During phototherapy neonates require ongoing monitoring of: adequacy of hydration (urine output) and nutrition (weight gain) temperature clinical improvement in jaundice
What are the guidelines for newborns under phototherapy?
Infants must be weighed on admission to the nursery and 2nddaily as per the guideline All infants in Newborn Care receiving phototherapy should have a temperature, pulse and respiration rate documented 4 hourly. If an infant requires continuous cardio-respiratory monitoring for other reasons, then, this should continue whilst under phototherapy.
Why should nevi be monitored when children receive phototherapy?
Therefore, when children receive phototherapy, the nevi should be closely monitored to prevent the development of melanoma.
What are the side effects of neonatal phototherapy?
Generally, it is accepted that the side effects of neonatal phototherapy are not serious and seem to be well controlled, however recent research has provided new evidence. The short-term side effects of phototherapy include interference with maternal-infant interaction, imbalance of thermal environment and water loss, electrolyte disturbance, ...
What is the pathophysiology of phototherapy lamp toxicity in neonates?
With exposure to phototherapy lamps, these infants develop a dark, gray-brown discoloration of skin, urine, and serum. Although the exact etiology is not understood, this effect is thought to be the result of an accumulation of porphyrins and other metabolites.
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 is a common adverse effect of phototherapy in a newborn infant with jaundice?
Side effects — Phototherapy is very safe, but it can have temporary side effects, including skin rashes and loose stools. Overheating and dehydration can occur if a baby does not get enough breast milk or formula. Therefore, a baby's skin color, temperature, and number of wet diapers should be closely monitored.
How does phototherapy cause hypocalcemia?
The etiology of hypocalcemia in infants treated with phototherapy is believed to be caused by a decrease in melatonin level and corticosterone secretion . In addition, urinary calcium excretion is increased after exposure to phototherapy . This decrease in calcium can be explained by melatonin secretion .
What nursing measures are required for the newborn while receiving phototherapy?
Baby temperature Your baby's temperature should be between 98°F (36.7°C) and 100°F (37.8°C) during phototherapy. Take your baby's temperature by holding the thermometer under your baby's armpit (axillary temperature). start therapy or after a 1-hour break. – Take their temperature before phototherapy.
Can phototherapy cause jaundice?
Phototherapy. 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.
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...
When does kernicterus occur?
In some cases, symptoms and physical findings of kernicterus appear two to five days after birth. Within the first few days of life, affected infants develop abnormally high levels of bilirubin in the blood (hyperbilirubinemia) and persistent yellowing of the skin, mucous membranes, and whites of the eyes (jaundice).
Why is calcium added to melatonin?
Melatonin and calcium carbonate can significantly improve antioxidative ability in rats with osteoporosis, increase bone density, elevate serum calcium level and reduce bone mineral loss, thus preventing and treating osteoporosis, and the combination displays more remarkable effects.
Does phototherapy cause hyperthermia?
We observed that LED phototherapy of ≥60 μW/cm2/nm intensity significantly increased BT in hyperbilirubinemic newborns whereas LED phototherapy at low irradiances and conventional phototherapy with blue fluorescent light did not cause significant hyperthermia.
What are the contraindications of 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...•
What are the nursing problems of neonatal jaundice?
Nursing Diagnosis: Hyperthermia related to infection and excessive bile in the blood secondary to adult jaundice as evidenced by temperature of 39 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.
What is blue light used for?
Blue light has been widely used for the treatment of neonatal hyperbilirubinemia since the 1950s. Neonatal phototherapy can decrease plasma unconjugated bilirubin level, thus preventing bilirubin encephalopathy, and greatly reduces the exchange transfusion rate.
Does blue light help with bilirubin?
Neonatal phototherapy can decrease plasma unconjugated bilirubin level , thus preventing bilirubin encephalopathy, and greatly reduces the exchange transfusion rate. Generally, it is accepted that the side effects of neonatal phototherapy are not ...
Why is phototherapy used?
Treatment with phototherapy is implemented in order to prevent the neurotoxic effects of high serum unconjugated bilirubin. Phototherapy is a safe, effective method for decreasing or preventing the rise of serum unconjugated bilirubin levels and reduces the need for exchange transfusion in neonates.
How long does it take for jaundice to resolve in neonates?
Approximately 60% of term babies and 85% preterm babies will develop clinically apparent jaundice, which classically becomes visible on day 3, peaks days 5-7 and resolves by 14 days of age in a term infant and by 21 days in the preterm infant. Treatment with phototherapy is implemented in order to prevent the neurotoxic effects of high serum unconjugated bilirubin. Phototherapy is a safe, effective method for decreasing or preventing the rise of serum unconjugated bilirubin levels and reduces the need for exchange transfusion in neonates.
What is the pathogenic diagnosis of bilirubin staining of the brain stem and cerebellum?
Kernicterus: the pathogenic diagnosis characterised by bilirubin staining of the brain stem and cerebellum. Also the term used to refer to chronic bilirubin encephalopathy. Clinical findings include cerebral palsy, developmental and intellectual delay, hearing deficit, dental dysplasia and oculomotor disturbances.
What does it mean when an infant is exposed to a phototherapy lamp?
With exposure to phototherapy lamps, these infants develop a dark, gray-brown discoloration of skin, urine, and serum. Although the exact etiology is not understood, this effect is thought to be the result of an accumulation of porphyrins and other metabolites.
How is phototherapy determined?
The effectiveness of phototherapy is determined largely by the distance between the lamps and the infant, so phototherapy can easily be intensified by bringing the lamps closer to the infant. Because a closed isolette does not allow the lamps to be moved in close, if there is a concern about the effectiveness of phototherapy, ...
