How should phototherapy be handled in neonates?

July 10, 2022by Kalstein
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Phototherapy in the neonate is a therapeutic measure or technique based on the use of ultraviolet (UV) radiation to treat neonatal hyperbilirubinemia. The increase in serum bilirubin usually occurs due to an imbalance between the elimination and production of bilirubin, which causes it to accumulate in the mucous membranes and skin of the newborn causing a typical yellowish color; condition known as jaundice.

Light has the ability to transform bilirubin into more water-soluble compounds that are excreted in an easier way, which generates a decrease in the high levels of serum bilirubin present in this clinical picture.

How is the diagnosis of neonatal hyperbilirubinemia performed?

It is essential to make an early diagnosis of neonatal hyperbilirubinemia, assessing jaundice correctly. Approximately 60% of full-term newborns present a physiological jaundice; It is characterized by low levels of bilirubin in the blood (less than 12.9 mg/dl in neonates with artificial lactation or 15 mg/dl if breastfeeding) and short duration. We are faced with pathological jaundice when it begins in the first 24 hours of life or after a week of birth; serum bilirubin increases to more than 5 mg/dL per day or presents figures greater than 13 mg/dL in artificial lactation or 17 mg/dL in breastfeeding, and is accompanied by other symptoms.

It is important to perform a thorough physical examination, which must take into account if the progression of jaundice is cephalocaudal. To assess the yellowish coloration, the skin should be pressed observing the color of the skin; in patients with dark skin this procedure is much more complicated, so you can resort to checking the color of the sclera, tears, saliva, because they may be dyed by the increase of bilirubin, just as you should look for if there is colluria and acolia.

Phototherapy in neonates

Phototherapy is considered the treatment of choice for neonates with unconjugated hyperbilirubinemia; early onset of this therapy decreases the need for exchange transfusion, which is a more aggressive technique and can cause considerable clinical complications, as well as the serious consequences of neonatal hyperbilirubinemia.

The use of phototherapy is based on the principle of radiating light with blue spectrum (430-490 nm) to the patient to be absorbed by the epidermis, transforming unconjugated bilirubin into water-soluble isomers that are excreted in the feces and urine of the newborn. Radiation is done through the use of a light lamp, special blue fluorescent lamps or LED systems can be used. Depending on the maximum wavelength produced by light there are different types of phototherapy:

Management of phototherapy in neonates

As mentioned above, phototherapy is considered the definitive treatment of neonatal hyperbilirubinemia, because it prevents irreversible brain damage, the most serious consequence of this pathology, the technique of phototherapy consists in placing a light at a distance of 30-40 cm from the naked body surface of the neonate previous placement of radiopaque glasses and removal of any cream or lotion of the skin. Standard or conventional phototherapy can be applied continuously or intermittently (with lamp on/off cycles).

If conventional phototherapy treatment does not work, multiple or intensive phototherapy is started with either lamps emitting high radiation or by placing more units of conventional lamps, in this case two conventional lamps would be placed at the same time for double phototherapy and three for triple phototherapy.

What should be taken into account when phototherapy is performed in neonates?

  • Postural changes should be made every three hours of the newborn, placing the patient in a supine, lateral or prone position, if their baseline state allows, maintaining in any case the monitoring of the child, to avoid the appearance of pressure ulcers.
  • Provide food to the newborn, to make it in the most physiological way possible whenever the conditions of the child allow. If you are undergoing simple phototherapy you can turn off the lamp and remove it from the crib to feed, either with breastfeeding or artificial, for about 20-30 minutes.
  • Check and control the level of hydration of the child, checking his skin and mucous membranes for signs of dehydration, making supplements with formula milk if necessary.
  • Carry out strict control of the patient’s weight, diuresis and constants. Above all, temperature control since when exposed to the heat of light the child may suffer from hyperthermia, so it is important to also control the temperature of the incubator or cradle to adjust it to the need of the neonate.

What does Kalstein offer you?

Kalstein is a company MANUFACTURER of medical and laboratory equipment of the highest quality and the best technology at the best PRICES in the market, so you can make your PURCHASE with us, knowing that you have the service and advice of a company specialized in the field and committed to provide you with safe, economical and effective options for the performance of your functions in the right way. This time we present our Child bilirubin phototherapy unit YR02195. This equipment has the following characteristics:

  • This model has 4 suction cup legs to be fixed in an incubator.
  • LED as radiant elements of phototherapy
  • Fan-less design for quiet atmosphere
  • Large area light source for better curing
  • It can be used with most other types of baby incubators.

For more information we invite you to take a look at: HERE

 

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