For newborns.

1. PHOTOTHERAPY
Jiget Lyn B. Layugan, RN, CNN, LPT, MSN

3. Objectives
1. Define phototherapy
2. List causes of jaundice
3. Identify history of phototherapy
4. Understand the mechanism of phototherapy
5. List the benefits of phototherapy
6. Identify the factors affecting on efficacy of
phototherapy
7. Enumerate the side effects of phototherapy
8. Apply the nursing care for infant’s receiving
phototherapy

4. What is phototherapy?
Phototherapy is a medical treatment in
which natural or artificial light is used
to improve a health condition.

7. What are the different types of newborn
jaundice?
Physiological Jaundice - This is the most
common cause of newborn jaundice and occurs
in more than 50% of babies.
 Pathologic Jaundice - is the most serious
type of jaundice. It occurs within 24 hours after
birth, and is characterized by a rapid rise in a
baby's bilirubin level. The most likely cause is
blood incompatibility or liver disease.

8. Breast-feeding jaundice: Breastfeeding
jaundice may occur when your baby does
not drink enough breast milk. It occurs in 5%
to 10% of newborns. The jaundice
symptoms are similar to those of
physiological jaundice, just more
pronounced.

9. Breast-milk jaundice
Breast-milk jaundice occurs in 1% to 2% of
breast-fed babies. It is caused by a special
substance that some mothers produce in
their milk. This substance causes your
baby's intestine to absorb more bilirubin
back into his body than normal.

10. Causes of jaundice
Appearing within 24 hours of age
Hemolytic disease of NB : Rh, ABO
Infections: TORCH, malaria, bacterial
G6PD deficiency
Appearing between 24-72 hours of life
Physiological
Sepsis
Polycythemia
Concealed hemorrhage
Intraventricular hemorrhage

11. Causes of jaundice
After 72 hours of age
Sepsis
Cephalhaematoma
Neonatal hepatitis
Extra-hepatic biliary atresia
Breast milk jaundice
Metabolic disorders

12. Signs and Symptoms of Jaundice
Yellowing of skin color, soft palate and
sclera of eyes
Lethargy
Poor feeding
Darkened urine
Dark or grey stools (Macqueen et al. 2012)

13. Remember jaundice
JAUNDICE
J - jaundice within first 24 hrs of life
A - a sibling who was jaundiced as neonate
U - unrecognized hemolysis
N – non-optimal sucking/nursing
D - deficiency of G6PD
I - infection
C – cephalhematoma /bruising
E - Extra-hepatic biliary atresia

14. History of PHOTOTHERAPY
Care for the infant under
phototherapy

15. Care for the infant under
phototherapy

16. History of PHOTOTHERAPY
• The use of phototherapy was first
discovered, accidentally, at Rochford
Hospital in Essex, England. The ward
sister (Charge Nurse) of the premature
baby unit
• Nils Ryberg Finsen
Care for the infant under
phototherapy

17. Mechanism of Action
Bilirubin is a naturally occurring molecule
of the red blood cells. It is released into
the bloodstream when the red blood cells
break down. This is normal and occurs
often. Our livers break down the bilirubin
and it is excreted.

18. Mechanism of action-Continue
Phototherapy (light treatment) is the process
of using light to eliminate bilirubin in the
blood. The baby's skin and blood absorb
these light waves.

19. Mechanism of action-Continue
Wavelength of 420-448 nm, oxidized the
bilirubin to biliverdin, a soluble product that
does not contribute to kernicterus

20. Mechanism of action
•The phototherapy will help the liver to process
bilirubin, bringing your baby's level down to
normal
• The light waves convert the bilirubin to water
soluble nontoxic forms which are then easily
excreted. Every attempt should be made to
find out the cause of jaundice.
• The advantages of phototherapy are that it is
noninvasive, effective, inexpensive and easy
to use.

21. What are the benefits of phototherapy?
• The jaundice can be treated
• preventing the need for more invasive
treatment and the serious complications,
which can occur if excessive levels of
bilirubin develop
• Phototherapy is a safe
• Effective method of treatment.
• It provides the highest level of therapeutic
light available to treat your baby.

22. FACTORS AFFECTING EFFICACY OF
PHOTOTHERAPY
1-TYPE OF LIGHT USED and Intensity
2-DISTANCE
3-SURFACE AREA OF SKIN EXPOSED TO
LIGHT

23. Assessment should be Before
Phototherapy
• GA Of the baby
• Weight The baby
• Postnatal Age
• Types of Jaundice
• the level of jaundice

24. Nursing Care for
Infant
Receiving
Phototherapy

25. Babies under phototherapy
Baby under conventional
phototherapy
Baby under triple unit intense
phototherapy

26. NJ - 27 Teaching Aids: NNF
Nursing Care for Infant Receiving
Phototherapy
Technique
Perform hand wash
Place baby naked in cradle or incubator
Fix eye shades
Keep baby at least 45 cm from lights, if
using closer monitor temperature of baby
Start phototherapy

27. NJ - 28 Teaching Aids: NNF
Phototherapy
Frequent extra breast feeding every 2
hourly
Turn baby after each feed
Temperature record 2 to 4 hourly
Weight record- daily
Monitor urine frequency
Monitor bilirubin level

28. Side effect of phototherapy
• Bronze – baby syndrome.
• Loss , greenish stool .
• Transient skin rashes.
• Hyperthermia .
• Increasing metabolic rate.
• Dehydration .
• Electrolyte disturbance

29. THANK YOU!