Patent Publication Number: US-2023136463-A1

Title: Phototherapy Shield

Description:
BACKGROUND 
     A patent ductus arteriosus (PDA) is a common problem in premature infants with a reported incidence of 70% in premature infants≤29 weeks gestational age (GA). A persistent PDA has been associated with the development of neonatal morbidities such as pulmonary hemorrhage, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity. 
     Current treatment options for PDA closure include the use of nonsteroidal inflammatory drugs (NSAIDs) and/or surgical ligation. Despite their effectiveness, NSAIDs have serious side effects including renal dysfunction, decrease in blood flow to the brain, platelet dysfunction, intestinal perforation, and necrotizing enterocolitis. Surgical PDA ligation has also been associated with serious complications such as bleeding, vocal cord paralysis, chylothorax, ligation of arterial structures within the chest, pneumothorax, and death. Due to the serious complications of the current treatments, alternative methods to prevent PDA related symptoms are urgently required. 
     One such alternative method is to target the relationship between phototherapy treatment of infants and vasodilation of the PDA. The photorelaxation or dilation of blood vessels with light of a certain wavelength (e.g., 420-460 nm) has been verified in many animal studies and clinical studies in premature infants. It has been suggested that phototherapy induced dilation of the PDA may be primarily seen in premature infants due to increased translucency of their premature skin. In addition, LED phototherapy units in use since 2007 provide increasingly higher irradiance in the range of 20 to 30 μW/cm 2 /nm (microwatts per square centimeter per nanometer). This is an alarming concern, since the current LED units may be associated with increased dilation and higher incidence of PDA in premature infants that are being born at extremely low birth weights and even earlier gestational ages. 
     SUMMARY 
     Phototherapy shields and associated methods are provided. Such phototherapy shields and methods are useful for shielding an infant undergoing phototherapy, and more particularly, for shielding the chest of a premature infant undergoing phototherapy to treat jaundice. 
     A phototherapy shield for an infant includes a shield body that is sized and shaped to extend around at least a portion of a torso of an infant. A fastener is attached to the shield body to secure the phototherapy shield around the torso of the infant. The shield body includes a reflective foil layer that is sandwiched between an upper fabric layer and a lower fabric layer and that is configured to block phototherapy light. 
     In general, phototherapy light can have a wavelength in a range of about 400 nanometers to about 500 nanometers. The fabric layers of the phototherapy shield can be configured to pass the phototherapy light without substantial attenuation. The fabric layers can include a biocompatible material, a nonwoven fabric material, an elastic fabric material, or combinations thereof. 
     The reflective foil layer of the phototherapy shield can have a transmittance of less than 0.1% of light having a wavelength in a range of about 400 nanometers to about 500 nanometers. An average thickness of the foil layer can be in a range of about 0.01 millimeters to about 0.1 millimeters. The reflective foil layer can include metalized polymer film. For example, the foil layer can include aluminum. 
     The shield body of the phototherapy shield can be sized and shaped to cover a portion of the chest of the infant, e.g., a portion of the chest over the second to fourth thoracic rib position, to shield an area of skin above a patent ductus arteriosus (PDA). The shield body can be sized to cover an area that is at least 10% less than an expected total body surface area of the infant. 
     The expected total body surface area of the infant can be calculated based on other measurements such as height and weight. The Mosteller formula is one method that can be used to calculate body surface area (BSA), which takes the square root of the height (cm) multiplied by the weight (kg) divided by 3600, e.g., BSA (m 2 )=square root of (height (cm)×weight (kg)/3600). The average BSA for a premature female is in the range of 0.07 m 2  to 0.12 m 2 . The average BSA for a premature male is in the range of 0.06 m 2  to 0.12 m 2 . 
     The shield body can have a length of about 20 centimeters to about 28 centimeters and a width of about 3 centimeters to about 5 centimeters. For example, the shield body can be rectangular and can have a length-to-width ratio of about 3.5:1 to about 4:1. The reflective foil layer can have a length of about 6 centimeters to about 8 centimeters and a width of about 2 centimeters to about 4 centimeters. For example, the reflective foil layer can have a length-to-width ratio of about 7:3. 
     A method of preparing an infant for phototherapy includes applying a phototherapy shield to an infant, the phototherapy shield including a shield body that includes a reflective foil layer sandwiched between two fabric layers. The phototherapy shield is then secured around the torso of the infant using a fastener attached to the shield body. Applying the phototherapy shield to the infant can include positioning the shield body in a horizontal fashion on a chest of the infant over the second to fourth thoracic rib position. 
