Iowa Neonatology Handbook: Jaundice

Use of Phototherapy

1. Infant receiving phototherapy should be left unclothed except for eye protection (mask) and a diaper. Care should be taken to ensure that the mask is not too loose such that it can slip over the nose and obstruct respiration. To increase the area of skin exposed to light the diaper may be omitted by a physician's order in cases where it is desirable to lower plasma bilirubin more quickly (required because diaper protects gonads from potentially harmful exposure to light). To keep control over the mess that loose phototherapy stools can cause, a surgeon’s face mask may be used as an alternative to a diaper.
   
2. To monitor the potential for increased insensible water loss occurring with the use of overhead phototherapy, daily weights and urine output should be monitored every shift.
   
3. The output of the phototherapy units will be monitored by the nursing staff with a Bili-meter (Olympic Mark II ) as follows:
   1. The phototherapy unit should be placed 40 cm above the infant and have a plexiglass shield between the light bulbs and the infant.
   2. Connect sensor head to Bili-meter and set range switch to 0.1 - 19.9.
   3. Place the Bili-meter’s sensor head on the infant's abdomen (if supine) or back (if prone) and aim toward the center of the phototherapy light.
   4. Press the "READ" button and record reading in microwatts per square centimeter per nanometer. For example, if the display reads 7, the reading is recorded as 7 µw/cm2/nm. In the unusual situation where the display blinks rhythmically, it means that the reading is above 19.9. For adequate phototherapy, the display should read between 7 and 12 µw/cm2/nm.
   5. If adequate reading is not obtained, replace bulbs and repeat procedure.
   6. Monitoring of the phototherapy lights will be performed every 48 hours.
      
4. Phototherapy blankets instead of phototherapy lights should be considered for extremely premature infants who require phototherapy. Use of phototherapy blankets should reduce inadvertent exposure of the developing retina to bright ambient light, a putative factor in retinopathy of prematurity.

References:

Maisels MJ, Conrad S. Transcutaneous bilirubin measurements in full-term infants. Pediatrics 1982;70:464-467.

Hyperbilirubinemia. In: Guidelines for Perinatal Care, Frigoletto FD and Little GA (eds). 1992, American Academy of Pediatrics, Elk Grove, IL, pp 208-210.

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