Deals with Phototherapy in Newborns. Useful for B.Sc. Nursing and M.Sc. Nursing students.

2. CARE OF BABY ON
PHOTOTHERAPY
MRS. ANNA HIMA THOMAS
ASSISTANT PROFESSOR
MGM NEW BOMBAY COLLEGE OF NURSING

3. HYPERBILIRUBINEMIA
• Excessive level of accumulated bilirubin in the blood and is
characterized by yellowish discoloration of the skin, sclera and the
nails.
• Over two-third of newborn babies develop clinical jaundice
• Cephalo-caudal progression

4. BILIRUBIN METABOLISM

5. TYPES OF HYPERBILIRUBINEMIA
1.UNCONJUGATED HYPERBILIRUBINEMIA
2.CONJUGATED HYPERBILIRUBINEMIA

6. PHOTOTHERAPY
₪most common treatment for reducing high bilirubin levels
that cause jaundice in a newborn
₪baby lies in a bassinet/ incubator and is exposed to
fluorescent light that is absorbed by baby's skin.
₪bilirubin in the baby's body is changed into another form
that can be more easily excreted in the stool and urine

7. DEFINITION
A treatment for
hyperbilirubinemia and jaundice
in the newborn that involves the
exposure of an infant's bare skin
to intense fluorescent light.

8. MECHANISM
• Phototherapy light in the range of 420-470nm
• The absorption of light by the normal bilirubin generates
configuration isomers, structural isomers, and photo oxidation
products
• Configurational isomerization :reversible and much faster than
structural isomerization. E isomers(4Z 15E,4E 15E, 4E 15Z) are
formed which are more polar, non stable water soluble
compounds are formed.

9. • Structural isomerization :slow and irreversible. Stable water soluble
compounds are formed like lumirubin
• Photo oxidation occurs more slowly than both configurational and
structural.
• Photo oxidation products are excreted mainly in urine and stool..

11. WHEN TO START
PHOTOTHERAPY?
• American Academy of pediatrics
recommends that phototherapy should be
started if the serum bilirubin level reaches
15-18mg/dl in a healthy full term infant
• Prophylactic phototherapy is
recommended in extremely low birth
weight babies with perinatal risk factors

12. PHOTOTHERAPY LIGHTS
• The narrow spectrum blue light is more effective.
• A combination of 4 special blue lights and 2 white compact fluorescent 20 watts tubes
are ideal
• The distance between the baby and the phototherapy should be maintained between
15-20 cm
• Double light system where the total infant is exposed to light both from below and
above is more effective
• Blue light emitting diodes (LEDs) which emits a narrow spectral brand of high intensity
lights are now available
• For effective phototherapy, a spectral irradiance / flux of 8-10µw/cm2/nm

13. TYPES OF PHOTOTHERAPY
• Conventional Phototherapy
• Fibre Optic Phototherapy
• Multiple Phototherapy

14. Conventional phototherapy
Phototherapy given using a single light source (not fibre optic) that is
positioned above the baby.
Fibre optic phototherapy
Phototherapy given using a single light source that comprises a light
generator, a fibre optic cable through which the light is carried and a flexible light
pad, on which the baby is placed or that is wrapped around the baby.

15. Multiple phototherapy
Phototherapy that is given using more than one light
source simultaneously; for example, two or more
conventional units, or a combination of conventional
fibre optic units.

17. DURING PHOTOTHERAPY
ᴥ The baby is undressed so that as much
of the skin as possible is exposed to the
light.
ᴥ The baby's eyes are covered to protect
retina from the bright light
ᴥ Feeding should continue. There is no
need to stop breast-feeding.
ᴥ The bilirubin level is measured at least
once a day (6-8 hours interval)

18. ADMINISTERING PHOTOTHERAPY
General care of the baby during phototherapy
• Perform a clinical hand wash in line with standard precautions
• Undress the baby ensure treatment is applied to the maximum area of
skin.Put on the baby with diaper
• Give the baby eye protection
• Remove eye shields and check eyes regularly
• Do not apply any cream or oil to the exposed area of skin

19. • Encourage frequent breast feeding every 2 hours
• The infant’s weight, voiding and stooling pattern should be evaluated
• Monitor the baby’s temperature two hourly and ensure the baby is kept in a
thermo neutral environment

20. • Monitor hydration by daily weighing of the baby and assessing wet nappies.
• Observe for potential signs of bilirubin encephalopathy (e.g. lethargy, poor
feeding, hypotonia, arching of the head and neck, and seizures).
• Document time of commencement and completion of phototherapy in the
neonate’s health care records and on the phototherapy chart.

21. CEASING PHOTOTHERAPY
Phototherapy is discontinued when serum bilirubin levels fall 25-50 µmol/L
(1.5-3 mg/dL) below the level that triggered the initiation of phototherapy.
Serum bilirubin levels may rebound after treatment has been discontinued,
and follow-up tests should be obtained within 6-12 hours after discontinuation.