What is the difference between conventional and intensive phototherapy?
What's the difference between "conventional" and "intensive" Phototherapy? "Intensive phototherapy" means the irradiance of the light is at least 30µW/cm2 per nm as measured at the baby's skin below the center of the phototherapy lamp. A hand-held radiometer can be used to measure the spectral irradiance emitted by the light.
How long does phototherapy last?
In some cases, phototherapy will only be needed for 24 hours or less, in some cases, it may be required for 5 to 7 days.
What lights are used for phototherapy?
Special blue, regular blue, and cool white lights are all acceptable alternatives. Increasing the skin surface area exposed to phototherapy will also maximize treatment. Commonly, an overhead phototherapy unit is combined with a bili blanket that can be place under the infant.
Can you see bilirubin before turning off the lights?
In general, serum bilirubin levels should show a significant decrease before the lights are turned off. Physical examination for jaundice is not helpful once treatment has started as the yellow color of the skin is temporarily "bleached" by the phototherapy.
Do you need to measure irradiance when using phototherapy?
In general, it is not necessary to rountinely measure irradiance when administering phototherapy, but units should be checked periodically to ensure that the lamps are providing adequate irradiance, according to the manufacturer's guidelines.
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.
Does phototherapy help with jaundice?
Phototherapy is universally recognized as the first option for treating neonatal jaundice due to its unparalleled efficiency and safety in reducing the high serum free bilirubin levels and limiting its neurotoxic effects. However, several studies have suggested that phototherapy may elicit a series of short- and long-term adverse reactions associated with pediatric diseases, including hemolysis, allergic diseases, DNA damage or even cancer. The aim of the present review was to summarize the etiology, mechanism, associated risks and therapeutic strategies for reducing high neonatal serum bilirubin levels. In order to shed light on the negative effects of phototherapy and to encourage implementation of a reasonable and standardized phototherapy scheme in the clinic, the present review sought to highlight the current understanding of the adverse reactions of phototherapy, as it is necessary to further study the mechanism underlying the development of the adverse effects of phototherapy in infants in order to explore novel therapeutic alternatives.
What factors influence the type of information given to support parents during their infant's phototherapy treatment?
The gestation, postnatal age and infant’s general well being, along with the aetiology of jaundice, serum bilirubin levels and rate of rise will all influence the type of information given to support parents during their infant’s phototherapy treatment.
What is the aim of phototherapy?
The aim of phototherapy is to decrease the level of unconjugated bilirubin in order to prevent acute bilirubin encephalopathy, hearing loss and kernicterus (American Academy of Paediatrics 2004)
Where do infants nurse?
Infants will be nursed in an incubator, open care system or a cot. This will be dependent on gestation, weight, aetiology of jaundice and type of phototherapy system to be used.
Can a nurse manage an infant receiving phototherapy?
Nurses will be able to effectively and appropriately manage an infant receiving phototherapy Nurses will be able to use phototherapy devices correctly Nurse s will be able to discuss management strategies with the family and ease concerns
Introduction
Aim
Definition of Terms
- Jaundice: the yellow appearance of the skin that occurs with the deposition of bilirubin in the dermal and subcutaneous tissues and the sclera.
- Bilirubin: the orange-yellow pigment of bile, formed principally by the breakdown of haemoglobin in red blood cells at the end of their normal life-span. Neonate’s bilirubin production rate is doub...
- Jaundice: the yellow appearance of the skin that occurs with the deposition of bilirubin in the dermal and subcutaneous tissues and the sclera.
- Bilirubin: the orange-yellow pigment of bile, formed principally by the breakdown of haemoglobin in red blood cells at the end of their normal life-span. Neonate’s bilirubin production rate is doub...
- Bilirubinaemia: the presence of bilirubin in the blood.
- Hyperbilirubinaemia: the excess of bilirubin in the blood. Types of Neonatal Hyperbilirubinaemia:
Assessment
- Please note that when charting the TSB level onto the Phototherapy or Exchange Transfusion charts, in the presence of risk factors (sepsis, haemolysis, acidosis, asphyxia, hypoalbuminaemia) TSB values should be plotted on the range 1 lower than the neonate’s gestational age/weight. This is because the risk of developing kernicterus increases in the presence of the above risk factors…
Potential Complications
- Overheating – monitor neonate’s temperature
- Water loss from increased peripheral blood flow and diarrhoea (if present)
- Diarrhoea from intestinal hypermotility
- Ileus (preterm infants)
Discharge Planning and Community-Based Management
- Documentation in the neonates discharge letter and Child Health Booklet should include details about TSB/SBR levels and duration of phototherapy treatment.
Family Centered Care
- Explain to parents the need for and actions of phototherapy, particularly in relation to the need for skin surface to be exposed to the phototherapy light, and hence the need to care for neonates receiving phototherapy to be nursed in a neutral thermal environment. Potential complications of phototherapy and the need for protective eye coverings during phototherapy treatment should b…
Special Considerations
- Normal hand hygiene measures should be attended to during care of a neonate receiving phototherapy. More details on the neoBLUE LED lights can be found in the definition of terms.
Companion Documents
- RCH Phototherapy Trial Chart - COMING SOON
- RCH Exchange Transfusion Chart
- RCH Phototherapy competency
- RCH: Neonatal Clinical Practice Guideline: Exchange Transfusion http://www.rch.org.au/uploadedFiles/Main/Content/neonatal_rch/EXCHANGE_T…
Links
- http://www.nice.org.uk/
- http://www.nice.org.uk/guidance/CG98
- http://pathways.nice.org.uk/
- National Centre for Health and Care Excellence Pathways;