Conventional phototherapy changes the thermal environ-ment of infants, which leads to insensible water loss,hypothermia/hyperthermia, and dehydration [24,55,60].Also, infants might experience intestinal fluid losses fromloose stools during NNPT. An RCT demonstrated that fluidsupplementation in term neonates with severe hyperbilir-ubinemia could decrease the rate of exchange transfusionand the duration of NNPT. Therefore, the coretemperature of infants undergoing NNPT should be closelymonitored and appropriate fluid supplementation should begiven when necessary, especially in very low birth weightinfants [24,66,97].
Full Answer
What are the possible side effects of phototherapy for neonates?
A neonate undergoing phototherapy treatment must be monitored for which adverse effect? a. Severe decrease in platelet count b. Hyperglycemia c. Increased GI transit time d. Increased insensible water loss
What is the goal of phototherapy in premature babies?
Apr 06, 2022 · Generally, phototherapy is very safe and may have no serious long-term effects in neonates; however, the following adverse effects and complications have been noted: Insensible water loss may...
Is phototherapy safe in neonates with indirect hyperbilirubinemia?
infants, NNPT affects neonatal behavior, including visual and auditory orientation and alertness [1, 45]. For parents, NNPT causes parental anxiety, excessive medical concerns, and increased outpatient visits in the first year [88]. Thus, unless jaundice is too severe, phototherapy can be safely interrupted at feeding time to allow breastfeeding, parental
Are neonates under phototherapy at high risk of hypocalcemia?
A neonate undergoing phototherapy treatment must be monitored for which adverse effect? Increased insensible water loss A nurse is caring for a child with complex esophageal atresia who will be undergoing surgery for repair.
What is a common adverse effect of phototherapy?
Abstract. Phototherapy is a valuable therapeutic tool in Dermatology, but there may be drawbacks. Acute and long-term adverse effects, of variable severity, include skin erythema, xerosis, pruritus, blistering, altered pigmentation, photoaging, and photocarcinogenesis.
What are the indication of phototherapy?
The main indications are actinic keratoses, in-situ squamous cell carcinoma and superficial basal cell carcinoma. PDT may prove useful for other skin diseases as experience is gained. UVA1 phototherapy is not available in New Zealand.
Does phototherapy cause eye damage?
In adults, prolonged exposure to blue light can cause retinal damage. Although retinal damage from phototherapy has not been reported, eye covers for newborns are standard prophylaxis.
Can phototherapy cause vomiting?
When used for skin conditions, phototherapy is generally considered safe. However, you may experience a few side effects such as redness, dry skin, itchy skin, nausea (with PUVA), blisters, or folliculitis.Aug 12, 2021
What are the contraindications to phototherapy?
ContraindicationsDysplastic naevus syndrome.Systemic lupus erythematosus.Dermatomyositis.Genetic skin cancer syndromes (xeroderma pigmentosum, Gorlin syndrome)Bloom syndrome, Cockayne syndrome.Patients unwilling or unable to comply with safety procedures.More items...•Feb 4, 2022
When should phototherapy be started?
Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours.Feb 15, 2002
What are the complications of neonatal jaundice?
Possible Complications Cerebral palsy. Deafness. Kernicterus, which is brain damage from very high bilirubin levels.Jan 1, 2020
What are the complications of jaundice?
What are the complications of jaundice?bleeding.anemia.infections.abdominal bloating.swelling of legs.liver failure.kidney failure.constipation.More items...
How can you prevent phototherapy complications?
Maintain a strict fluid balance chart. Ensure that phototherapy unit is turned off during collection of blood for TSB/SBR levels, as both conjugated and unconjugated bilirubin are photo-oxidized when exposed to white or ultraviolet light. Observe for signs of potential side effects.
What is the effect of phototherapy to babies with jaundice?
Phototherapy is treatment with a special type of light (not sunlight). It's sometimes used to treat newborn jaundice by making it easier for your baby's liver to break down and remove the bilirubin from your baby's blood. Phototherapy aims to expose your baby's skin to as much light as possible.
Why does phototherapy cause Diarrhoea?
