Phototherapy is performed with a special type of light and not ultraviolet light. In phototherapy, shining fluorescent lights from the bili-light lamps are used on the bare skin of newborns. A specific wavelength of this light used in this therapy can break down the bilirubin into a form that the body can get rid of through urine and stool.
It looks blue, and it may emit light in the blue-green spectrum with wavelengths of 430-490 nm. This therapy is given with a lamp known as a bili-light or with a bili-blanket.
There are two main types of photo therapies given to newborns:
- Conventional phototherapy: In this phototherapy, your baby will be kept under a halogen or compact fluorescent lamp (CFL).
- Fiberoptic phototherapy: In this phototherapy, the baby is kept on a blanket that incorporates fiberoptic cables; light travels through the fiberoptic cables and shines on to your baby’s back.
In both the methods of phototherapy, your baby’s skin is exposed to the light.
In most cases, the first conventional phototherapy is usually tried. If the baby is premature, then fiberoptic phototherapy may be used. Even after conventional or fiberoptic phototherapy if your baby’s jaundice does not improve, then continuous multiple photo therapies may be given that involve using more than one light and often a fiberoptic blanket at the same time.
What is phototherapy?
Phototherapy is a special light treatment given to newborns who have jaundice. Jaundice is a yellowish discoloration of the skin and eyes in newborns due to a pigment called bilirubin. 60% of babies are born with jaundice at birth. However, a few babies have a bilirubin level at birth that is high enough to cause brain damage. The reason may be an infection at birth, low birth weight, or breast milk. Phototherapy helps your baby’s body to get rid of the accumulated excess bilirubin (yellow substance) by making it water-soluble. This process makes it easier for your baby’s liver to break down and remove the bilirubin from their blood through urine and stools.
What happens during phototherapy?
- The baby with jaundice will be kept naked under the special light.
- The eyes of the baby will be covered to protect them from damage.
- Supplemental feeding will be given to your baby because your baby’s body may lose extra water through the skin.
- In fiberoptic and conventional phototherapy, therapy is usually stopped for 30 minutes every three to four hours, and the baby is given to the mother for breastfeeding, changing their nappy, and cuddling.
- Continuous multiple phototherapies will be given continuously without a break, and the mother’s breastmilk may be given through a tube into the baby’s stomach or fluids may be given into one of their veins.
- Signs of dehydration will be checked timely, and intravenous fluids may be given to the baby if it is dehydrated or if the baby is not able to drink a sufficient amount of milk.
- Your baby’s temperature will be monitored to ensure that it is not too hot.
- Bilirubin levels will be tested every four to six hours after phototherapy to check if the treatment is working or not.
- Once your baby’s bilirubin levels have stabilized or started to fall, the doctor will check it after every 6-12 hours.
How long phototherapy is usually needed?
The baby needs phototherapy for two days at least, even longer in a few cases. While the baby is under phototherapy, the bilirubin level is tested and retested. Once your baby’s bilirubin is below a certain level, phototherapy will be stopped. Another bilirubin level will be checked 12-18 hours later to make sure it is not high again.
There are no specific guidelines for when to discontinue phototherapy.
Serum bilirubin levels should show a significant reduction before the lights are turned off. Only physical examination for jaundice is not enough, but bilirubin levels in the blood should be checked timely.
The American Academy of Pediatrics (AAP) guidelines suggested that a newborn with jaundice with a very high bilirubin level in the blood (hyperbilirubinemia) at ≥18 mg/dL should lower the bilirubin level up to 13-14 mg to discontinue phototherapy.
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Standford Medicine https://med.stanford.edu/newborns/professional-education/jaundice-and-phototherapy/faqs-about-phototherapy.html
AIIMS WHO CC https://www.newbornwhocc.org/ONTOP-DATA/Equipment-PDF/Phototherapy/Phototherapy-FAQ.pdf