     A method of making a phototherapy shield for an infant includes preparing a shield body sized and shaped to extend around at least a portion of a torso of an infant, the shield body including a reflective foil layer sandwiched between an upper fabric layer and a lower fabric layer, the reflective foil layer configured to block phototherapy light. The method further includes attaching a fastener to the shield body, the fastener configured to secure the phototherapy shield around the torso of the infant. 
     In the above described phototherapy shields and associated methods, the fastener can be an elastic fastener. Preferably, the fastener is made from material that is soft, breathable, and flexible. 
     The incidence of PDA is 70% in premature infants≤29 weeks GA and a majority of these infants will require phototherapy for the management of unconjugated hyperbilirubinemia (jaundice). These infants are at high risk of developing complications from a hemodynamically significant PDA due to the vasodilatory effects of phototherapy. Currently, shielding of the eyes and gonads prior to the start of phototherapy is part of standard of care in term and preterm infants. The approach described here is useful to establish placement of a chest shield in premature infants prior to the start of phototherapy as a part of standard of care as well. Thus, every premature infant who is ≤29 weeks GA or is ≤1000 grams at birth would have a chest shield placed prior to being treated with phototherapy. Currently, the rates of preterm birth rates in the U.S. are increasing and the average cost for each infant born≤29 weeks GA admitted to the NICU can range from US$200,000 and up. Thus, the use of the chest shield may not only decrease complications from a PDA but also decrease the cost of hospitalization in preterm infants. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The foregoing will be apparent from the following more particular description of example embodiments, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating embodiments. 
         FIGS.  1 A and  1 B  are front and back views, respectively, of a prior phototherapy shield applied to an infant manikin. 
         FIG.  2 A  is a schematic view of a phototherapy shield according to an example embodiment. 
         FIG.  2 B  is an exploded, sectional view of the shield of  FIG.  2 A  illustrating the reflective foil sandwiched between fabric layers. 
         FIGS.  3 A and  3 B  are front and back views, respectively, of a phototherapy shield according to an example embodiment. 
         FIG.  3 C  is a perspective view of the shield of  FIG.  3 A  in a closed loop configuration. 
         FIGS.  4 A and  4 B  are front and back views, respectively, of the phototherapy shield of  FIG.  3 A  illustrating the shield secured around the torso of an infant manikin. 
         FIGS.  5 A and  5 B  are schematic views illustrating example shields applied to an infant body during phototherapy. 
         FIG.  6    illustrates an example integrating sphere set-up for measuring parameters to determine optical properties of sample shield material. 
         FIG.  7    illustrates an experimental setup used for shield material temperature monitoring. 
         FIGS.  8 A- 8 C  are graphs illustrating absorption coefficients ( FIG.  8 A ), scattering coefficients ( FIG.  8 B ), and anisotropy factors ( FIG.  8 C ) of biocompatible fabric materials at light wavelengths between 400-500 nm. Squares—Spunbond Polypropylene 100 gsm. Circles with a Cross— K160082 60 gsm. Half-filled Upright Triangle— K170081 35 gsm. Upside-down Triangle with an X— K170087 50 gsm. Bars—standard deviations. 
     
    
    
     DETAILED DESCRIPTION 
     A description of example embodiments follows. 
     Phototherapy treatment of neonatal jaundice includes exposing the afflicted infant to visible blue light having a wavelength in a range of 425-475 nm. During the phototherapy treatment of jaundiced infants, shields or shades are commonly placed over the eyes of the infant to protect the eyes from the blue light. Prior art eyeshades include self-adhesive shades that are affixed to the infant&#39;s temples and are kept in place with the use of a headband attached to the eyeshade by means of fabric fasteners such as VELCRO™ fasteners. Other eye shields include a strap of soft material, which is sized and shaped to pass around the head of the infant, and an eye pad that is attached to the strap. An example eye shield for protecting babies&#39; eyesight during phototherapy treatment for neonatal jaundice is described in U.S. Pat. No. 6,973,930 B2. 
