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‫‪Phototherapy‬‬
‫)‪S.A.Afjeh (MD‬‬
‫‪SBUMS‬‬
‫‪MMC‬‬
‫‪1396‬‬
I) Introduction
• Almost all newborns develop HB (TB > 1 mg/dl)
• Severe HB (TB > 25 mg/dl)
• Hazardous HB (TB > 30 mg/dl)
• Complications :
a) BIND
b) ABE
c) Kernicterus
II) Approach to HB
1) Observed Evidences
2) Consensus Opinions (AAP, NICE, …)
3) Clinical Access to Intervention
4) Predictive modeling
5) Prevention; HRI, Pre-discharge Tc.Bil. Screening, Early
Phototherapy (Age & GA)
6) No Prophylactic Phototherapy
III) Risk Factors
1) IHDN
2) G6PD
3) HIE
4) Temperature Instability
5) Acidosis
6) Sepsis (EOS), Lethargy
7) Serum Albumin < 3 gr/dl (Bil/Alb > 7)
8) Calculator (TB, Age;hrs, GA, Risk Factors)
IV) Phototherapy
1) 60 years experience for reducing TB (all HB)
2) Decreases need for Exchange Transfusion
3) Apparently safe !
4) Overuse ?
5) Long term adverse effect ?
6) Neuro Developmental Outcome ?
V) Mechanisms of Action

1) Structural Isomerization : Bil → Lumirubin (Irreversible)

2) Photo Isomerization : 4Z, 15Z Bil → 4Z, 15E Bil (Reversible)

3) Photo Oxidation : Polar molecules, Colorless products

VI) Phototherapy Effects
1) Irradiance : 15-25 micW/cm² (425-475nm)
• Conventional Photo. : 6-12 micW/cm²
• Intensive Photo. (LED) : > 30 micW/cm²
2) Surface Area, Distance (10-30cm), White Curtain, Aluminum Foil
3) Higher Initial TB (Reduced up to 10mg/dl during few hours)
4) Conventional vs. Intermittent Phototherapy (ELBW)
5) Aggressive vs. Conservative Phototherapy
6) Transport Phototherapy
VII) Lights
1) Bilirubin Absorption : Blue to Green Light (460-490nm)
2) Fluorescent Special Blue Light (F20T12/BB & TL52)
3) Halogen White Light : Thermal Injury
4) Fiber Optic Blankets : Adjunctive
5) Blue LEDs : ELBW
6) Sunlight (425-475nm), Heliotherapy : Filtered, UV Light
7) Green Light ?
VI) Total Bilirubin For Phototherapy

Newborns 24hrs 48hrs 72hrs

FT, No R.F > 12 mg/dl > 15 mg/dl > 18 mg/dl

FT ē R.F
> 10 mg/dl > 13 mg/dl > 15 mg/dl
LPT, No R.F

LPT ē R.F > 8 mg/dl > 11 mg/dl > 13.5 mg/dl

Preterm <28W /
>5-12 mg/dl
<35W
VII) Monitoring
1) TB Measurement (2-12hrs)
2) Oral Feeding (Breast Feeding, EBM, Formula)
3) IVT ? (Dehydration ? Hypovolemia ? Hypernatremia ?)
4) Discontinuation of Phototherapy
5) Rebound HB
• GA < 38w
• Initial TB
• Breast Feeding
• DAT Positive
• Early Phototherapy (age < 72hrs)
VIII) Home Phototherapy
1) Full term, Well Baby, Well Fed, Non Hemolytic, No Risk Factor, Lower T.B,
Close Follow Up
2) Advantages
• Satisfaction, Separation
• Cost
• Optimal Phototherapy Range
• Bilirubin Monitoring
3) Disadvantages
• Eye Patch, Corneal Abrasion
• Weight Loss, Thermoregulation
• Ineffective Use, Overuse
‫‪Thanks God‬‬

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