Phototherapy

Phototherapy_for_neonatal_jaundice
hrdeguzman,LPT,RN
 Objectives

At the end of this lesson,the students would be able to:

• Define what is Phototherapy
• Understand the indications and contraindications of
Phototherapy
• Describe the steps on administration of Phototherapy
 .
Phototherapy
• A treatment for jaundice where the exposure of skin to a light
source converts unconjugated bilirubin molecules into water
soluble isomers that can be excreted by the usual pathways.
• Phototherapy, also known as light therapy, is a procedure
that uses blue-green light to treat jaundice in newborns. The
light breaks down bilirubin in the baby's skin so it can be
excreted in urine and stool.
• Phototherapy is the use of visible light to treat severe jaundice
in the neonatal period.
 .

• Approximately 60% of term babies

and 85% preterm babies may
develop clinically apparent jaundice,
which classically becomes visible on
day 3, peaks days 5-7 and resolves
by 14 days of age in a term infant
and by 21 days in the preterm infant.
• Treatment with phototherapy is implemented in order to
prevent the neurotoxic effects of high serum unconjugated
bilirubin. Phototherapy is a safe, effective method for
decreasing or preventing the rise of serum unconjugated
bilirubin levels and reduces the need for exchange transfusion
in neonates.
 .
• Phototherapy is a dependent nursing intervention.
• Physician’s order is needed before a nurse can start
administering phototherapy.
 cont..

Phototherapy should be instituted when the total serum

bilirubin level is :
• at or above 15 mg per dL (257 mol per L) in infants 25 to 48
hours old,
• 18 mg per dL (308 mol per L) in infants 49 to 72 hours old,
and
• 20 mg per dL (342 mol per L) in infants older than 72hours
 definitionm

• Jaundice: the yellow appearance of

the skin that occurs with the
deposition of bilirubin in the dermal
and subcutaneous tissues and the
sclera.
Bilirubin metabolism
INTRODUCTION
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
JAUNDICE
JAUNDICE
JAUNDICE
JAUNDICE
JAUNDICE
 definition

Bilirubin: the yellowish substance/ pigment of bile, formed

principally by the breakdown of haemoglobin in red blood
cells at the end of their normal life-span.
Bilirubinaemia: the presence of bilirubin in the blood.
Hyperbilirubinaemia: the excess of bilirubin in the blood.
 cont..
Conjugated bilirubin ( direct bilirubin) -a type of bilirubin that is not
reabsorbed from the proximal intestines and is degraded in the edigestive
tract.
Unconjugated bilirubin (indirect bilrubin) -bilirubin that is partially
reabsorbed across the lipid membrane of the small intestinal epithelium and
undergoes enterohepatic circulation.
 definition

Isoimmunization
• A condition that happens when a pregnant woman's blood
protein is incompatible with the baby's, causing her
immune system to react and destroy the baby's blood
cells.
• Kernicterus is a type of brain damage that can result from
high level of bilirubin in the baby’s blood
• It can cause athetoid cerebral palsy and hearing loss.
Kernicterus also causes problems with vision and teeth
and sometimes can cause intellectual disabilities.
 Pathophysiology.
• bilirubin is processed through the liver, • When this excretion process is low
where it is conjugated to glucuronic following birth, does not work
acid by the enzyme uridine efficiently, or is overwhelmed by the
diphosphate glucuronyl transferase amount of endogenously produced
(UGT) 1A1. bilirubin, the amount of bilirubin in the
• This conjugated form of bilirubin is body increases, resulting in
then excreted into the bile and hyperbilirubinemia and jaundice.
removed from the body via the gut.
.
 types of jaundice
Physiologic jaundice-most abundant type of newborn
hyperbilirubinemia having no serious consequences,usually occurs
between 24-72 hrs and peaks in 4th-7th day in term ,preterm 7th
day,disappeasrs in 10-14 days.Unconjugated bilirubin is the
predominant form and usually serum level is <15mg/dl.

Pathologic jaundice-bilirubin levels w/ deviation from normal range

and requiring intervention-w/in 24 hrs due to increase in s.bilirubin
beyonf 5mg/dl /day ,peak level higher than normal range,presence of
clinical jaundice more than two weeks and conjugated bilirubin (dark
urine staining the cloths)
 cont.
• Breast milk jaundice: develops within 2-4 days of birth, is most likely
related to limited fluid intake as breast milk supply is established, may
peak at 7-15 days of age and may persist for weeks.rarely very large amt
of bilirubin accumulates and cause problems.management in term and
healthy baby is to breastfed 10-12 x a day and observe

• HEMOLYTIC JAUNDICE-incompatibility of blood grps w/ABO and RH

factors,when the fetus and mother blood groups are not compatible and
the fetus blood cross the barrier of the umbilical cord before birth causing
blood hemolysis owing to severe immune response .
 how phototherapy works

• LIGHT SOURCE

SKIN EXPOSURE

BLUE-GREEN light is most

UNCONJUGATED BILIRUBIN - effective for phototherapy as it
both penetrates the skin and is
CONVERTED TO WATER SOLUBLE
absorbed by bilirubin to have a
ISOMERS
PHOTOCHEMICAL EFFECT
EXCRETED IN TO URINE
 .