     Since light penetrates the translucent skin of premature infants, the present approach is based on the realization that chest shielding during phototherapy can prevent phototherapy induced dilation of the PDA. There are few clinical studies in premature infants that have evaluated the association between phototherapy used for jaundice and PDA. In an observational study, Barefield et al. reported increased incidence of PDA in infants with birth weights≤1000 grams undergoing phototherapy (Barefield E S, Dwyer M D, Cassudy G. Association of patent ductus arteriosus and phototherapy in infants weighing less than 1000 grams.  J Perinatal  1993; 13: 376-380). They speculated that phototherapy induced dilation of the PDA may be primarily seen in premature infants due to increased translucency of their premature skin. There are only a few randomized clinical trials that have evaluated the effect of chest shielding during phototherapy on the incidence of PDA. The initial trial published in 1986 involved 72 infants and showed that chest shielding using aluminum foil during phototherapy reduced the incidence of PDA in 26-32 weeks GA infants by 50% (Rosenfield W, Sadhev S, Brunot V, Jhaveri R, Zabaleto I, Evans HE. Phototherapy effect on the incidence of patent ductus arteriosus in premature infants: prevention with chest shielding.  Pediatrics  1986; 78: 10-14). The subsequent clinical trial published in 2006 involved 54 premature infants and failed to show any beneficial effect of chest shielding using aluminum foil during phototherapy on the incidence of PDA (Travadi J, Simmer K, Ramsay J, Doherty D, Hagan R. Patent ductus arteriosus in extremely preterm infants receiving phototherapy: does shielding the chest make a difference? A randomized, controlled trial.  Acta Paediatr  2006; 95: 1418-1423). However, the lack of beneficial effect demonstrated in this study is likely due to inadequate power. 
     In addition, the randomized studies mentioned above were performed using standard phototherapy units which provided irradiance in the range of 4 to 12 μW/cm 2 /nm. The LED phototherapy units in use since 2007 provide much higher irradiance in the range of 20 to 30 μW/cm 2 /nm. Therefore, the current LED units may be associated with a much more enhanced photorelaxation effect and higher incidence of PDA specifically in very premature infants. A recently published study by Kapoor et al. did not show any benefits of a chest shield during phototherapy, but that study was also underpowered and enrolled more mature infants (Kapoor S, Mishra D, Chawla D, Jain S. Chest shielding in preterm neonates under phototherapy—a randomized control trial.  Eur. J Ped  2021; 180:767-773). In addition, these previous randomized trials were not blinded. Due to the deficiencies present in these trials as well as the Cochrane paper on chest shielding (Bhola K, Foster J P, Osborn D A. Chest shielding for prevention of a haemodynamically significant patent ductus arteriosus in preterm infants receiving phototherapy.  Cochrane Database Syst Rev.  2015 Nov. 3;(11):CD009816), another meta-analysis was performed by Mannan et al., which proposed that chest shielding during phototherapy may lead to a decrease in the incidence of PDA (Mannan J, Amin S. Meta-Analysis of the effect of chest shielding on preventing patent ductus arteriosus in premature infants.  Am J Perinatol  2017; 34: 359-363). 
     Final analysis of a single center prospective double blind randomized pilot study (ClinicalTrials.gov, NCT02552927) reported a non-significant trend in increased incidence of symptomatic PDA, surgical ligation, necrotizing enterocolitis, chronic lung disease, and severe chronic lung disease at 36 weeks among non-shielded infants&lt;27 weeks compared to infants in the chest shield group. In addition, this trial found no difference in the duration of phototherapy or peak total serum bilirubin levels between the two groups. These findings verify the association between phototherapy and incidence of PDA as well as verify the safety of a chest shield in preterm infants during phototherapy. The results of this trial are also similar to the results of the trial by Kim et al., who found an increased incidence of PDA in non-shielded preterm infants in comparison to infants who had a chest shield placed during phototherapy (Kim H S, Kim E K, Lee Y K, Lee H E, Park C H, Park R K. Influence of phototherapy on incidence of patent ductus arteriosus in very low birth weight infants.  J Korean Pediatr Soc.  1997; 40: 1410-1418). 
     As stated above, four randomized trials to date have studied chest shielding during phototherapy to decrease the incidence of PDA in premature infants. These trials used a double folded piece of standard aluminum foil covered on one side by a gauze pad, which was taped to the infant&#39;s left chest as a shield. Described here is a chest shield made from a soft, elastic fabric with a reflective foil, e.g., an aluminized foil, embedded within the shield, e.g. embedded between fabric layers of the shield. The shield can be sized to wrap completely around the infant&#39;s chest. Preferably, this shield is adjustable for premature infants of varying size in order not to constrict chest rise. Although the top and bottom fabric layers are elastic and can be adjusted or stretched, shields of varying sizes may be used to ensure comfort and that the device is properly secured. For example, shields can come in three sizes, e.g., lengths, to fit different ranges of chest circumferences: small=20 cm-22 cm, medium=23 cm-25 cm, and large=26-28 cm. To the best of our knowledge, there have been no published data or trials using such a device or method to shield premature infants during phototherapy. 
