PHOTOTHERAP

Y
Author: Taylor L. Sawyer
December 7, 2015 Updated Version
Medscape
ANN E. LOYGOS
GROUP 7-6
DEC. 18, 2017
 Good
Afternoon!
OUTLINE:
 Background
 Indications
 Contraindications
 Technical Considerations
 Outcomes
 Equipment
 Patient Preparation
 Monitoring & Follow-up
 Approach Considerations
BACKGROUND
 Cremer et al (1958) – first described the effect of
light on jaundice in neonates to decrease bilirubin
levels, now called PHOTOTHERAPY

 PHOTOTHERAPY refers to the use of light to convert

bilirubin molecules in the body into water soluble
isomers that can be excreted by the body.
INDICATIONS
 Total serum bilirubin concentration before
phototherapy is initiated which depends on several
factors: TOTAL SERUM BILIRUBIN,
GESTATIONAL AGE, AGE OF THE INFANT IN
HOURS AT THE TIME OF TESTING, INDIVIDUAL
RISK FACTORS FOR HYPERBILIRUBINEMIA
(Hemolysis, G6PD, Asphyxia, Temperature
Instability, Sepsis, Acidosis, Hypoalbuminemia)
 AAP GUIDELINES ON THE
MANAGEMENT OF
HYPERBILIRUBINEMIA IN NEWBORNS
35 OR MORE WEEKS GESTATION

Algorithm for the management of jaundice

Initiation of Phototherapy based on TSB levels
Gestational Age
Infant Age in Hours
Individual Risk Factors
NO EVIDENCE-BASED
GUIDELINES AVAILABLE
ON THE INDICATION FOR
PHOTOTHERAPY IN PT
INFANTS <35 WEEKS
GESTATION
*Rule of thumb in NICU:
Start Phototherapy when TSB is more than 5 times the
birth weight
CONTRAINDICATIONS:

oPhotosensitizing Medications Use

oCongenital Erythropoietic Porphyria/Family
History of Porphyria
oInfants with Cholestatic Jaundice
TECHNICAL
CONSIDERATIONS
PHOTOTHERAPY DOSE
 Wavelength of Light
 Irradiance delivered
to Infant’s Skin
 Total Spectral Power
(amount of skin exposed)
COMPLICATION
PREVENTION
 Eye Protection

Eye Shield
Lubricating Eye Drops
 Temperature
 Medications (NSAID, Diuretics, Antibiotics)
OUTCOMES
 Complications are rare and mild
 2 most common are increased insensible water loss &
cutaneous reactions
 Photorelaxation or the increase in skin blood flow
 10mL/kg/d is recommended because of the water loss
(Preterm Infants)
 Bronzed-Baby Syndrome or greyish-brown discoloration
 Bolus and Purpuric Reactions (accumulation of porphyrins)
PATIENT EDUCATION &
CONSENT
“All hospitals should provide verbal or
written information to parents explaining
jaundice, the need to monitor infants for
jaundice, and details on how that mo itoring
should be done.”
EQUIPMENT
1. HALOGEN-BASED
PHOTOTHERAPY LAMPS
 A.k.a. Spotlights
 Tungsten-halogen light bulb
 White/yellow light
 Free-standing or part of a radiant warmer
 Most heat-producing
2. FLUORESCENT TUBES

 Classified as “Daylight”, “Blue”, and “Special Blue”

 the special blue tubes are most effective because
they emiy light in blue-green spectrum, w/c
penetrates skin well & maximally absorbed by
bilirubin
3. FIBEROPTIC
PHOTOTHERAPY
 Delivers light from a high intensity lamp to a fiberoptic
blanket
 Typically used in conjunction with overhead halogen,
fluorescent, or LED systems
 Also used to provide home phototherapy
4. LED PHOTOTHERAPY
SYSTEMS
 Uses gallium nitride (emit high intensity light in blue-
green portion of the spectrum w/in the narrow
wavelength of 460-485nm)
 Newest
 Narrow wavelength equates to maximal bilirubin
absorption
 Can be customized
 Generates less heat thus, can be positioned very close to
the skin without oberheating or burns
 Patient
Preparation
POSITIONING

 Lying flat on a radiant warmer or bassinet or incubator

 Naked with exception of eye protection and diaper to
maximize the surface area exposed
 Phototherapy device at the side of infant’s bed covering
as much surface area as possible
Monitoring and
Follow-up
• Serial Bilirubin values - to confirm that the
therapy is effective
• Most significant drop is typically seen within
the first 4-6 hours
• Check levels after 4-6 hours, then repeat 12
to 24 hour intervals until levels are low
enough (<13 to 14mg/dL)
• Infants with Hemolytic Disease, or those younger than
3 to 4 days: REBOUND Bilirubin should be checked
w/in 24hours after discontinuation of phototherapy

• Premature Infants: no evidence-based guidelines;

phototherapy is stopped when the TSB level is several
points lower than when it was started.
 Approach
Considerations
• Determine if the infant requires phototherapy based
on TSB level, gestational age, hours of life, and
individual risk factors
• Place infant on warmer or bassinet with diaper on
and eye protection in place.
• Position phototherapy device at bedside with lights
set at recommended distance from the infant. For
FLUORESCENT & LED lights, this is as close as
possible to the infant’s skin typically less than
10cm. If using HALOGEN spotlight, the light should
be kept at the manufacturer recommended distance
to avoid overheating.
• Turn on phototherapy lights.
• Direct light towards the infant with exposure of
maximal surface area.
• Measure the spectral irradiance ot the
phototherapy setup with a commercially available
radiometer in several areas over the surface of the
infant and average results.
• Follow serial bilirubin levels to ensure the
phototherapy is effectively decreasing the bilirubin
levels
• Intermittently repeat measurementsof spectral
irradiance & maintain the lights in the proper
positionto provide maximum benefit.
THANK YOU!