Phototherapy

PHOTOTHERAP
Presented by:
Ms. Sudhalata yadav
Child Health Nursing
M.Sc (N) 2nd Year
INTRODUCTION
CONSIDERED AS “DRUG”
WITH APPROPRIATE DOSE AND

DURATION
LIGHTCOLOR OF THE LIGHT
DURATION OF EXPOSURE
EFFECTIVENESS EEXPOSED BODY SURFACE
OF
PHOTOTHERAP
Y DEPENDS ON: INTENSITY OF THE LIGHT
INTRODUCTION
Phototherapy has been used since 1958 for the
treatment of neonatal hyperbilirubinaemia. It causes
unconjugated bilirubin to be mobilised from the skin
by structural isomerisation to a water soluble form
(lumirubin) that can be excreted in the urine.
The aim of phototherapy is to decrease the level of

unconjugated bilirubin in order to prevent acute
bilirubin encephalopathy, hearing loss and kernicterus.
CONT…
Lamps emitting light between the wavelengths of 400 -
500 nanometres (peak at 460nm) are specifically used
for administering phototherapy as bilirubin absorbs
this wavelength of light. The light is visible blue light
and contains no ultraviolet light.
DEFINITION
Phototherapy (light therapy) is a way of treating
jaundice. Special lights help break down the bilirubin
in your baby's skin so that it can be removed from his
or her body. This lowers the bilirubin level in your
baby's blood.
It is defined as exposure of skin to a specialised light
sources that converts unconjugated bilirubin into water
soluble conjugated molecules that can be excreted
through normal pathway ( through urine and feces)
APP recommends phototherapy should be started if serum
bilirubin level is 15 mg/dl in full term baby
Rule of thumb
If jaundice is pathological then phototherapy should be
started only when the bilirubin level is more than 5
times of birth weight.
E.g. birth weight of new born: 4 kg
Then, 4 X 5 = 20 mg/dl
PURPOSE
To support the care of babies with hyperbilirubinemia.
To decrease infant serum bilirubin levels.
To maintain phototherapy treatment safely and
effectively.
 To minimize infant-maternal separation and facilitate
breastfeeding.
INDICATION OF PHOTOTHERAPY
WEIGHT (gms) PHOTOTHERAPY(mg/dl)
500-700 5-8
750-1000 6-10
1000- 1250 8-10
1250-1500 10-12
1500-2500 15-18
LIGHTS USED IN
PHOTOTHERAPY
Micro White Halogen lights
They deliver light via a quartz halogen bulb and have a
tendency to become quite hot so should not be positioned
closer to the infant than the manufacturers
recommendations of 52cm. The lights can continue to be
bright despite having low irradiance levels.
Fluoro- 2 Blue and 2 White Fluorescent lights
The fluorescent blue tubes must have the serial number
F20T12/BB or TL52/20W to be special phototherapy
lights. Blue light is the most effective light for reducing the
bilirubin.
CONT…
Ohmeda Biliblanket - Blue Halogen light
This uses a halogen bulb directed into a fiberoptic mat.
There is a filter that removes the ultraviolet and infrared
components and the eventual light is a blue-green colour.
Biliblankets are not to be used on infants less than 28
weeks gestation or infants with broken or reduced skin
integrity.
Blue Fluorescent light
A blue fluorescent tube is fitted into a plastic crib with a
stretched plastic cover over the top for the baby to lie on
TYPES OF PHOTOTHERAPY
UNITS
Single surface unit.
Double surface unit.
Triple surface unit.
PHOTOTHERAPY TECHNIQUES
 Perform hand wash.
 Place baby naked in cradle or incubator.
 Fix eye shades & genital area.
 Keep baby at least 45 cm from lights,if using closer monitor
temperature of baby.
 Start 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.
MECHANISM OF PHOTOTHERAPY
STRUCTURAL ISOMERIZATION
PHOTO-OXIDATION
CONFIGURATIONAL ISOMERISATIOBN
MECHANISM OF
PHOTOTHERAPY
Blue-green light in the range of 460-490 nm is most
effective for phototherapy. The absorption of light by
the normal bilirubin (4Z,15Z-bilirubin) generates
configuration isomers, structural isomers, and
photooxidation products. The 2 principal photoisomers