The high concentration of bile salts found in the colonic contents of neonates during phototherapy would appear to be a factor in the pathogenesis of phototherapy-associated diarrhea in the jaundiced neonate.
What are the side effects of UVB treatment?
Side effects of phototherapyYour skin disease may get worse before it gets better.Your skin may become red, itchy, or dry. This often gets better with regular treatments.You may get a sunburn at any time during your treatment. ... You may have flares of cold sores. ... You are at higher risk of developing skin cancer.
Can you cut down diapers during phototherapy?
However, because most hospitals use (cut-down) diapers during phototherapy, the issue of gonad shielding may be moot . Skin blood flow is increased during phototherapy, but this effect is less pronounced in modern servocontrolled incubators. However, redistribution of blood flow may occur in small premature infants.
Can you cover your eyes with a phototherapy patch?
Therefore, covering the eyes of infants undergoing phototherapy with eye patches is routine. Care must be taken lest the patches slip and leave the eyes uncovered or occlude one or both nares.
Is phototherapy safe for neonates?
Generally, phototherapy is very safe and may have no serious long-term effects in neonates; however, the following adverse effects and complications have been noted: Insensible water loss may occur, but data suggest that this issue is not as important as previously believed. Rather than instituting blanket increases of fluid supplements ...
Can hyperbilirubinemia cause DNA strand breakage?
Care must be taken lest the patches slip and leave the eyes uncovered or occlude one or both nares. The combination of hyperbilirubinemia and photo therapy can produce DNA-strand breakage and other effects on cellular genetic material.
What is a nurse conducting a presentation for a group of pregnant women about measures to prevent toxoplasm
The nurse determines that additional teaching is needed when the group identifies which measure as preventive? 1- washing raw fruits and vegetables before eating them.
What substance would a nurse question a pregnant woman about?
There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance? 1- marijuana. 2- alcohol. 3- heroin. 4- cocaine. 4.
What is the difference between a preterm and a neonate?
2- The infant was born at term but at a low birth weight and small for gestational age. 3- The infant was born at term but a very low birth weight and small for gestational age.
Which organ allows blood to pass from the right atrium to the left atrium during fetal life?
1- "The foramen ovale allows blood to pass from the right atrium to the left atrium during fetal life.". 2- "The ductus arteriosus carries deoxygenated blood from the aorta to the pulmonary artery during fetal life.". 3- "Oxygenated blood goes out to the body through the aorta.".
What is a nurse teaching?
A nurse is teaching a group of pregnant women about the adverse effects of substances on the fetus. The nurse determines that additional teaching is needed when the the group identifies which substance as being teratogenic? 1- alcohol. 2- nicotine.
What is BBS in neonates?
Bronze baby syndrome (BBS) is a rare complicationoccurring in neonates with a raised conjugated bilirubinlevel (cholestasis) undergoing NNPT [33]. The pathogen-esis of BBS is unclear. Cu–protoporphyrin metabolismdisturbance and congenital biliary hypoplasia may beinvolved in its development [65,77,95]. The threshold ofconjugated bilirubin for the syndrome has not yet beendetermined since not all babies with cholestasis developBBS during NNPT. It is generally believed that BBS isharmless, and pigmentation returns slowly to normal ifNNPT is discontinued [65]. However, BBS may constitutean additional risk for developing kernicterus [21]. Thus,neonates with a mixed (direct–indirect) hyperbilirubinemiaundergoing NNPT should be closely investigated forunderlying BBS.
Does the epidermis absorb blue light?
It is estimated that the epidermis may absorb 60% of bluelight irradiation. Melanocytic cells, localized to the epider-mis, are easily affected by irradiation with blue light [63].Neonatal skin has reduced enzymatic activity, low meta-bolic detoxification, and incomplete immunologic defense,which increase the sensitivity and vulnerability of neonatesto NNPT [63].
Does NNPT cause asthma?
NNPT degradation of bilirubin may increase oxidativestress, a possible risk factor for asthmatic manifestations inlater life [40]. Thus , the decreased bilirubin level inducedby NNPT and the resulting impaired antioxidant defensemay contribute to the development of asthma.
