Guidelines to deliver safe and effective phototherapy

In this webinar, we shall discuss the guidelines to deliver safe and effective PT
Few general guidelines for optimising phototherapy equipment are listed below: Phototherapy can be delivered by special blue fluorescent tubes or light - emitting diode (LED) with similar efficacy. Please note thatuse of white tube lights aloneis not effective. Do not use sunlight as treatment for hyperbilirubinaemia. Irradiance is a measure of the efficacy of phototherapy. In simple words, higher the irradiance, better is the efficacy of phototherapy. It is not necessary to measure irradiance before each use of phototherapy; however it is important to perform periodic checks of phototherapy units to make sure that an adequate irradiance is being delivered. The target irradiance while giving phototherapy is at least 30 microW/cm2/nm. Keep the phototherapy unit as close as possible [up to 15 cms] ensuring that the neonate maintains normal temperature. Align the phototherapy unit so that the neonate lies directly beneath the centre of the unit.
Increase the exposed body surface area of the infant exposed to phototherapy by placing another phototherapy unit beneath/ by the side of the neonate. The use of reflecting material like white cloth or aluminium foil around the incubator or radiant warmer bed is optional, making sure not to impede the airflow that cools the tube. Keep the baby naked keeping the diapers as short as possible, to cover the genitalia.
It is safe to continue breast feeding/ breast milk feeding while the neonate is on phototherapy; It is important to ensure adequate hydration while the neonate is on phototherapy. However, please remember that there is no role of routine intravenous fluids or supplemental feeds, unless the neonate is clinically dehydrated. Phototherapy can be briefly interrupted for feeding / clinical care procedures provided the neonate’ bilirubin level is less than the exchange threshold. Ensure that the neonate has an adequate urine output of at least 1 ml/kg/hr. Cover the eye with eye patches. Monitor temperature every 2 hours.
  • Introduction...
  • 1. Guidelines for ...
  • 2. Guidelines for ...
  • 3. Guidelines for ...
  • 4. Measures to inc...
  • 5. Supportive care...
 

Introduction

Dr. C. APARNA
MD, DM (Neonatology)

Consultant Neonatologist
Ankura Hospital for Women and Children
Kukatpally, Hyderabad

1. Guidelines for optimizing phototherapy – equipment factors-01

â–º Use special blue tubes or LED light source
      ♦ Using only white tube lights is less effective
      ♦ Do not use sunlight as treatment for jaundice

2. Guidelines for optimizing phototherapy – equipment factors-02

â–º Monthly irradiance check with flux meter is a must
      ♦ Ideal irradiance of at least 30 microW/cm2/nm

3. Guidelines for optimizing phototherapy – equipment factors-03

â–º Keep the phototherapy unit as close as possible [upto
    15 cms] ensuring that the neonate maintains normal
    temperature



â–º Align the phototherapy unit so that the neonate lies directly
    beneath the centre of the unit

4. Measures to increase effectiveness of phototherapy

â–º Increase the exposed body surface area of the infant under
    phototherapy
       ♦ By placing another phototherapy unit beneath/ by the side
         of the neonate
       ♦ Reflecting material around the incubator or radiant
         warmer bed is optional
       ♦ Keep the diapers as short as possible

5. Supportive care

â–º Ensure adequate hydration - Continue breast feeding/ breast
    milk feeding
â–º No role of routine intravenous fluids or supplemental feeds,
    unless baby is clinically dehydrated
â–º May interrupt for feeding/ clinical care procedures provided
    total serum bilirubin is lower than exchange threshold
â–º Monitor urine output
â–º Cover the eye with opaque eye patches
â–º Monitor temperature every 2 hours
â–º Routine position changing is not recommended