     Advantageously, infants can have their chest shielded with the presently disclosed chest shield while undergoing phototherapy treatment. The chest shield is intended to be placed in a horizontal fashion on the chest over the second to fourth thoracic rib position to primarily shield the area of skin overlying the PDA. In certain embodiments, the shield combines one or more stretchable nonwoven biocompatible fabrics, such as Spunbond Polypropylene 100 gsm, K160082 60 gsm, K170081 35 gsm, and K170087 50 gsm fabrics (Uniquetex Engineered Nonwovens, Grover, N.C., USA). The shield can be fashioned around the back and chest of the infant with the use of an elastic fastener, such as Avery Dennison Y9725D Wave C elastic diaper tape. Each shield includes a piece of reflective foil. Suitable reflective foils include foil DM146 and foil DE 050 (Dunmore, Bristol, Pa., USA), which are aluminized polyester film (e.g., aluminized Mylar). The reflective foil can be adhered to the nonwoven fabric to shield the heart. 
     This shield design provides an improvement over shields used in prior clinical trials, which only utilized food grade aluminum that was taped to the skin of preterm infants during phototherapy. Except for a pilot trial at the University of Rochester conducted on chest shielding preterm infants during phototherapy (ClinicalTrials.gov, NCT02552927), none of the prior trials used a shield that wrapped around an infant&#39;s chest and back. 
     An example of the shield used in the University of Rochester trial is shown in  FIGS.  1 A- 1 B . This trial also used food grade aluminum for the shield and, although it did not use tape to affix the shield to the infant&#39;s skin, it relied on VELCRO™ fasteners to keep the shield in the proper position. The concept of a chest shield for premature infants that would not need to be taped to the skin and that could easily be applied and wrapped around an infant, was developed during the design of the pilot trial. The shield used for the pilot study did not include the materials of the present shield and did not provide the ease of use of the present shield. 
       FIGS.  1 A and  1 B  are front and back views, respectively, of the prior phototherapy shield device  100  applied to an infant manikin  110 . The shield device  100  includes a front strap  102 , a front shield region  104 , a back strap  112 , and a back shield region  114 . Front and back straps  102  and  112  are connected by VELCRO™ fasteners  106  and  108 . In one group of patients, the front shield region  104  included a food grade aluminum foil covered by a piece of paper. In the control group, no aluminum foil was present and the front shield region  104  included only the paper. Because the study was a double-blind study, the paper ensured that the presence of aluminum foil was hidden from the patient and the physician. The front and back of these shields were made from the same material. The straps were made from 3M™ Dual Lock™ Reclosable Fastener SJ3560. 
     Applying tape to the skin of premature infants has led to skin peeling and degradation of the skin, which has further increased the risk of sepsis and infection in these critically ill infants. In contrast, embodiments of the present shield use a fastener, e.g., Avery Dennison elastic tape, which is already in use in the diapers placed on these infants as standard of care. Using such a fastener ensures that the chest shield will not incur any injury or harm to the infant while remaining in place. 
     The aluminum foil used in the previous trials was only tested to assess if light could penetrate through the shield. The present shield material was tested using integrating spheres with Silicon (Si) detectors to measure the diffuse reflectance, total transmittance, and diffuse transmittance of the material, as further described in Example 1 below. The optical properties of the shield material were determined using the inverse Monte Carlo method. For thermal characterization of the shield, a Minco temperature sensor was utilized. These testing steps, which were not performed in the previous trials, help ensure the validity and safety of the shield device disclosed herein. 
       FIGS.  2 A- 2 B  schematically illustrate a phototherapy shield  200  according to an example embodiment. The phototherapy shield  200  includes a shield body  202  including fabric layers and a reflective foil layer  204  that is configured to block phototherapy light. The foil layer  204  is sandwiched between an upper (e.g., outer) fabric layer  201   a  and a lower (e.g., inner, patient facing) fabric layer  201   b . The shield body  202  is sized and shaped to extend around at least a portion of a torso of an infant. At least one fastener  205  is attached to the shield body  202  to secure the phototherapy shield around the torso of the infant. In the example shown, the fastener  205  has one end that is attached to the shield body  202 , at one end of the shield body. The other end of the fastener  205  is free but can be releasably attached to the other end of the shield body, to secure the shield to the infant. 
