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Phototherapy

Jaundiced newborns have high levels of bilirubin which can damage the brain. Phototherapy light will change the structure of the bilirubin which will be easily excreted.

The doctor is responsible for the initiation of phototherapy, and the nurse caring for the baby should implement the phototherapy session for the baby.

Indications​

A clinical decision by the doctor based on a serum bilirubin level, gestation age and live hours/ days after birth.

If you detect a jaundiced baby, report to the doctor.

Multiple phototherapy​

Phototherapy that is given using more than one light source simultaneously; for example two or more conventional units.

Do not use sunlight as treatment for hyperbilirubinemia.

PROCEDURE​

  • The distance between the baby and the light source should not be greater than 50 cm and can be less (down to 10 cm) provided the baby's temperature is monitored.
  • Check that all lamps are working properly.
  • Undress the baby and use as small diaper as possible so most of this skin area gets exposed to the light. Make sure the baby is surrounded by white or bright linen only, since white color reflects the light. Keep a nest around the baby as therapeutic supportive care.
  • Cover the eyes with patches during treatment. Remove eye patches and check eyes every shift, preferably when cared for by family. If the baby is out of bed due to KMC, breastfeeding etc, always remove eye patches to enable positive stimuli for the baby.
  • Monitor the baby's temperature manually every 2 hourly and ensure the baby is kept in an environment that will minimize energy expenditure (thermoneutral environment)
  • Provide frequent breastfeeding every 2-3 hourly. Follow up with weighing before and after if baby is lethargic and sucking poorly. Try to give extra amount by suthi, let the doctor know if the baby is not able to get proper feeding.
  • Avoid lotions and ointments because they absorb heat and can cause burns.
  • Monitor bilirubin level as per physician's order, and be aware last level. Skin color is not a guide to bilirubin levels in infants undergoing phototherapy.
  • Observe for potential signs of bilirubin effect on brain ( e.g. lethargy, poor feeding, hypotonia, arching of the head and neck and seizures).
  • Complications:
    • Insensible water loss
    • Watery diarrhea
    • Retinal damage
    • Hypothermia or hyperthermia

References​

  • Dr. Ashok Deorari Practical Procedures for the newborn nursery 3.edition(2010)
  • Merenstein&Gardner: Neonatal intensive care 7. edition(2011)
  • NICE: National Institute for health and care excellence(2010)
  • Oslo University Hospital(NICU): Procedure phototherapy (2006) revised 2013

Document Information​

Current Version

Version: 2.0
Published: August 20, 2015
Revised by: Dr Chetan Meena, Johanne M. E. Huurnink
Contributors: Senior neonatal project nurse Anne Marie Krokedal
Previous Versions: v1.0