22. EFFECTIVENESS OF PHOTOTHERAPY
The effectiveness of the phototherapy increases with:
• blue light
• intensity of the light
• the greater amount of skin exposed
• the closer the lights to the baby (limited by risk of overheating the baby)

23. DOCUMENTATION
• Time of phototherapy started and stopped
• Type of fluorescent lamp used
• Number of lamps
• Distance between the lamp and the infant
• Type of phototherapy used
• Photometer measurement of light intensity
• Occurrence of side effects

24. CONTRAINDICATIONS
• Concomitant use of photosensitizing
medications
• Congenital erythropoietic porphyria,
• Family history of porphyria
• Cholestatic jaundice
• Conjugated hyperbilirubinemia.

25. SIDE EFFECTS/COMPLICATIONS
• Skin rash
• Dehydration
• Diarrhoea (Loose, Greenish stool)
• Bronze Baby Syndrome
• retinal damage
• Hyper/Hypothermia
• Electrolyte disturbance
• Maternal-infant separation

26. NURSING CARE OF THE
INFANT RECEIVING
PHOTOTHERAPY

27. PHOTOTHERAPY AND PARENT INFANT
INTERACTION
• Family centered care
• Assess the parent’s understanding of the treatment
involved
• Encourage parents to continue feeding, caring for and
visiting their infant.
• Explain to the parents what newborn jaundice is, why
the infant is being treated, what precautions will be
taken and that the lights being used do not contain
ultraviolet light.

28. EYE CARE
• The baby's eyes are shielded by an opaque mask
to prevent exposure to the light.
• The eye shield should be properly sized and
correctly positioned to cover the eye completely
but prevent any occlusion of the nares.
• The baby's eyelids are closed before the mask is
applied, because the corneas may become
excoriated if they come in contact with the
dressing.

29. • On each nursing shift the eyes are checked for evidence of
discharge, excessive pressure on the lids or corneal irritation.
• Eye pads should be removed 4 hourly and eye cares attended with
normal saline.
• Eye shields are removed during feedings, which provide the
opportunity to provide visual and sensory stimulation

30. SKIN CARE
• Keep the infant clean and dry
• Clean only with water. Do not apply oils or
creams to the exposed skin
• Proper covering and shielding of external
genitalia
• Assess skin exposure

31. • Proper positioning
• Turn infant frequently to expose all skin area.
• Promote elimination and skin integrity
• Keep diaper area dry and clean because skin in this area is prone to break down.

32. OBSERVATIONS
• Infants must be weighed on admission to the nursery and daily as per the guideline
• All infants in Newborn Care receiving phototherapy should have a temperature, pulse and
respiration rate documented 4 hourly.
• If an infant requires continuous cardio-respiratory monitoring for other reasons, then, this
should continue under phototherapy.
• Infants under the Blue fluorescent lights need at least saturation monitoring as it is difficult to
assess the infants color under these lights.

33. • If the infant receiving phototherapy is tachycardic, plethoric or restless, then
the temperature should be rechecked as the infant may be overheating.
• Well babies > 35 weeks gestation who are receiving white light
phototherapy do not require any monitoring unless they are nursed prone
and then they will require cardiorespiratory monitoring.

34. FLUID REQUIREMENTS
All Infants
• Accurately document fluid intake (oral or
intravenous) and output.
• Urinalysis and specific gravity check should be
performed 8 hourly.
• Assess and record stools.
• Provide frequent breast feeding.

35. • Adequate fluid intake should be provided either orally or
intravenously
• Ensure that the baby passes adequate urine (6-8 times per day)
• keep urine specific gravity below 1.015. (Breastfeeding or 10-20%
extra fluids are provided)

36. TERM INFANTS
• Breast fed infants should continue on demand breast feeds.
• Sucking, attachment and mother's supply should be observed and
documented.
• Bottle fed infants should be fed on demand 4-6th hourly
• Complementary feeds in the form of intragastric or bottle feeds with
EBM/formula may be required if oral intake is insufficient and there are
concerns that the infant is dehydrated.

37. • Breastfed infants > 32 weeks gestation should be complemented
with a hydrolyzed formula . if there is insufficient breast milk and
the parents consent to formula feeding
• Assessment of dehydration should take into account the baby's
fluid input and output, weight and urine specific gravity.

38. PRETERM INFANTS
• Preterm infants have about a 20% increase in trans epidermal water loss
when they receive phototherapy despite being nursed in humidity and a
double walled crib.
• The daily fluid rate may need to be increased by 10ml-15ml/kg/day to
prevent dehydration.

39. OTHER MEASURES
• During breastfeeding switch off the photo therapy unit
• Turn the baby after each feed to expose maximum surface area of baby to light.
• Babies who are in an open crib must have a protective plexiglas shield between
them and the fluorescent light to minimize the amount of un desirable ultraviolet
light reaching their skin and to protect them from accidental bulb breakage.
• Maintaining the baby in a flexed position with rolled blankets along the sides of
the body helps maintain heat and provides comfort.

41. Shhhhhhhhhh ..
Let me sleep
THANK YOU
FOR YOUR
ATTENTION