INDICATION:
• indicated for hyperbilirubinemia to decrease the
serum bilirubin level to normal.
• Prevent the neurotoxic effects of high serum
bilirubin.
• Reduces the need for exchange transfusion in
neonates.
 .

CONTRAINDICATION: POSSIBLE COMPLICATIONS

• Overheating – monitor neonate’s temperature
• Photosensitivity conditions • Water loss from increased peripheral blood flow
:lupus erythematosus, and diarrhea (if present)
• Diarrhea from intestinal hypermotility
xeroderma pigmentosum • Ileus (preterm infants)
• History of cutaneous • Rash
• Retinal damage
malignancies
• ‘Bronzing’ of neonates with conjugated
hyperbilirubinaemia
• Temporary lactose intolerance
 Phototherapy light sources
T
1.LED
2.Compact fluorescent
light or cfl
 .
• 3.Ohmeda Biliblanket (blue halogen
light)-this uses a halogen bulb
directed into a fiberoptic mat.
• There is a filter that removes the UV
and infrared components and
eventual light is a blue –green color.
• Bili blankets are not to be used on
infants less than 28 weeks with
broken or reduced skin integrity.
 Types of phototherapy unit

• 1.Single unit
• 2.Double unit
• 3.Triple unit
 PLANNING

• Check on the phototherapy unit and make sure that all

lights are working
• Follow the setting parameters according to the
manufacturer’s instructions.
 Equipments

• eye shields
• diaper of
appropriate size
• extra linen
 IMPLEMENTATION

1.Perform Hand washing Handwashing is a universal

precaution and is the single
most effective means of
preventing the transfer of
infection.
 .

2. Expose the entire body except

for the eyes and genital area. While
retinal damage from phototherapy
is rare, using eye covers for
newborns is standard practice for
protection.
 .

3. Turn on the phototherapy unit and avoid placing anything

on top of it.

• .
 .

4. Position the infant close to the phototherapy unit

according to the manufacturer's instructions, ensuring
the eye patch does not cover the nostrils to avoid
obstructing breathing.
 .
5. Encourage breastfeeding, as it's
essential for infants undergoing 6. Change the infant's position to
phototherapy to stay hydrated. ensure all body parts are
Adequate fluid intake helps in the exposed to the phototherapy
excretion of bilirubin through urine light
and stool.
 .

7. Monitor the infant’s 8. Check the baby's weight daily to

monitor for increased insensible
temperature every 2 -4 hours or
water loss due to overhead
more frequently if there is phototherapy. Daily weights and
fluctuation in baby ‘s urine output should be recorded
temperature and record every shift.
 .

9. Ensure the baby passes adequate urine 6-8 times per

day or record napkin weight to monitor for potential
increased insensible water loss due to phototherapy.
 .
10. Monitor bilirubin levels at least
once daily, or as per the
physician’s orders.

Phototherapy should be
discontinued when bilirubin returns
to normal value as per the unit
protocol
 .
• 11. Monitor clinically for a 12. Monitor for the following
rebound rise in bilirubin complications:
within 24 hours after stopping - diarrhea,
- dehydration,
phototherapy, especially in - hypo- or hyperthermia.
infants with hemolytic Note that any skin rash is
disorders. generally temporary and will
resolve after discontinuation of
treatment.
 Side effect of phototheraphy
• Increase insensible water loss from
increased peripheral blood flow and diarrhea (if present)

• Loose stoolsfrom intestinal hypermotility • Ileus (preterm infants)

• Skin rash • Retinal damage
• Bronze baby syndrome • Temporary lactose intolerance
• Hyperthermia • may result to hypocalemia
• Upsets maternal baby interaction
 Nursing considerations
• A SBR should be collected 24 hours post cessation of
phototherapy lights to check for rebound hyperbilirubinaemia.

• Remember to change light source i.e, the CFL bulbs every 3-6
months or every 1000 hours of use when the tube flickers or ends
turn black
• Ensure that the nappy covers as minimum surface as possible
• While in NICU and infant being monitored ,cover the pulse
oximeter probe properly so to avoid interference of readings from
the phototherapy light
 references
• https://www.aafp.org/pubs/afp/issues/2002/0215/p599.html#:~:text=Phototherapy%20should
%20be%20instituted%20when,infants%20older%20than%2072%20hours
• ://www.aafp.org/pubs/afp/issues/2002/0215/p599.html#:~:text=Phototherapy%20should%20b
e%20instituted%20when,infants%20older%20than%207https2%20hours
• Newborn jaundice
• . - Treatment - NHShttps://www.nhs.uk › conditions › treatmen
• https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Ph
• https://www.ncbi.nlm.nih.gov/books/NBK470290/#:~:text=Degradation%20in%20the%20dige
stive%20tract,epithelium%20and%20undergoes%20enterohepatic%20circulation.
• https://emedicine.medscape.com/article/1894477-
overview#:~:text=A%20commonly%20used%20rule%20of,10mg%2FdL%20and%20so%20o
n.

• .
 FIN

thankyou