Phototherap

y.
Introduction
Phototherapy is thought to affect
brain chemicals linked to mood and
sleep, thereby alleviating symptoms of
gestational affective disorder. Using a
phototherapy lamp can also help with
other types of depression, sleep
disorders, and other illnesses.
Phototherapy is also known as
“luminotherapy” or “light therapy.”

What is it?
Phototherapy , a technique consisting of
the incidence of light on the patient, is
the most used procedure for the
treatment of jaundice in newborns .
• Hyperbilirubinemia occurs when there is
excessive formation of bilirubin, due to the
inability of the newborn's liver to remove the
substance from the blood quickly enough.
) MAYDR UNVEWSITY
• Phototherapy uses light energy to structurally
modify bilirubin, converting it into molecules
that are easier to excrete. The absorption of
light by the dermis and subdermis leads to
photochemical reactions at different levels of
its pigments.
 Types of phototherapy
• Simple continuous: remains on 24 hours a day.
• Simple intermittent: consists of keeping the neonate
for 4 hours with the phototherapy on, and 4 hours off.
• Double or triple intensive: consists of introducing two
or three phototherapies respectively.
Normativity
• Mexican official standard NOM-025-SSA3-2013 (for the
organization of intensive care units), dictates that every
neonatal intensive care unit must have a “radiant heat crib
with phototherapy for neonatal intensive care”,
• The spectrum of the irradiated light must be between 430 and
490 nm.
• White, halogen and blue light are recommended.
• Special blue light with fluorescent tubes is the most effective.
• It is recommended to start phototherapy immediately, with the
type of light available.
• Healthy term and preterm neonates should be treated with
phototherapy for the prevention of severe hyperbilirubin.
• The effectiveness is better the greater the exposed body
surface area.
• The maximum level of response is observed in the first 2 to 6
hours of onset.
• Investigate active hemolysis as a possible etiology.
• The newborn's eyes should be covered for the entire duration
of the treatment.
• Phototherapy should be discontinued when total serum
bilirubin levels of 13 to 14 mg/dL are reached.
• Term and near-term neonates should be treated in a crib,
rather than an incubator, to allow the light source to be 10-15
cm from the neonate.
• If the newborn is in an incubator, the light rays should be
perpendicular to the surface of the incubator, in order to
minimize loss of effectiveness due to reflection.
• Axillary temperature control every 3 hours.
• Interrupt phototherapy for as little time as possible during feeding or
other procedures.
• Turn off phototherapy during serum bilirubin extraction and eye
cleansing.
• Provide psychological support to parents and relatives regarding the
treatment of the newborn.
• The newborns at highest risk of post-phototherapy rebound that require
treatment are: premature newborns; NB with ongoing hemolysis;
positive direct Coombs test, NB, treated before 72 hours of age.
• Only if it is proven that breast milk is the cause of jaundice is it removed
for 24-48 hours.
Nursing care
Before starting therapy:
- The correct functioning of the chosen phototherapy equipment
must be checked.
- The manufacturer's recommendations must be followed
depending on the equipment to be used.
- It is recommended to reduce the air temperature of the
incubator by 2ºC, 15 minutes beforehand.
- If there is humidity control in the incubator, the
aforementioned humidity will be adjusted between 80
85%.
- The beginning and end of phototherapy should be recorded in
the nursing chart.
Preparation of the child:
- Greater surface area of the child's skin exposed to light.
- Eyes will be covered with protective glasses to avoid retinal
injuries.
- Do not place any object between the child and the light
emitting source.

Vital signs control:

-It is necessary to monitor and control the temperature of the
neonate.
 -Control of the child's RR, HR, activity and coloring, as
frequently as required and especially in the case of associated
pathologies.
-Daily weight control, if there is no medical contradiction, and
water balance to adjust liquid contributions, since insensible
losses increase, especially in hot phototherapy due to the effect
of heat. Incubators with servo-controlled humidification will
help reduce losses.

Feeding:
-Assess the level of hydration.
-If enteral feeding was started and is well tolerated, we will
promote breastfeeding, since being a laxative, it facilitates the
excretion of products derived from bilirubin.

Elimination:
-Control and record diuresis by diaper weight, as well as the
number of bowel movements and their characteristics.
-Control vomiting and regurgitation, if any.