Importance of Phototherapy in Managing Newborn Jaundice
Phototherapy uses blue light wavelengths to treat unconjugated hyperbilirubinemia and is necessary to prevent morbidity and mortality from dangerous levels of neonatal jaundice. Bilirubin absorbs the blue light and is then broken down in the blood, allowing the infant to excrete the excess bilirubin before it can accumulate and cause permanent irreversible health issues.
Key Considerations for Selecting a Phototherapy Device
A baby’s response to the appropriate dose of phototherapy for newborn jaundice depends on a few factors that will be at the judgment of the healthcare provider: Duration of phototherapy; Degree of irradiance given which is dependent on wavelength and type of light used; the amount of body surface area irradiated; and the distance of light from patient (typically 10-30cm).
Phototherapy devices vary in a couple ways: the light sources; irradiance, single or double sided and compatibility with other devices such as incubators.
There are many types of phototherapy lights and modalities including LED, spotlights, fluorescent blue lights, halogen lights, and phototherapy blankets. LED lights have been shown to be the safest and most efficacious for administering phototherapy, as they give off the least heat and are associated with the lowest risk of hyperthermia and dehydration, but may be more expensive. (3)
Phototherapy is often categorized as “conventional phototherapy (CPT)” or “intensive phototherapy” (IPT), which really refers to the irradiance that is emitted. (2)
- Conventional phototherapy (CPT) should have an irradiance of at least 8-10 μW/cm2/nm
- Intensive phototherapy should have irradiance of is at least 30µW/cm2 per nm (2)
A hand-held meter can be used to measure the spectral irradiance emitted by the light and the appropriate radiometer will vary based on the phototherapy system used, so manufacturer recommendations should be followed.
Single or Double Sided
Some phototherapy devices are lamps that can be positioned above a baby who is in a cot, crib, or incubator. Other devices are “double sided” or fully dedicated phototherapy units providing the light from above and below.
Regardless of the light source and irradiance, the effectiveness of phototherapy devices can be affected by disruptions in power supply, inadequate skin exposure (surface area of baby’s skin) either by too much covering or from overcrowding with multiple infants placed under a single device, sub-optimal irradiance levels, or properly maintaining the device per manufacturer’s instructions.
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References and Acknowledgments
(1) National Institute for Health and Clinical Excellence (NICE). Neonatal jaundice. (Clinical guideline 98.), 2010. www.nice.org.uk/CG98.
(2) Olusanya, Bolajoko O et al. “Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings.” BMC pediatrics vol. 15 39. 12 Apr. 2015, doi:10.1186/s12887-015-0358-z