     As shown in  FIG.  2 A , the shield body  202  can have a length L 1 , which can be about 20 centimeters to about 28 centimeters, and a width W 1 , which can be about 3 centimeters to about 5 centimeters. For example, the shield body can have a length-to-width ratio of about 3.5:1 to about 4:1. In one example, the shield body  202  is rectangular, as illustrated in  FIG.  2 A , and has a length of about 24 centimeters and a width of about 4 centimeters. The reflective foil layer  204  can have a length, L 2 , of about 6 centimeters to about 8 centimeters and a width, W 2 , of about 2 centimeters to about 4 centimeters. For example, the reflective foil layer can have a length-to-width ratio of about 7:3. In one example, the reflective foil layer  204  is rectangular and has a length of about 7 centimeters and a width of about 3 centimeters. 
     Generally, the reflective foil layer  204  has a smaller width and length than the shield body, including the fabric layers  201   a  and  201   b . As illustrated by the rows of up and down arrows in  FIG.  2 B , the reflective foil layer  204  can be bonded to one or both fabric layers  201   a ,  201   b , to form the shield body  202 . In that way, the reflective foil layer  204  forms a middle layer of the shield body. A suitable method of bonding the layers is heat bonding. 
     Advantageously, the fabric layers  201   a ,  201   a  can be configured to pass the phototherapy light without substantial attenuation. Further, the fabric layers can be made from a biocompatible material, which can be a nonwoven fabric material. Preferably, the fabric material is elastic, to facilitate applying the shield to the infant and to allow for chest expansion during breathing. 
     To effectively block phototherapy light, the reflective foil layer  204  can have a transmittance of less than 0.1% of light having a wavelength in a range of about 400 nanometers to about 500 nanometers. An average thickness of the foil layer can be in a range of about 0.01 millimeters to about 0.1 millimeters. As further described herein, the reflective foil layer  204  can be a metalized polymer film. 
       FIGS.  3 A and  3 B  are front and back views, respectively, of a phototherapy shield  300  according to an example embodiment. Similar to phototherapy shield  200 , the phototherapy shield  300  includes a shield body  302  including a reflective foil layer  304  that is sandwiched between an upper fabric layer  301   a  and a lower fabric layer  301   b . The foil layer  304  is made from suitable material and configured to block phototherapy light. A fastener  305  is attached to the shield body  302  and can be used to secure the phototherapy shield  300  around the torso of the infant. As shown, the fastener  305  comprises two fastener parts  305   a ,  305   b , each attached to one or the other end of the shield body  302 . The fastener parts  305   a ,  305   b  can releasably attach to each other, to secure the shield to the infant.  FIG.  3 C  is a perspective view of the shield  300  illustrating the shield in a closed loop configuration with fastener parts  305   a ,  305   b  attached to each other. The two fabric layers can be formed folding over one piece of fabric material. The sides opposite the fold can be bonded together, e.g. using heat bonding, to enclose the reflective foil layer. 
       FIG.  4 A  is a front view of the phototherapy shield  300  of  FIG.  3 A , illustrating the shield secured around the torso of an infant manikin  410 . The shield body  302  is sized and shaped to extend around at least a portion of a torso of the infant. The reflective foil layer  304  is positioned over the chest of the infant.  FIG.  4 B  is back view of the shield  300  and infant manikin  410  illustrating the fastener  305 , which securely attached the ends of the shield body  302  at a side of the infant manikin. 
       FIGS.  5 A and  5 B  are schematic views illustrating example phototherapy shields applied to a biological body, such as the torso of an infant, during phototherapy.  FIG.  5 A  illustrates a shield  500  that includes a shield body  502  which can be secured around biological body  510  by a fastener  505 , to shield a selected portion of the body  510  from irradiation from phototherapy light source  520 . The shield body includes a reflective foil  504 , e.g., aluminized Mylar, as further described herein. In  FIG.  5 A , the reflective foil  504  is schematically illustrated below the shield body  502 ; however, the reflective foil is preferably sandwiched between layers of the shield body, as further described herein. 
     A shown in  FIG.  5 B , a shield  550  includes a two-part shield body comprising a front portion  502   a  and back portion  502   b , which can be secured to each other and around the body  510  by fasteners  505 . At least the front portion  502   a  of the shield body includes a reflective foil (not shown), as further described herein, to shield a selected portion of the body  510  from phototherapy light from light source  525 . Light sources  520  and  525  are drawn differently to demonstrate different angles of illumination, e.g., phototherapy at an angle ( FIG.  5 A ) and phototherapy more directly above the patient ( FIG.  5 B ). Regardless of the angle, the phototherapy light sources and light intensity would typically be identical. 
