PHOTOTHERAP

Y
 HYPERBILIRUBINEMIA

• Excessive level of accumulated bilirubin in the blood

and is characterized by yellowish discoloration of the
skin, sclera and the nails.
• Over two-third of newborn babies develop clinical
jaundice
 PHOTOTHERAPY

 Consists of application of fluorescent light to the

infant’s skin

 Most commonly used treatment for unconjugated

hyperbilirubinemia
MECHANISM OF ACTION OR
PRINICPLES OF PHTOTHERAPY
1. Geometric photoisomerization of unconjugated bilirubin resulting in a
more soluble form of Bilirubin
 Accounts for 80% of conversion)

2.Converting bilirubin to lumirubin through structural isomerization which

can be excreted into bile without need for further hepatic conjugation

3.Oxidation mechanism resulting in colourless by products and excreted

by liver and kidney without need for conjugation
INDICATIONS

 Used when level of bilirubin may be hazardous to the

infant

 Prophylactic phototherapy may be indicated in

circumstances like extremely low birth weight
or severely bruised infants.
Types of phototherapy lights
• Fluorescent lamps
– Colors: Cool white, blue, green, blue-green.
– Shapes: Straight, or U-shaped (CFL)
• Halogen bulbs
• High Intensity Light Emitting Diodes
(LED)
• Fibro-optic lights
TECHNIQU
E
 Bilirubin absorbs light maximally in the blue light
ranges ( 420-500 nm)

 Daylight and cool white lamps have a spectral peak

between 550-600 nm & are less effective than
special blue lamps, which have an average of 420-
480 nm
 But….

 Blue lamps interfere with observation of skin colour

in the baby and cause headache, & nausea to care
givers

 Hence… a combination of white and blue lamps is

preferred
 A unit with 4 special blue & 4 daylight lights will give
an effective irradiance of 11 µW/cm2 /nm which is
far above the required 4-6µW/cm2/nm.
 Type
s
Single light phototherapy

Double and triple light phototherapy

 Distance of the baby from the light source
affects the effectiveness

 Typically a distance of 45 cm is
used
 Nursing care
 Keep the baby naked, except for diapers , as larger the
surface exposed , more effective is the phototherapy.

 Eyes must be shielded to prevent potential adverse effects

on the retina

 closely monitor temperature for hyper/hypothermia

 Maintaining baby in a flexed position with rolled blankets

along the sides
helps to maintain heat and provide comfort

 Oily lubricants should be avoided to prevent tanning /

frying effect
 Accurate charting

 1. times that phototherapy started and stopped

 2. proper shielding of eyes
 3. type of fluorescent lamp
 4.Number of lamps
 5. Distance between surface of lamp and infant
 6. Use of phototherapy in combination with incubator
orbassinet
 7. Photometer measurement of light
intensity
 8. Occurrence of side effects
 SUMMARIZATION
 Definition of hyperbilirubinemia
 Definition of Phototherapy
 Mechanism of Action
 Indications of Phototherapy
 Types of Phototherapy Lights
 Techniques of Phototherapy
 Nursing care during Phototherapy
 Complications of Phototherapy
 RECAPTUALIZATION
1. Excessive level of Bilirubin in the blood termed as_____
2. The Principles of Phototherapy are________.
3. The types of Phototherapy are__________.
4. Distance of baby from the light source should be
(a) 60 cm
(b) 50 cm
(c) 65 cm
(d) 45 cm
5. Bronze baby syndrome is the main complication of
phototherapy. (TRUE/ FALSE)
 ANSWERS
1. Hyperbilirubinemia
2. Structural Isomerization ,Geometric photo-
isomerization & oxidation mechanism.
3. Single, double & triple light therapy.
4. 45 cm
5. True