A Comprehensive Guide to Phototherapy for Neonatal Jaundice
More than 80% of newborn infants will experience some degree of jaundice. While often a temporary condition, severe hyperbilirubinemia (high bilirubin levels) requires intervention. Phototherapy stands as an essential treatment, especially for neonates at high risk, to prevent serious complications like acute bilirubin encephalopathy and kernicterus.
The Fundamentals of Effective Phototherapy
The primary goal of phototherapy is to expose as much of the infant’s skin surface area as uniformly as possible to a specific light spectrum. This helps convert bilirubin into a form that can be more easily excreted by the baby’s body.
Key considerations for intensive phototherapy include:
Irradiance: A minimum of 30 µW/cm²/nm is recommended for intensive phototherapy.
Distance: The light source should be positioned carefully, not exceeding 30 – 50 cm from the baby.²
Essential Care for Babies During Phototherapy
Caring for an infant undergoing phototherapy involves diligent monitoring and specific protective measures:
Monitor for Danger Signs: Be vigilant for changes such as pale stools, dark urine, or signs of sepsis.
Monitor Vital Signs: Keep a close watch on the baby’s temperature and hydration status, as phototherapy can sometimes lead to increased fluid loss.
Eye Protection: Always cover the baby’s eyes to prevent potential retinal damage from the intense light.
Monitor TSB Levels: Regularly check Total Serum Bilirubin (TSB) levels. Investigate cases of prolonged jaundice, which is defined as:
14 days in term babies
21 days in preterm babies
Filament vs. LED Light Sources: What's the Difference?
The type of light source used in phototherapy can impact its effectiveness and potential side effects. A randomized controlled trial has shed light on the comparison between traditional filament lights and modern LED (Light Emitting Diode) lights.³
Efficacy: LED phototherapy has been shown to produce a faster rate of decrease in total serum bilirubin levels. Furthermore, infants treated with LED lights demonstrated higher excretion of urine lumirubin (a byproduct of bilirubin breakdown) compared to those treated with filament phototherapy.³
Side Effects: Patients in the filament phototherapy group experienced a higher incidence of skin rashes.³
