Phototherapy for Jaundice

Phototherapy is a common and effective treatment for neonatal jaundice, a condition characterized by high levels of bilirubin in the blood, causing a yellowing of the skin and eyes in newborns. Bilirubin is a substance produced by the normal breakdown of red blood cells. Normally, the liver processes bilirubin, but in newborns, this system is often underdeveloped. Phototherapy uses blue light to convert bilirubin into a form that can be easily excreted by the baby’s body, helping to reduce the levels of bilirubin in the blood and alleviating jaundice symptoms.

Types of Phototherapy for Jaundice

Conventional Phototherapy

Conventional phototherapy involves placing the baby under fluorescent or LED light sources. The baby is often unclothed to expose as much skin as possible to the light, and their eyes are covered for protection. The light breaks down bilirubin in the skin, converting it into water-soluble isomers that can be excreted in bile and urine. This type of phototherapy is usually administered in a hospital setting.

Fiberoptic Phototherapy

Fiberoptic phototherapy uses a fiberoptic blanket or pad that emits light. The baby is placed on or wrapped in the blanket, allowing treatment while the baby is held and fed by caregivers. This method is less intense than conventional phototherapy but is useful for milder cases of jaundice or in combination with other treatments.

Indications for Phototherapy

Elevated Bilirubin Levels

Phototherapy is indicated for newborns with significantly elevated bilirubin levels that pose a risk for kernicterus, a form of brain damage caused by very high bilirubin levels. The exact bilirubin level at which phototherapy is started depends on the baby’s age in hours, weight, and overall health.

Premature Infants

Premature infants are more susceptible to jaundice due to their underdeveloped liver function. Phototherapy is often indicated at lower bilirubin levels in these infants compared to full-term infants to prevent complications.

Benefits of Phototherapy

• Non-invasive Treatment: Phototherapy is a non-invasive treatment method, making it safe and relatively painless for newborns.
• Effective Bilirubin Reduction: It effectively lowers bilirubin levels, reducing the risk of severe complications such as kernicterus.
• Quick Onset of Action: Phototherapy can start working within hours, providing rapid relief from jaundice symptoms.
• Allows Continuation of Feeding: The treatment allows babies to continue breastfeeding or bottle-feeding, which is important for their overall health and growth.

Equipments Used in Phototherapy

• Fluorescent Lamps: These are traditional light sources used in conventional phototherapy. They emit blue light that helps break down bilirubin in the skin.
• LED Lamps: LED lamps are more energy-efficient and have a longer lifespan compared to fluorescent lamps. They provide a specific wavelength of light that is most effective for bilirubin breakdown.
• Fiberoptic Blanket/Pads: These devices consist of a fiberoptic cable that transmits light to a blanket or pad. The baby can lie on or be wrapped in the blanket, allowing light to penetrate the skin.
• Eye Shields: Protective shields are essential to cover the baby’s eyes during phototherapy to prevent damage from the intense light.

Patient Monitoring and Management in Phototherapy

• Regular Bilirubin Level Checks: Bilirubin levels are regularly monitored to assess the effectiveness of the treatment and to determine when it can be stopped.
• Hydration and Feeding: Ensuring the baby remains well-hydrated is crucial. Breastfeeding or formula feeding should continue regularly.
• Temperature Monitoring: The baby’s temperature is monitored to avoid overheating, which can be a side effect of phototherapy.
• Skin Care: Regular checks for skin integrity and signs of rash or burns due to prolonged exposure to light.

Who Needs Phototherapy

• Newborns with Hyperbilirubinemia: Babies with high bilirubin levels that do not resolve naturally within a few days of birth.
• Premature Infants: Premature babies often need phototherapy due to their higher risk of developing severe jaundice.
• Babies with Hemolytic Disease: Infants with conditions like Rh incompatibility or ABO incompatibility, leading to increased red blood cell breakdown.
• Babies with Bruising or Birth Injuries: Newborns with extensive bruising from birth injuries or cephalohematomas are at increased risk for jaundice and may require phototherapy.

Special Situations for Phototherapy

• Exchange Transfusion Need: In severe cases where phototherapy alone is insufficient, an exchange transfusion may be needed.
• Persistent Jaundice: If jaundice persists beyond two weeks, especially in breastfed babies, phototherapy might be reconsidered or other underlying causes investigated.
• Underlying Health Conditions: Babies with other health conditions that may contribute to prolonged jaundice may require a more extended course of phototherapy.

Diagnostic Assessments for Phototherapy

Before initiating phototherapy, several diagnostic assessments are conducted to determine the necessity and appropriateness of the treatment:

• Bilirubin Level Measurement: Total and direct bilirubin levels are measured using a blood test or transcutaneous bilirubinometer.
• Blood Type and Coombs Test: To check for blood type incompatibility between the mother and baby, which can cause increased bilirubin levels.
• Complete Blood Count (CBC): To assess the overall health and detect any underlying infections or conditions contributing to jaundice.
• Reticulocyte Count: To determine if there is an increased production of red blood cells due to hemolysis.

In conclusion, phototherapy is a critical and effective treatment for managing neonatal jaundice. It helps reduce high bilirubin levels in newborns, preventing severe complications and promoting healthy development. By understanding the types, indications, benefits, and management of phototherapy, healthcare providers can ensure optimal care for infants with jaundice. For any further inquiries or to share your experiences with phototherapy, please leave a comment below.