formed in humans are shown. Configurational
isomerization is reversible and much faster than
structural isomerization.
Structural isomerization is slow and irreversible.
Photooxidation occurs more slowly than both
configurational and structural isomerization.
Photooxidation products are excreted mainly in urine.
Nursing care of phototherapy
SKIN CARE
Keep the infant clean and dry.
Clean only with water. Do not apply oils or creams to the
exposed skin.
 Eucerin has been proven to be safe for use when the
infant is receiving phototherapy.
Infants nursed in nappies where the buttocks are not
exposed may have zinc and castor oil applied to areas of
skin excoriation.
Cont…
OBSERVATION
All infants in Newborn Care receiving phototherapy
should have a temperature, pulse and respiration rate
documented 4 hourly & prevent dehydration.
If an infant requires continuous cardiorespiratory
monitoring for other reasons, then, this should continue
whilst under phototherapy
EYE CARE
Eye pads should be removed 4 hourly and eye cares
attended with normal saline. •
There have never been human studies showing that retinal
damage occurs from with phototherapy.
Cont…
FLUID REQUIREMENTS
Accurately document fluid intake (oral or intravenous)
and output.
Urinalysis and specific gravity should be checked 8
hourly.
Assess and record stools.
Breast fed infants should continue on demand breast
feeds.
Bottle fed infants should be fed on demand 4-6th hourly.
The daily fluid rate may need to be increased by 10ml-
15ml/kg/day to prevent dehydration.
SIDE EFFECTS OF
PHOTOTHERAPY
 Increased insensible water loss.
 Loose stools.
 Intestinal absorption of water, NaCl and k+ is impaired.
 Skin rash.
 Due to phototherapy lights
 Bronze baby syndrome.
 Increase porphyrins due to cholestasis leads to increase in copper level in serum
and liver. This can resolves in 3 days.
 Hyperthermia .
 It can occur due to phototherapy lights.
 Upsets maternal baby interaction.
 May result in hypocalcemia
 Increased calcium excretion leads to decrease in total ionized calcium level of
neonates.
 Phototherapy leads to pineal secretion of melatonin causing hypocalcemia
Riboflavin deficiency
LONG TERM COMPLICATIONS
 PDA: photons acts on heart muscles leading to
vasodilation and relaxation of cardiac muscles
 Occular manifestation: ROP, Uveal melanoma
 Skin cancer
NURSING DIAGNOSIS
Fluid volume deficit r/t inadequate fluid intake,
phototherapy, and diarrhea.
Increased body temperature r/t effects of
phototherapy.
Risk for injury r/t effects of phototherapy.
Impaired skin integrity r/t hyperbilirubinemia and
diarrhea.
Impaired parenting r/t separation.
Anxiety: parents r/t therapy given to infants.
Cont.
Fluid volume deficit r/t inadequate fluid intake,
phototherapy, and diarrhea.
Assess the general condition of the baby.
Monitor the intake and output chart of the baby.
Administer IV fluid as prescribed by the Dr.
Check skin turgidity.
Encourage breatfeeding.
Cont…
 Altered body temperature r/t effects of phototherapy.
 Assess the general condition of the baby.
 Monitor the temperature.
 Keep the phototherapy on manual mode.
 Impaired skin integrity r/t hyperbilirubinemia and
diarrhea.
 Assess skin color every 2 hours
 Monitor direct and indirect bilirubin
 Change positions every 2 hours
 Massage prominent area
 Keep your skin clean and moisture
Cont..
Impaired parenting r/t separation.
Bring the baby to the mother for breastfeeding
Encourage parents to talk to their children.
Involve parents in care when possible.
Encourage parents to express feelings.

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PHOTOTHERAP

WITH APPROPRIATE DOSE AND

EFFECTIVENESS EEXPOSED BODY SURFACE

The aim of phototherapy is to decrease the level of

WEIGHT (gms) PHOTOTHERAPY(mg/dl)

1000- 1250 8-10

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