PHOTOTHERAPY

• A treatment for jaundice where the exposure of newborn skin to a light source converts unconjugated bilirubin molecules into water soluble isomers that can be excreted by the usual pathways in the urine or feces. · most co

  Phototherapy
• Yellowish discoloration of the skin and sclera of the eyes

  Jaundice
• • Appears after 24 hours
  • Total bilirubin rises by less than 5mg/dl per day
  • Maximum intensity by 4th-5th day in term and 7th day in preterm
  • Serum levels less than 15mg/dl
  • Clinically not detectable after 14 days 


  Physiological Jaundice
• • Appears age appears within 24 hours of age
  • Increase of bilirubin >5mg/dl day
  • Jaundice days : Jaundice days pesisting after 14 days
  • Stool clay/white colored and urine staining yellow staining clothes to biliary obstruction
  • Direct bilirubin >2mg/dl

  Pathological Jaundice
• 0.3-1 mg/dL

  Normal Bilirubin
• 0.2-0.8 mg/dL

  Indirect
• 0.1-0.3 mg/dL

  Direct
• Bilirubin level is above 12mg/dl

  Term Infants
• Bilirubin level is above 15mg/dl

  Preterm Infants
• stimulated bilirubin (after the absorption of the photon) envelopes an oxygen molecule, which is then transformed into a free radical capable of destroying native bilirubin, producing renal excretion products.

  Photooxidation
• • Bilirubin _____ products excreted in urine.

  oxidized to water-soluble
• • Faster, and two different products can be formed which are eliminated by the liver: structural isomer (lumirubin) and the configuration isomer.

  Photoisomerization
• is a stable product with a slow formation and rapid excretion, so great quantities do not accumulate in the circulation

  Lumirubin
• alters bilirubin into isomers :

  lumirubin and configuration of isomer for fast secretion
• • Loose-greenish stools

  • Transient skin rashes

  • Mild hyperthermia

  • Increased metabolic rate

  • DHN/ electrolyte imbalance – uncommon

  • Rebound effect

  Side effects of Photo therapy
• • Eye covering
  • W/ diaper to protect the ovaries or testes
  • Checks the newborn’s eyes every 4-6 hours for evidence of discharge, excessive pressure on the lids or corneal irritation.
  • Remove the newborn under the lights for feeding
  • Remove eye shield before feedings, which provide the opportunity for visual and sensory stimulations.


  Nursing Management
• • Monitor infant’s temperature
  • Distance between the phototherapy light source and infant must be maintained as outlined by the manufacturer’s guidelines. (USUALLY 12 INCHES AWAY)
  • Maintaining the infant in a flexed position w/ rolled blankets along the sides of the body helps maintain heat and provides comfort.
  • Assess skin turgor and I & O
• he application of fluorescent light (430-488 nm) to the neonate’s exposed body surface area
• • Treatment can be stopped once serum bilirubin levels demonstrate a trending down (without rebound) or when the level is less than 10 mg/dl.

  Fluorescent Light
• Halogen Spotlight: could cause thermal burns
• cannot achieve desired irradiance (light intensity due to single bulb structure)

  Halogen Spotlight
• Bank Bilirubin Light or fluorescent tubes
• Can mask cyanosis, and cause dizziness and nausea

  • often administered with white lightbulbs

  Blue spectrum light
• Newborn is accessible for care, feeding, and diaper changes

  • Greater surface area covered
  • Eyes are not covered

  Phototherapy Blanket /Fiber Optic Blanket
• contains halogen lights and is plugged to an outlet

  • remains cool · Still Need Intensive Phototherapy , alone is not enough


  Phototherapy Blanket / Fiber-optic blanket
• Primarily used for decreasing physiologic jaundice rather than that associated with blood incompatibility

  Home phototherapy
• Has an advantage of allowing for uninterrupted contact between the parents and the newborn

  Home phototherapy
• Lights must be a full 12 inches (30cm) away from an infant


  Health Teaching for Home phototherapy
• Infant must continuously wear eye patches while on the therapy and should have the eye patches removed when away from the lights for feeding and for a period of visual stimulation and interaction

  Health Teaching for Home phototherapy
• Assessment of bilirubin level with the use of

  bilirubinometer
• • Monitoring temperature every 4 hours throughout the course of therapy
  • Monitoring infant’s urine output.
  • Monitoring infant’s bowel movement.


  Health Teaching Using the Phototherapy Blanket
• • In wrapping the baby, leave a space about the size of two fingers between the panel and the baby’s skin
  • Encourage bonding
  • Call the pediatric care provider if untoward signs and symptoms

  occur
• • Spectrum of light
  • Sufficiently High irradiance
  • Surface Area

  Effectiveness of Phototherapy
• . Position Phototherapy units not more than 30.5 cm from the patient (can be positioned as close as 15 cm to patient. Refer to specific phototherapy units manufacturing guidelines for more details
• Expose as much of the skin surface as possible to th phototherapy light. To maximize skin exposure, dress the baby in a nappy and protective eye covers only
• Observe for signs of lethargy, hypotonia, high pitch cry, and poor feeding. (BILIRUBIN ENCEPHALOPATHY)
• Monitor bowel movement, urine output and assess skin turgor.
• Check the dressing (eye patch) frequently.
• Check the bilirubin levels every 4-6 hours as per doctor’s order.
• 23. Stop Phototherapy for 30 minutes every 3 to 4 hours to feed the baby, change the nappy and give a cuddle, ensure eye covers are removed for eye care during infant care of feeding