherapy across the three implementation phases. All treated neonates achieved the predefined bilirubin treatment endpoints and were successfully discharged. Among cases with comprehensive treatment data, mean treatment duration was 16.5 ± 3.4 h. No treatment interruption due to power failure occurred. No treated neonate was reported to require subsequent exchange blood transfusion, and no device-related serious adverse event or treatment-related mortality was identified. Treatment remained feasible under task-shifted grassroots implementation. Conclusion Fully solar-powered phototherapy was successfully translated from specialist-controlled tertiary care to decentralised grassroots neonatal services while maintaining treatment effectiveness and operational independence from grid electricity. These findings suggest that progress in LMIC neonatal care should encompass not only advances in clinical technology, but also the capacity to redesign and deliver effective interventions equitably where infrastructure, specialist personnel, and family resources are most constrained