     EXEMPLIFICATION 
     Example 1: Characterizing Materials for a Phototherapy Shield 
     Optimal shield properties and design are of vital importance for preventing adverse effects of light-based clinical procedures. The goal of this study was to select the most appropriate materials for a two-layer phototherapy shield. Four biocompatible fabrics, to be utilized as the layer contacting patient&#39;s skin, and two reflective materials, to be utilized as the layer facing the light source, were investigated. The optical properties of the four biocompatible fabrics and transmittance of the two reflective materials were determined in the 400-500 nm range. Absorption coefficient, scattering coefficient, and anisotropy factors of biocompatible fabrics were determined using integrating sphere spectrophotometry and an inverse Monte Carlo method. The materials that exhibited highest attenuation of the blue light were selected, a two-layer composite prototype was assembled and tested to ensure negligible temperature increase under clinically relevant exposure conditions. The testing protocol employed in this study may prove valuable for designing protective gear for a range of clinical procedures. 
     1. Introduction 
     Side effects from various phototherapy procedures have been well documented. Blue light phototherapy for treating jaundice in neonates has been shown to cause retinal damage as well as damage to red blood cells, which may lead to bronchopulmonary dysplasia, retinopathy, and necrotizing enterocolitis (Stokowski 2011). Blue light phototherapy has also been associated with the formation of patent ductus arteriosus (Stokowski 2011) and may increase the chance of melanocytic nevus development (Csoma et al. 2011). UV phototherapy for psoriasis, vitiligo, and polymorphic light eruption may lead to carcinogenesis, cataracts, lentigines, photoaging (Holme and Anstey 2004). Keratitis with facial erythema has also been reported forming after UV treatments (Komericki et al. 2005). Atrophy of the superonasal iris, iris transillumination defects, pigmentation on the anterior capsule, anisocoria, and dyscoria have all been reported developing in patients receiving Intense Pulsed Light (IPL) therapy (Javey et al. 2010) (Crabb et al. 2014). Therefore, it is important to use phototherapy shields to reduce side effects from light treatments (Stokowski 2011). Shielding must sufficiently attenuate treatment light to provide protection for the patient. 
     In this study, materials for a two-layered, blue light phototherapy shield were tested and compared. Reflective foils were considered for the top layer, facing the light source, while biocompatible fabrics were examined for the bottom layer, facing the patient. Biocompatible fabrics were evaluated using integrating sphere spectrophotometry. Reflective materials were characterized by transmittance measurements. 
     2.1 Biocompatible Fabrics 
     The optical properties of Spunbond Polypropylene 100 gsm, K160082 60 gsm, K170081 35 gsm, and K170087 50 gsm biocompatible fabrics (Uniquetex Engineered Nonwovens, Grover, N.C., USA) were investigated using integrating sphere spectrophotometry. Seven samples were prepared for each material type. Lateral dimensions of the samples were at most 42×50 mm. Sample thicknesses ranged from 0.172±0.004−0.306±0.002 mm. Sample thickness was measured using a digital micrometer (293-340 Digital Micrometer, Mitutoyo, Japan). 
     2.2 Reflective Foils 
     Reflective foils DM146 and DE 050 (Dunmore, Bristol, Pa., USA) were compared using transmittance spectrophotometry. Seven samples with lateral dimensions 45×12 mm were prepared for each foil. Average thicknesses of DM146 and DE 050 samples were 0.021±0.001 mm and 0.082±0.001 mm, respectively. Thicknesses were measured using a micrometer (293-340 Digital Micrometer, Mitutoyo, Japan). 
     2.3 Integrating Sphere Spectrophotometry 
       FIG.  6    illustrates a single integrating sphere system that was used to measure the total transmittance, diffuse transmittance, and diffuse reflectance of the biocompatible fabrics in the spectral range of 400-500 nm. The illustrated example set-up 600 includes an integrating sphere  602  and a halogen lamp  604  coupled into an optical fiber  610 . Light emanating from the optical fiber was focused onto the sample by a lens  608 . Light transmitted and reflected from the sample was collected by the integrating sphere  602  and detected by a grating spectrometer  606 . Data acquisition was controlled by external PC  612 . Samples were placed at the entrance and exit ports of the integrating sphere (4P-GPS-033-SL, Labsphere, North Sutton, N. H.) for transmittance and reflectance measurements, respectively. Light from a halogen lamp (HL-2000, 360-2000 nm, Ocean Optics, Dunedin, Fla.) was focused onto the samples. The focal spot had a diameter of 3 mm. Sample and exit ports of the integrating sphere had a diameter of 14 mm and 25.4 mm, respectively. Transmittance through air, and reflectance from Spectralon (&gt;99% reflectance) were used as a reference. The exit port of the integrating sphere was opened during diffuse transmittance measurements to allow collimated light to escape. Collimated transmittance was calculated by subtracting diffuse transmittance from total transmittance at each wavelength investigated. An HR2000 spectrometer (Ocean Optics, Dunedin, Fla.) was coupled to the auxiliary port of the integrating sphere via an optical fiber (P600-2-SR, Ocean Optics, Dunedin, Fla.) to measure the spectral response in the 400-500 nm range. 
