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PROTOCOL PHOTOTHERAPY

Aims​

To lower the bilirubin level in the blood. Jaundiced newborns have high levels of bilirubin which can damage the brain. The light will change the structure of the bilirubin which will be easily excreted.

Responsibility​

The doctor is responsible for the initiation, and the nurse caring for the baby for the implementation of the phototherapy.

Indications​

A clinical decicion 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.

warning

Do not use sunlight as treatment for hyperbilirubinemia

Procedure​

  • The distance between the baby and the lightsource 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.
  • Place the baby in a supine position unless other clinical conditions prevent this and ensure that the treatment is applied to maximum area of skin.
  • Cover the eyes with patches during treatment. Remove eyes patches and check eyes every shift, preferably when cared for by family.
  • Monitor the baby's temperature every 3-4 hourly and ensure the baby is kept in an environment that will minimise 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 oinments because they absorbe heat and can cause burns.
  • Monitor bilirubin level as per physcians 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 exelence(2010), Oslo University hospital(NICU):Procedure phototherapy(2006)revised 2013.

Document Information​

Archived Version

Version: 1.0 (Archived)
Published: August 3, 2015
Contributors: Senior neonatal project nurse Anne Marie Krokedal
View: Current Version