219-RLE

• Phototherapy is used for the treatment of hyperbilirubinemia, helping the liver process bilirubin and prevent kernicterus
• Factors affecting phototherapy effectiveness:

  • Type of light: Blue fluorescent light/white fluorescent light in the 430-490NM range
  • Light intensity
  • Surface area of skin exposed to light
  • Distance of light source from baby (35-50cm in conventional lights)
• Procedure for phototherapy:

  • Ensure effective irradiance, keeping the light source 35-50cm from the baby
  • Assess skin exposure, with the baby naked apart from a diaper
  • Maintain a neutral thermal environment
  • Expose as much skin surface as possible
  • Dress the baby in a diaper and protective eye covers only
  • Provide eye protection with appropriate opaque covers, ensuring they are removed every 4 hours during care/feeding
  • Observe for any skin changes, hydration, and document them
  • Review hydration needs daily, individualized for gestational and postnatal age
  • Maintain strict fluid balance, limiting breastfeeding to 20 minutes if bilirubin levels are high
• During phototherapy, monitor vital signs and temperature at least every 4 hours, more frequently if needed
• Monitoring bilirubin levels is crucial during phototherapy, covering lipid lines with light-resistant material and using reflective tape to avoid peroxidation
• Both conjugated and unconjugated bilirubin are photo-oxidized when exposed to white/UV light
• Potential side effects of phototherapy include:

  • Overheating
  • Retinal damage
  • Rashes
  • Temporary Lactose intolerance
  • Ileus (especially in preterm infants)
  • Bronzing with Conjugated hyperbilirubinemia
• Total Serum Bilirubin (TSB) and Serum Bilirubin Level (SBR) should be monitored, with physiologic jaundice appearing within 24 hours and disappearing without treatment
• Pathologic jaundice persists after 14 days in full-term infants