What is the most common therapeutic intervention in neonatology?
Phototherapy represents the most common therapeutic intervention at neonatology departments in the first days of life. The beneficial effects of light on the decrease of the serum bilirubin level were first described by Cremer et al. in 1950’s (1). Since then phototherapy has been successfully used to treat severe hyperbilirubinaemia and has almost completely replaced exchange transfusion. Phototherapy is a relatively non-invasive method. However, along with decreasing bilirubin level, it can also influence some other functions: perfusion of organs, predominantly skin; peripheral vascular resistance; distribution of blood flow; heart activity and, thus, also systemic blood pressure along with breathing. A side component of applied light is a certain amount of heat which warms the body surface up and, therefore, the risk of exogenous overheating and increased water loss through the skin arise. Maternal-infant separation, modification of calcium homeostasis, disturbed circadian rhythm, or changes of the hemodynamics of various organ systems are only a few of the undesired effects which prove phototherapy not to be a treatment without any side effects. Careful indication of phototherapy is essential, particularly in premature infants.
What is NNPT used for?
Neonatal phototherapy (NNPT), a noninvasive, easily available therapy, has been widely used for the treatment of neonatal jaundice for more than half a century. Its efficiency in decreasing plasma bilirubin concentration is well documented, and NNPT leads to greatly reduced exchange transfusion rates for neonates with hyperbilirubinemia. It is generally accepted that the side effects of NNPT are not serious and seem to be well controlled. This review will focus on these possible side effects as well as the approaches to minimize them.
What is the purpose of the Cochrane review protocol?
The objectives are as follows: To determine whether administration of prebiotics reduces the incidence of hyperbilirubinaemia among term and preterm infants compared with enteral supplementation of milk with distilled water or no supplementation.
Is phototherapy harmful to neonatal health?
Some investigations have expressed concern about potential toxic effects of phototherapy, one possible harmful is affection of cytokines production, which can affect the function of neonatal immune system.
Is phototherapy safe for neonates?
Numerous studies assessing these possible adverse effects of phototherapy on neonates have been published over the past years. Through this review, we seek to analyze what we know about the side effects of phototherapy in the neonatal period. The main causes of jaundice, phototherapy techniques, acute and late side effects, and effects on the immune and inflammatory system were reviewed. It was concluded that phototherapy is not a treatment free of side effects and further studies need to be conducted to elucidate its harmful effects on neonates.
BACKGROUND
In October 1994, the Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia of the American Academy of Pediatrics (AAP) produced a practice parameter dealing with the management of hyperbilirubinemia in the healthy term newborn.
DEFINITION OF RECOMMENDATIONS
The evidence-based approach to guideline development requires that the evidence in support of a policy be identified, appraised, and summarized and that an explicit link between evidence and recommendations be defined.
BILIRUBIN ENCEPHALOPATHY AND KERNICTERUS
Although originally a pathologic diagnosis characterized by bilirubin staining of the brainstem nuclei and cerebellum, the term “kernicterus” has come to be used interchangeably with both the acute and chronic findings of bilirubin encephalopathy.
FOCUS OF GUIDELINE
The overall aim of this guideline is to promote an approach that will reduce the frequency of severe neonatal hyperbilirubinemia and bilirubin encephalopathy and minimize the risk of unintended harm such as increased anxiety, decreased breastfeeding, or unnecessary treatment for the general population and excessive cost and waste.
PRIMARY PREVENTION
In numerous policy statements, the AAP recommends breastfeeding for all healthy term and near-term newborns. This guideline strongly supports this general recommendation.
SECONDARY PREVENTION
RECOMMENDATION 2.0: Clinicians should perform ongoing systematic assessments during the neonatal period for the risk of an infant developing severe hyperbilirubinemia.
TREATMENT
RECOMMENDATION 7.1: Recommendations for treatment are given in Table 3 and Figs 3 and 4 (evidence quality C: benefits exceed harms). If the TSB does not fall or continues to rise despite intensive phototherapy, it is very likely that hemolysis is occurring. The committee’s recommendations for discontinuing phototherapy can be found in Appendix 2.