109 RLE

• Phototherapy


  The process of using light to eliminate bilirubin in the blood
• Phototherapy


  1. Light waves are absorbed by the baby's skin and blood

  2. Light waves change bilirubin into products

  3. Products can pass through the baby's system
• Photo oxidation


  The process by which light causes breakdown of bilirubin
• Phototherapy


  Alters the structure of bilirubin to a soluble form for easier excretion
• Phototherapy


  Application of fluorescent light (blue or white) to the newborns naked skin
• Jaundice


  The yellow appearance of the skin that occurs with the deposition of bilirubin in the dermal and subcutaneous tissues and sclera
• Bilirubin


  The orange – yellow pigment of the bile, formed principally by the breakdown of hemoglobin in red blood cells at the end of their normal life-span; is a waste product that's produced when the liver breaks down old red blood cells so the body can remove them
• Conjugated bilirubin


  Water soluble and is excreted by the liver
• Unconjugated bilirubin


  Not water soluble and cannot be excreted by the liver, and it is toxic to the body in high levels
• Bilirubinemia


  The presence of bilirubin in the blood
• Hyperbilirubinemia


  The excess of bilirubin in the blood
• Kernicterus


  Type of brain damage that can result from high levels of bilirubin in the baby's blood; when indirect bilirubin is deposited in brain cells and disrupts neuronal metabolism and function especially in the basal ganglia
• Types of jaundice


  • Physiological jaundice
  • Pathological jaundice
• Physiological jaundice


  Not harmful, disappears as liver matures, appears after 24 hours, maximum intensity by 4th-5th day in term and 7th day in preterm, clinically not detectable after 14 days, disappears without any treatment
• Pathological jaundice


  Harmful, occurs when bilirubin is high
• Causes of jaundice


  • Breast-feeding jaundice
  • Physiological jaundice
  • Breast-milk jaundice
  • Blood group incompatibility
• Breast-feeding jaundice


  Jaundice may occur when the baby does not drink enough breast milk, occurs in 5% to 10% of newborns, should have 8 to 12 feeding per day for the 1st several days of life
• Physiological jaundice


  The most common cause of newborn jaundice and occurs in more than 50% of babies, because the baby has an immature liver, bilirubin is processed slower
• Breast-milk jaundice


  Occurs in 1% to 2% of breast-fed babies, caused by a special substance that some mothers produce in their milk, causes the baby's intestine to absorb more bilirubin back into his body than normal, starts at 4 to 7 days after, may last 3 to 10 weeks, most often occurs in the 2nd or later weeks of life
• Blood group incompatibility


  Rh or ABO problems if a baby and mother have different blood types, sometimes the mother produces antibodies that destroy the newborn's red blood cells, causes a sudden buildup of bilirubin in the baby's blood
• Assessment before phototherapy


  • Gestational age of the baby
  • Weight the baby
  • Postnatal age
  • Types of jaundice
  • Level of jaundice
• Side effects of phototherapy


  • Dehydration due to increased insensible water loss
  • Watery diarrhea
  • Hypocalcemia
  • Retinal damage
  • Erythema and skin rashes
  • Bronze baby syndrome
  • Maternal newborn interaction is affected
  • Dark yellow urine
• Nursing care for infant receiving phototherapy

  • Assess skin exposure
  • Proper position
  • Assess and adjust thermoregulation device
  • Promoting elimination and skin integrity
  • Hydration
  • Provide eye protection, eyes are covered with eye patches to prevent damage to the retina by the light and Proper covering and shielding of gonads
  • Baby is placed naked 45cm away from the tube lights in a crib or incubator
  • If using closer, monitor temperature of the baby
  • During phototherapy, the bilirubin level in the baby's blood will be checked at least once every day. Phototherapy is stopped when the level decreases
  • Baby is turned every two hours or after each feed
  • Temperature is monitored every two to four hours
  • Weight is taken at least once a day
  • Urine frequency is monitored daily
  • More frequent breastfeeding or 10-20% extra fluid is provided
  • Baby should spend as much time as possible under the phototherapy lights for it to be most effective, but the baby can come out for feeding or cuddles if he is upset
• Phototherapy


  Treatment with a special type of light, used to treat newborn jaundice, lowers the serum bilirubin level by transforming bilirubin into water-soluble isomers that can be eliminated without conjugation in the liver
• Phototherapy


  1. Use of intense fluorescent lights to reduce serum bilirubin

  2. Expose much of skin as possible

  3. Cover the genital area and eyes

  4. Remove patches one per shift to check for irritation and infection

  5. Monitor skin temperature
• Phototherapy is done 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, 20 mg per dL (342 mol per L) in infants older than 72 hours
• Complications of phototherapy


  • Overheating – monitor neonate's temperature
  • Water loss from increased peripheral blood flow and diarrhea (if present)
  • Diarrhea from intestinal hypermotility
  • Ileus (preterm infants)
  • Rash
  • Retinal damage
• Interventions for phototherapy


  • Increase fluid (breast milk or IVF)
  • Expect loose green stools and green/darker urine
  • Monitor skin color with fluorescent lights out
  • Reposition every 2 hours
  • Provide stimulation