P.

Phototherapy Units: It increases the excretion of bilirubin and reduces the risk of bilirubin
toxicity by emiting photons to convert unconjugated bilirubin to polar photoproducts which
can be excreted in bile and urine without conjugation. Structural (Z and E lumirubins) and
configurational (4Z, 15E and 4E, 15Z bilirubins) photoisomerization has greater impact on
efficacy of phototherapy than the slower bilirubin photooxidation.
1. Photobiology: The most effective wavelength of light for photoconversion of bilirubin is
460 nm. Light emission to skin should be between 460-490 nm. The dose of photons depends
on “spectral power”. It is the product of irradiance (atleast 30 W/cm2/nm in late preterm and
term babies) and body surface area being irradiated. Maximal skin exposure except orbits and
diaper area is desired. Main therapeutic effects occur in capillary circulation and turning the
baby has no added benefit. Intermittent/cycled phototherapy with on/off schedules of various
intervals seem to be effective with advantages of reduced photon exposure.
2. Light sources: Mobile units with easy portability, adjustable height and tiltable axis are
desirable.
a. Fluoroscent Lamps: They deliver light in 400-520 nm (blue to blue-green)
wavelengths. Because of scarcity and higher costs of special blue lamps, arrays of
regular white and daylight fluorescent tubes may be used as reasonable alternatives.
The tubes lose about 35-40% of blue light irradiance after 1200 hours of use and may
require replacement. They can achieve irradiances of 20-40 W/cm2/nm under
optimum circumstances [close range, perpendicular direction, reflecting sheets and
curtains]. Baby’s temperature should be strictly monitored to avoid overheating.
b. Halogen Spotlights: They consist of a 150 W, 21 V halogen bulb with specially
coated reflector to absorb infrared wavelength. Risk of overheating and the need to
maintain the position of the baby within the circular footprint of light to attain optimal
spectral power have limited the use of this device.
c. Fiberoptic pads: They use flexible, plastic, fiberoptic light guides to transmit light
in 400-550 nm range from a halogen lamp or high intensity, high powered blue light
emitting diodes to a pad or blanket which is wrapped around or placed under, in direct
contact with baby’s skin. It can be used as the sole source of phototherapy, to augment
the effect of overhead lamps, and to continue phototherapy during exchange
transfusion.
d. Light Emiting Diodes (LED): Blue LED devices emit light in narrow spectrum
(450-470 nm), that overlaps with the peak absorption wavelength of bilirubin. They
 are durable (>20000 hrs), power efficient, portable, produce little heat or noise and are
increasingly becoming the preferred option.
3. Side Effects: Temperature instability may be present even with newer “cool” devices.
Increased transepidermal water loss upto 25% have been reported. Transienr loose stool and
skin rashes may be seen. Phototherapy may increase cutaneous blood flow and contribute to
patent ductus arteriosus. Bronze baby syndrome, an innocuous dark discolouration of skin
may be seen in babies with conjugated hyperbilirubinemia receiving phototherapy. Eyes are
kept covered for comfort and protection against any potential retinal damage. Phototherapy is
contraindicated in congenital porphyria and babies receiving photosensitizing drugs.