Demonstration

on
Care of neonate under
phototherapy


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1 1 min Introduction I am Diksha, MSc

Nursing 1st year
student. I am going to
demonstrate the “care
of child under
phototherapy.”

2 2 min To define INTRODUCTION Lecture What is

phototherapy. Phototherapy is a non- phototherapy?
invasive method for
treating jaundice. It is
one of the most
effective and safe
methods for treating
neonatal jaundice using
light therapy.

3 To discuss the MECHANISM OF Lecture What are the

mechanism of PHOTOTHERAPY different
phototherapy Phototherapy acts by Mechanisms of
converting insoluble phototherapy?
bilirubin into soluble
isomers that can be
excreted through urine
and faeces. It occurs by
three mechanisms:
Configurational
Isomerisation :
Here, the Z isomers of
bilirubin are converted
into E isomers.This
reaction is instant but is
reversible as bile
reaches into the bile
duct.
Structural
Isomerisation :
This is an irreversible
reaction where bilirubin
is converted into
lumirubin.
Lumirubin is excreted

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4 through bile and urine .

Photo - oxidation :
This is a minor reaction
where colourless photo
products are excreted in
urine. This is very slow.

5 To enlist the PARTS OF Lecture Identify

parts of PHOTOTHERAPY different parts
phototherapy UNIT : of
unit It consists of: Phototherapy
Overhead unit unit.
Power switch
Boost button
Boost indicators
Display
Curtain Hangers
Angle adjustments
Height adjustments
Height/ swivel lock
Lockable castors

6 To discuss the Types of Phototherapy Lecture What are the

types of Devices : different types
phototherapy of phototherapy
device 1st generation devices ?
phototherapy device

The most commonly

used lamps in this
machine are fluorescent
lamps. Although these
lamps are
inexpensive and
affordable, the light
emission and the
intensity will drop over
time. Today, in
phototherapy devices,
LED lamps are preferred
over other types of lamps
because:

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2) They produce less

heat, but the light
intensity is higher, so
the lamps are put in
less distant with the
neonates, so their effect
on the jaundice is
greater.
3) These lamps are
small, have lighter
weight, non-fragile and
have low power
consumption.
4) The light stability of
these lamps is high for a
long time application
and does not decrease in
intensity.

2nd generation
phototherapy Device :

In this type of device,

the light source is a
quartz halogen lamp
that emits the light and
reaches the
pads via the optical
fibres.
1) Treatment and baby
care without separation
from the mother.
2) No retina damage
and complications such
as inflammation,
corneal or the eye
irritation, etc. due to
direct transmission of
light to the baby's body.

3rd generation
phototherapy Device :

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In this type of
phototherapy, both the
first-generation and the
second-generation
devices are used
simultaneously under
the conditions
described above. This
phototherapy is a dual
device which
includes the first
generation and the fibre-
optic device. This
generation of
phototherapy devices is
more commonly used in
cases of very high
neonatal jaundice

7 Discuss the FCATORS

factors AFFECTING
influencing EFFICIENCY OF
efficiency of PHOTOTHERAPY :
phototherapy
1. Spectral qualities
( wavelength and peak)
Bilirubin absorbs light
maximally at 425 -
475nm. The narrow
spectral blue light is
more effective but it
interferes with proper
observation the
infant.White day
fluorescent lamps are
commonly used in our
country.

Intensity of the Light

(irradiance)
Intensity depends on the
distance between the

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8 baby and the light.

Intensity of light is
inversely proportional
to the distance square.
Minimum distance
should be at least 15 cm
from the basinet.

Exposed body surface

area
The greater the body
surface exposed greater
will be the fall of
bilirubin.

Skin thickness and

pigmentation
Pigmented skin has
been reported to
increase the effect of
phototherapy.

Ethology of Jaundice
Phototherapy is less
effective if jaundice is
due to hemolysis.

Duration of
Phototherapy
More the duration of
phototherapy, more
rapidly the TSBL will
decrease.

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9 To discuss the INDICATIONS OF Lecture What are the

indications of PHOTOTHERAPY: guidelines to
Phototherapy initiate
Acc. To AAP phototherapy?
guidelines,
phototherapy should be
started when TSBL
reaches 20mg/dl in a
healthy term neonate ie.
above 38 weeks.
In neonates born
between 35 to 37
weeks,And term sick
neonates phototherapy
should be started when
TSBL reaches 18 mg/dl.
In neonates born before
35 weeks, phototherapy
should be started when
TSBL reaches 15 mg/dl
.
10 To discuss the CARE UNDER Lecture What
care of baby PHOTOTHERAPY precautions
undergoing should be taken
phototherapy Undress the baby while caring for
completely except eyes baby under
and gonads. phototherapy?
Shield the eyes to
prevent retinal damage.
Cover the gonads with
diaper.
Infants’s position should
be changed so that
maximum area of the
skin is exposed to light.
Monitor the temperature
of the infant 2-3 hourly
to prevent hyperthermia.
Record the weight of
the infant daily.
Continue breast feeding.

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Switch off the

phototherapy unit while
breastfeeding.
Maintain adequate
hydration and nutrition
status in infant.
Measure TSB level
every 12 to 24 hours.
Discontinue
phototherapy when
TSBL returns to safe
level.
In term baby safe level
is considered at 13 - 14
mg/dl.
Check rebound rise in
TSBL till next 24
hours. Rebound rise
occurs by 1-2 mg/dl
within 6 to 12 hours.

11 To discuss the COMPLICATIONS Lecture What are the

complications of OF complications
phototherapy. PHOTOTHERAPY : of
phototherapy?
Although phototherapy
is safe but some
commonly reported side
effects are:

Passing Loose green

stools
It is because of transient
lactose intolerance and
irritating effects of
photocatabolites causing
Increased colonic
secretory loses.

Hyperthermia,
irritability and
Dehydration

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Hyperthermia,
irritability and
Dehydration can occur
due to increased
insensible water loss.
Extra fluid (20-40)ml/
kg/24 hours should be
given to prevent
dehydration.

Bleached Skin
During exposure to light
infant’s skin gets
bleached.

Bronze baby syndrome

In infants with
parenchymal liver
disease with biliary
obstruction may
develop bronze colour
of skin due to excessive
Accumulation of one of
the photo-isomers
(lumirubin) which is
retained and
polymerised to
bilifuscin imparting
brownish discolouration
of skin.

Other complications
include:
Temperature instability
Erythmatous rashes
Separation of mother
from the baby.

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12 SUMMARY:

We discussed about
phototherapy, its
mechanism, indications,
care of infant under
phototherapy and
complications of
phototherapy.

 Bibliography

• K. Paul Vinod., Bagga Arvind. Ghai Essential Pediatrics. 9th edition. New Delhi; CBS Publ.;
2019. Page no. 171-172.

• Singh Meharban . Care of The Newborn. 8th edition. New Delhi: CBS Publ.; 2016. Page no.
338-342.