Fundamentals of Phototherapy for Neonatal Jaundice

Abstract

Phototherapy is the use of visible light for the treatment of hyperbilirubinemia in the newborn. This relatively common therapy lowers the serum bilirubin level by transforming bilirubin into water-soluble isomers that can be eliminated without conjugation in the liver. The dose of phototherapy largely determines how quickly it works; the dose, in turn, is determined by the wavelength of the light, the intensity of the light (irradiance), the distance between the light and the infant, and the body surface area exposed to the light. Commercially available phototherapy systems include those that deliver light via fluorescent bulbs, halogen quartz lamps, light-emitting diodes, and fiberoptic mattresses. Proper nursing care enhances the effectiveness of phototherapy and minimizes complications. Caregiver responsibilities include ensuring effective irradiance delivery, maximizing skin exposure, providing eye protection and eye care, carefully monitoring thermoregulation, maintaining adequate hydration, promoting elimination, and supporting parent-infant interaction.

Neonatal management and outcome in alloimmune hemolytic disease

“…Phototherapy causes photo isomerization of bilirubin in the skin to watersoluble isomers that can be excreted by the kidneys and stool without further metabolism by the liver. The efficacy of phototherapy depends on several factors, including the wavelength of the light used, the intensity of the light source, the total light dose (time under phototherapy and amount of skin exposed), and/or the threshold at which phototherapy is commenced [12][13][14][15]. The light used in phototherapy needs to penetrate the skin and be absorbed by bilirubin, which happens with blue or green light with an optimal wavelength range of 460-490 nm [12].…”

Changes on Total Serum Bilirubin and Infant’s Position during Phototherapy

“…4 Phototherapy is a physically apparent therapy using light as a treatment for hiperbilirubinemia. 5 This treatment goal is to limit the increase bilirubin and to prevent it to become serious permanent neurological complications (Kern icterus). 6 The effect of phototherapy is associated with higher levels of bilirubin in the skin and light intensity.…”

“…The light intensity itself is influenced by the distance between light and skin, body surface area, the type and wavelength of light. 5,6 Changing position may improve the effectiveness in reducing TSB and shorten duration of this therapy. The evidence supporting this practice of changing position is still limited.…”

A Study to Assess the Jaundice and Physiological Outcome in Neonates Receiving Phototherapy with White Sling Application around the Cradle in Selected Neonatal Intensive Care Units of Mangalore

“…Therefore, the infant receiving phototherapy should have as much as possible, skin exposed to the lights. [7] The neonate is totally dependent and the early period of bonding between the mother and neonate is important. The neonatal jaundice and phototherapy might keep them separate, leading in increased cost and anxiety among parents.…”