Phototherapy in neonates is a frontline treatment for neonatal jaundice, a common condition caused by elevated levels of unconjugated bilirubin in the blood. It uses specific wavelengths of light to convert bilirubin into water-soluble forms that can be excreted without liver conjugation.
Indications
- Total serum bilirubin (TSB) above age-specific thresholds
- Rapidly rising bilirubin levels
- Risk factors: prematurity, hemolysis (e.g., Rh or ABO incompatibility), G6PD deficiency, sepsis
Preparation of child and parent
Physical preparation
- Collect history from parents to determine the possibility of ABO/Rh incompatibility.
- Check the blood values of newborn.
- Check weight.
- Do a brief physical assessment to determine the level of hydration, consciousness, signs of jaundice, etc.
Psychological preparation
- Explain the family members regarding:
- Reason for phototherapy
- Covering the child’s eyes during the procedure
- Possible side effects
- Importance of checking diaper q hour and meticulous skin care
General Considerations
- Verify the intensity of phototherapy.
- Infants receiving phototherapy treatment are weighed daily.
- Serum bilirubin levels are checked as per protocol.
- Plan activity such as feeding or bathing the infant so that family members may fully participate in the child’s care.
Procedure
- Gather the necessary articles
- Perform hand hygiene
- Set up bassinet/isolette
- Set up florescent over lights
- Distance: open bassinet-4 inches from infants
- Isolette:15-18 inches (halogen lamps emit more heat than fluorescents bulbs; therefore, increase the risk of burns, do not position it close to infants
- Turn the lights unit on using a light meter, verify whether the level of irradiance is appropriate to the manufactures recommendation for the system (min;10-12µW/ cm2/nm)
- Perform hand hygiene
- Undress the infant, leaving the diaper in the place to cover Genitals
- Cover the eyes completely with protective shields. Ensure that the doors are open. Remove the shield every 2 hrs.
- Place the infant is bassinet or isolette turn the infant every 2 hrs., assessing skin integrity, hydration, temperature and neurological status.
Nurses’ responsibility
- Reassure the parents regarding their baby’s progress and benefits and risks of procedure.
- Support the mother for successful and frequent breastfeeding during the therapy.
- Assess the parent’s level of understanding in clarification of this process.
- On each nursing shift, the eyes are checked for evidence of discharge, excessive pressure on the lids, or corneal irritation.
- Eye shields are removed during feeding, which provides the opportunity for visual and other sensory stimulation.
- During breastfeeding switch off the phototherapy unit.
- Babies who are in open crib must have a protective glass shield between them and the light source to minimize the amount of undesirable ultraviolet (UV) 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 to maintain heat and provide comfort.
- Maintain thermoregulation.
- Adequate fluid intake should be provided either orally or intravenously. Vasodilatation increases the insensible water loss and there is excess stool loss from occasional diarrhea (urine specific gravity should be <1.015).
- Ensure that the baby passes adequate urine (6-8 times/day).
- Weight is taken at least once a day.
- Ensure that serum bilirubin levels are obtained as per protocol. The diminishing icterus does not reflect the serum bilirubin concentration.
- Discontinue phototherapy when serum bilirubin returns to sate value as per protocol.
- Monitor clinically for rebound bilirubin rise within 24 hours after stopping phototherapy.
- Turn infant on abdomen for short period of time and will cease priapism.
- Accurate charting of the following:
- Type of fluorescent light/manufacturer
- Number of lamps
- Distance between surface of lamp and neonate.
- Use of phototherapy in combination with incubator or open bassinet
- Photometer measurement of light intensity
- Occurrence of side effects
- Length of time the bulb has been used
Note: The effectiveness of light decreases after 800 hours of use. Thus, the bulbs should be changed at the correct time. - Maintain vital signs, feeding chart, weight chart, and serum bilirubin chart.
Potential Side Effects
- Loose greenish stools
- Skin rash or dryness
- Temporary bronze discoloration (in cholestatic jaundice)
- Rare: dehydration, retinal damage (if unprotected)
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Naveen Bajaj, Rajesh Kumar, Manual of Newborn Nursing, 2nd Edition, 2023, Jaypee Publishers, ISBN:978-9354659294
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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