     2.4 Inverse Monte Carlo Technique 
     Absorption coefficients, scattering coefficients, and anisotropy factors of the biocompatible fabric materials were calculated from measured quantities under an assumption of Henyey-Greenstein scattering phase function (Henyey and Greenstein 1941) using an inverse hybrid Monte Carlo algorithm (Yaroslaysky et al. 1996). This method employed a forward Monte Carlo technique that accounted for the exact geometrical and optical properties of the integrating sphere walls and light losses at the edges of the samples. The forward Monte Carlo method was integrated into a Quasi-Newton inverse algorithm (Dennis and Schnabel  1983 ), optimized to reduce the number of forward Monte Carlo calls. 
     2.5 Transmittance Measurements 
     Transmittance through reflective materials in the spectral range of 400-500 nm was measured using a spectrophotometer (Lambda 1050, PerkinElmer Inc., Waltham, Mass.). The spectrophotometer slit width was set to 5 nm, and the wavelength step size was set to 2 nm. The illumination beam had a diameter of 4.5 mm. Transmittance through air was used as a reference. Transmittance of each reflective sample were measured twice, then averaged. 
     2.6 Temperature Monitoring 
     After determining the optical properties and selecting appropriate biocompatible and reflective materials, a two-layer shield prototype was assembled. The temperature of the composite shield exposed to 450-470 nm light was monitored over a 48-hour time interval. The experimental arrangement used for monitoring the temperature of the shield is shown in  FIG.  7   . In the illustrated experimental setup  700  for shield material temperature monitoring, light from the phototherapy lamp  702  was incident onto the sample shield material  704 . A temperature sensor  706  underneath the sample allowed the temperature monitor  708  to measure the temperature of the sample. A Natus neoBLUE mini LED phototherapy lamp (Natus Medical Incorporated, San Carlos, Calif.) was used as a light source. Shield samples were suspended above the optical table to provide thermal isolation. The lamp was placed 30.5 cm above the samples. The temperature sensor was attached to the biocompatible surface of the composite shield, where the shield would be in contact with patient skin. The sensor was connected to an external temperature monitor (CT16A2080-948, Minco, Minneapolis, Minn.). The geometry and duration of temperature monitoring experiments were exactly as those during the clinical phototherapy procedure. 
     3.1 Optical Properties of Biocompatible Fabric Materials 
     Absorption coefficients, scattering coefficients, and anisotropy factors of biocompatible fabric materials, determined in the spectral range of 400-500 nm, are shown in  FIGS.  8 A- 8 C . Absorption coefficients are presented in  FIG.  8 A . Absorption of Spunbond Polypropylene 100 gsm, K170081 35 gsm, and K170087 50 gsm monotonously increase with increasing wavelength. The absorption spectrum of K160082 60 gsm decreases with increasing wavelength between 400-420 nm, then increases with wavelength in the 420-500 nm range. K160082 60 gsm exhibited the greatest absorption out of all biocompatible fabrics investigated, ranging between 0.4 and 0.1 mm −1  over the entire spectral range. The absorption of all other fabrics was less than 0.09 mm −1 . 
     Scattering coefficients are shown in  FIG.  8 B . Scattering of all fabrics decreased with increasing wavelength. K160082 60 gsm has the greatest scattering over the entire spectral region, with coefficients greater than 7.3 mm −1 . All other fabrics have scattering less than 4.6 mm −1 . 
     Anisotropy factors are presented in  FIG.  8 C . All fabrics exhibited increasing anisotropy with increasing wavelength. Anisotropy of Spunbond Polypropylene 100 gsm, K160082 60 gsm, and K170087 50 gsm are negative over the entire spectral range, whereas K170081 35 gsm has positive values between 458-500 nm. K160082 60 gsm has the greatest negative anisotropy factors ranging between −0.7 and −0.65 over the investigated spectral region. 
