360 Section IX ■ Miscellaneous Procedures

without causing overheating, but halogen spot phototherapy lamps should not be positioned closer to the

infant than recommended by the manufacturer,

because of the risk of burns (10).

2. If increased irradiance is required, add additional units

or place a fiberoptic phototherapy pad under the infant

(10,16). Additional surface area may be exposed to phototherapy by lining the sides of the bassinet with aluminum foil or a white cloth (20).

3. Keep the photoradiometer calibrated and perform periodic checks of phototherapy units to make sure that

adequate irradiance is being delivered (10).

4. Maintain an intact acrylic/safety glass shield over phototherapy light bulbs to block ultraviolet radiation and

to protect the infant from accidental bulb breakage.

5. Provide ventilation to the phototherapy unit to prevent

overheating light bulbs.

6. Maintain cleanliness and electrical safety.

E. Technique (Fiberoptic Phototherapy)

Fiberoptic phototherapy can be used as the sole source of

phototherapy or as an adjunct to conventional treatment.

1. Insert the panel into disposable cover so that it is flat

and directed toward the infant.

2. Place the covered panel around the infant’s back or

chest and secure in position. The phototherapy blanket/pad must be positioned directly next to the infant’s

skin to be effective. Avoid constriction and skin irritation under the infant’s arms if the panel is wrapped

around the infant.

3. Discard disposable covers after each treatment and

when soiled.

4. Use eye patches if there is any direct exposure to lights

in panel or if used with conventional phototherapy for

double-sided effect.

5. Ensure stability and adequate ventilation of the illuminator unit by placing it on a secure surface.

6. Connect the fiberoptic panel to illuminator.

7. Keep the fiberoptic panel and illuminator clean and dry.

8. Allow the lamp to cool for 10 to 20 minutes before moving the illuminator. Do not place sharp or heavy objects

on the panel or cable.

Care of the Infant Receiving Phototherapy

1. Monitor temperature, particularly of infants in an incubator, who may develop hyperthermia.

2. Monitor intake, output, and weight. Fluid supplementation may be necessary secondary to increased insensible losses and frequent stooling. Encourage breastfeeding. Healthy term breast-fed infants may be

supplemented with milk-based formula if maternal

milk supply is inadequate. IV fluids are rarely required.

Milk feeding inhibits the enterohepatic circulation of

bilirubin (1).

3. The use of eye protection in the form of eye patches is

necessary for infants receiving overhead phototherapy.

Masks adhering directly to Velcro tabs on the temples

are preferable to circumferential headbands.

4. Maximize skin exposure to phototherapy source by

using the smallest possible diapers as well as keeping

blanket rolls from blocking light.

5. Avoid fully occlusive dressings, bandages, topical skin

ointments, and plastic in direct contact with the infant’s

skin, to prevent burns.

6. Remove plastic heat shields and plastic wrap that

decrease irradiance delivered to the skin (21).

7. If in use, shield the oxygen saturation monitor probe

from the phototherapy light.

8. Encourage parents to continue feeding, caring for, and

visiting their infant.

F. Home Phototherapy

Home phototherapy decreases costs of hospitalization and

eliminates separation of mother and infant. It is safe and

effective for selected infants. Home phototherapy should be

used only in infants whose bilirubin levels are in the

“optional phototherapy” range (Fig. 49.1).

1. Make arrangements to measure the infant’s serum bilirubin every 12 to 24 hours, depending on the previous

concentration and rate of rise. The infant should be

examined daily by a visiting nurse or at an office.

2. The supervising physician should be in contact with

the family daily during the period of treatment.

3. The infant should be rehospitalized if he or she shows

signs of illness or if the serum bilirubin concentration

exceeds 18 mg/dL.

G. Efficacy of Phototherapy

The clinical impact of effective phototherapy should be evident within 4 to 6 hours of initiation, with a decrease of

more than 2 mg/dL (34 mmol/L) in serum bilirubin concentration. The clinical response depends on the rates of

bilirubin production, tissue deposition and elimination,

and photochemical reactions of bilirubin. The therapeutic

efficacy of phototherapy depends on several factors.

1. Exposed body surface area: The greater the area exposed,

the greater the rate of bilirubin decline.

2. Distance of the infant from the light source

3. Skin thickness and pigmentation

4. Total bilirubin at clinical presentation

5. Duration of exposure to phototherapy