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Phototherapy for Jaundice Technique

  • Author: Taylor L Sawyer, DO, MEd, FAAP, FACOP; Chief Editor: Ted Rosenkrantz, MD  more...
 
Updated: Dec 06, 2015
 

Approach Considerations

See the list below:

  • Determine if the infant requires phototherapy based on the infant total serum bilirubin level, the gestation age, hours of life, and individual risk factors using established guidelines form the American Academy of Pediatrics.[6]
  • Place infant on warmer or in 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 and LED lights, this is as close as possible to the infant’s skin, typically less than 10 cm.[6] If using a halogen spot light, the light should be kept at the manufacturer recommended distance to avoid overheating.
  • Turn on the phototherapy lights.
  • Direct light towards the infant with exposure of maximal surface area. If halogen spotlights are used, more than one light may be required to cover the entire infant with light. This is typically done with one light directed at the chest and head, with the second directed at the abdomen and legs.
  • Measure the spectral irradiance of the phototherapy setup with a commercially available radiometer in several areas over the surface of the infant and average the results.[6] See the image below.
    neoBLUE light-emitting diode (LED) phototherapy raneoBLUE light-emitting diode (LED) phototherapy radiometer.
  • Follow serial bilirubin levels to ensure the phototherapy is effectively decreasing the bilirubin level.
  • Intermittently repeat measurements of the spectral irradiance and maintain the lights in the proper position to provide maximum benefit.
 
Contributor Information and Disclosures
Author

Taylor L Sawyer, DO, MEd, FAAP, FACOP Assistant Professor of Pediatrics, University of Washington School of Medicine; Associate Director, Neonatal-Perinatal Fellowship, Seattle Children's Hospital

Taylor L Sawyer, DO, MEd, FAAP, FACOP is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Medical Association, American Osteopathic Association, Association of American Medical Colleges, Society for Simulation in Healthcare, International Pediatric Simulation Society

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel P Chiles, DO Chief Resident, Department of Pediatrics, Tripler Army Medical Center

Daniel P Chiles, DO is a member of the following medical societies: American Academy of Pediatrics, American Osteopathic Association

Disclosure: Nothing to disclose.

Luke J Lindley, MD Resident Physician, Department of Pediatrics, Tripler Army Medical Center

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

Disclaimer

The views expressed in this manuscript are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

References
  1. Maisels MJ, McDonagh AD. Phototherapy for Neonatal Jaundice. N Engl J Med. 2008. 358:920-928.

  2. Maisel MJ. Neonatal Jaundice. Pediatrics in Review. 2006. 27(12):443-453.

  3. Cremer RJ, Parryman PW, Richards DH. Influence of light on the hyperbilirubinemia of infants. Lancet. 1958. 1:1094-1097.

  4. Slusher TM, Olusanya BO, Vreman HJ, Brearley AM, Vaucher YE, Lund TC, et al. A Randomized Trial of Phototherapy with Filtered Sunlight in African Neonates. N Engl J Med. 2015 Sep 17. 373 (12):1115-24. [Medline].

  5. Slusher TM, Vreman HJ, Olusanya BO, Wong RJ, Brearley AM, Vaucher YE, et al. Safety and efficacy of filtered sunlight in treatment of jaundice in African neonates. Pediatrics. 2014 Jun. 133 (6):e1568-74. [Medline].

  6. [Guideline] American Academy of Pediatrics. Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2004. 114 (1):297-316.

  7. Francisco Sweeney NM. Neonatology. Custer JW and Rau Rachele. The Harriet Lane Handbook. 8th Ed. Philadelphia: Elsevier Mosby, Inc.; 2009. 497.

  8. Gomella TL. Hyperbilirubinemia. Neonatology. 4th Ed. Connecticut: Appleton & Lange, Stamford; 1999. 235.

  9. Muchowski KE. Evaluation and treatment of neonatal hyperbilirubinemia. Am Fam Physician. 2014 Jun 1. 89 (11):873-8. [Medline]. [Full Text].

  10. Tan KL. The pattern of bilirubin response to phototherapy for neonatal hyperbilirubinemia. Pediatric Research. 1982. 16:670-674.

  11. Messner KH, Maisel MJ, Leure-DuPree AE. Phototoxicity to the newborn primate retina. Invest Ophthalmol Vis Sci. 1978. 17:178-182.

  12. Zhang AY, Elston DM. Drug-Induced Photosensitivity. Medscape Reference. Available at http://emedicine.medscape.com/article/1049648-overview. Accessed: April 25, 2011.

  13. Maayan-Metzger A, Yosipovitch G. Hadad E, Sirota L. Transepidermal Water Loss and Skin Hydration in Preterm Infants During Phototherapy. Am J Perinatology. 2001. 18(7):393-396.

  14. Furchgott RF. Endothelium-dependent relaxation, endothelium-derived relaxingfactor and photorelaxation of blood vessels. Semin Perinatol. 1991. 15:11-15.

  15. Grunhagen DJ, De Boer MG, De Beaufort AJ, Walther FJ. Transepidermal Water Loss During Halogen Spotlight Phototherapy in Preterm Infants. Pediatric Research. 2002. 5(3):402-405.

  16. Maisel MJ. Why use homeopathic doses of phototherapy. Pediatrics. Pediatrics. 1996. 98:283-287.

  17. Seidman DS, Moise J, Ergaz Z, Laor A, Vreman HJ, Stevenson DK, et al. A new blue light-emitting phototherapy device: A prospective randomized controlled study. J Pediatr. 2000. 136:771-774.

  18. Olusanya BO, Ogunlesi TA, Kumar P, Boo NY, Iskander IF, de Almeida MF, et al. Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings. BMC Pediatr. 2015 Apr 12. 15:39. [Medline]. [Full Text].

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Infant under Ohmeda halogen lamp with eye protection.
Infant under neoBLUE phototherapy light and lying on fiberoptic phototherapy blanket.
neoBLUE light-emitting diode (LED) phototherapy radiometer.
neoBLUEcozy light-emitting diode (LED) phototherapy bed.
neoBLUE light-emitting diode (LED) phototherapy lamp.
neoBLUE light-emitting diode (LED) phototherapy system.
Causes of hyperbilirubinemia in newborn infants. Adapted from Maisel MJ. Neonatal Jaundice. Pediatrics in Review. 2006; 27: p. 445.
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. Adapted from Maisel MJ, McDonagh AD. Phototherapy for Neonatal Jaundice. N Engl J Med. 2008;358:920-928.
Factors that affect phototherapy: The 3 factors that affect the dose of phototherapy include the irradiance of light used, the distance from the light source, and the amount of skin exposed. Standard phototherapy is provided at an irradiance of 8-10 microwatts per square centimeter per nanometer (mW/cm2 per nm). Intensive phototherapy is provided at an irradiance of 30 mW/cm2 per nm or more (430–490 nm). For intensive phototherapy, an auxiliary light source should be placed under the infant. The auxiliary light source could include a fiber-optic pad, a light-emitting diode (LED) mattress, or a bank of special blue fluorescent tubes. Term and near-term infants should receive phototherapy in a bassinet and the light source should be brought as close as possible to the infant, typically within 10-15 cm. However, if halogen or tungsten lights are used, providers should follow the manufacturer recommendation on the distance of the light from the infant to avoid overheating. Preterm infant can be treated in an incubator, but the light rays from the phototherapy device should be perpendicular to the surface of the incubator to minimize light reflectance. Adapted from Maisel MJ, McDonagh AD. Phototherapy for Neonatal Jaundice. N Engl J Med. 2008;358:920-928.
 
 
 
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