     Of the four biocompatible fabrics investigated, K160082 60 gsm has the greatest absorption and scattering in the 400-500 nm spectral range. The results show that scattering is the dominant attenuation process. Calculated absorption coefficients are an order of magnitude lower than the scattering coefficients. Due to the low absorption, a low temperature increase in the fabric during treatment can be expected. Moreover, K160082 60 gsm has the largest negative anisotropy factors out of the four fabrics tested. Thus, light has the highest probability of exhibiting backscattering when incident on fabric K160082 60 gsm. Due to predominant backscattering properties of the K160082 60 gsm fabric, more light will propagate towards the light source as compared to towards the patient. These results indicate that out of the four biocompatible fabrics tested, K160082 60 gsm is the most appropriate material for the bottom layer (e.g. the fabric layer) of the blue light phototherapy shield. 
     Ideally, the reflective material within the shield should predominately block the waves of blue light phototherapy and avoid any vasodilation. Thus, when undergoing phototherapy, infants should be placed on their backs or bellies and have the chest shield positioned in a such a manner to ensure that the reflective material is covering the upper left chest. Yet, infants may be positioned in a side lying position due to clinical necessity or the phototherapy light may have to be positioned at an angle rather than straight above. Although it is unlikely that an infant is placed in a position that the light is bypassing the reflective material, to ensure maximum protection, the chest shield design should preferably include a biocompatible fabric that provides some degree of blue light reduction although this would not be considered significant attenuation. Fabric K160082 60 was chosen since it exhibited these qualities to a higher degree in comparison to the other fabrics. 
     3.2 Transmittance Measurements of Reflective Materials 
     Transmittance of the two reflective materials were below 0.1% over the entire 400-500 nm range. Average transmittance measurements ranged between 0.039-0.071%, and 0.024-0.045% for foils Dm146 and DE 050, respectively. Lower transmittance points to higher attenuation of 400-500 nm light by foil DE 050 as compared to foil Dm146. Therefore, foil DE 050 was selected for the top layer of the blue light phototherapy shield. 
     3.3 Temperature Monitoring of Selected Shielding Materials 
     Based on the results of the optical experiments, composite shields were prepared with reflective foil DE 050 as the top layer facing the light and fabric K160082 60 gsm as the bottom layer facing patient&#39;s skin. Recorded shield temperatures ranged between 16.3° C. and 23.3° C. when exposed to blue treatment light. Temperatures of the shields followed the same temperature trends as room temperature. Thus, the phototherapy lamp did not have a significant effect on the shield temperature. 
     The 2-layer design was undertaken to assess direct exposure of the reflective foil to light and its effect on temperature. Since there was no effect, a 3-layer shield (with a top layer covering the reflective foil) should have similar results demonstrating that the shield is safe and does not exert heat. 
     4. Discussion 
     Many studies have been made to characterize and compare shielding materials. The most common approach is to measure optical transmission of the shields in the spectral range of interest. Chin et al. (1987) had investigated the transmission of 250-800 nm light through 12 potential eye shields using a spectrophotometer system. Robinson et al. (1991) measured the transmission of 300-750 nm light through three eye shield materials while placed in phototherapy units, to account for reflection from the therapy unit walls. Otman et al. (2010) determined the UV transmission of commercial sunglasses and contact lenses that were allowed to be worn by patients during treatments using a spectrophotometry system. Abdulla et al. (2010) measured UV transmission through potential shielding materials for genital protection from UVA, broad band UVB, and narrow band UVB illumination. This study explored a more general approach that can be utilized not only for testing and comparing prospective shields, but also to inform their selection, optimization, and design. Since attenuation of light is governed by the optical properties of the medium, this study started with determining the absorption coefficients, scattering coefficients, and anisotropy factors of the materials from diffuse reflectance and transmittance measurements using integrating sphere spectrophotometry (Jacques and Gaeeni 1989, Yaroslaysky et al. 2002, Bashkatov et al. 2005, Salomatina et al. 2006) and inverse Monte Carlo technique. This approach enables comparison of the shield attenuation properties irrespectively of the material thickness and allows for its optimization without exhaustive repetitive transmission measurements. 
     In conclusion, selecting shielding materials based on its optical and thermal properties enables straightforward optimization of shield design and ensures proper patient protection during phototherapy. While this study focused on shielding for blue light phototherapy, this method for characterizing shield materials can be utilized for any desired wavelength range and phototherapy procedure. 
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     The teachings of all patents, published applications and references cited herein are incorporated by reference in their entirety. 
     While example embodiments have been particularly shown and described, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the embodiments encompassed by the appended claims.