a

Rhesus disease, perinatal asphyxia, hypoxia, acidosis, hypercapnia.

From Maisels MJ, Watchko JF. Treatment of jaundice in low birthweight infants.

Arch Dis Child Fetal Neonatal Ed. 2003;88:F459.

Chapter 49 ■ Phototherapy 359

b. The pad emits insignificant levels of heat, so it can

be placed in direct contact with the infant to deliver

up to 35 mW/cm2

/nm of spectral irradiance, mainly

in the blue–green range (16).

c. The orientation of the fiberoptic fibers determines

the uniformity of emission and is unique to each of

the commercially available devices.

d. The main advantages of these systems are that,

while receiving phototherapy, the infant can be held

and/or nursed, thereby minimizing infant–parent

separation. In addition, covering the infant’s eyes is

not necessary, preventing further parental anxiety.

e. The main disadvantage of the fiberoptic pads is that

they cover a relatively small surface area and, therefore, have less efficacy compared to overhead

sources. They should not be used as the sole means

of providing phototherapy in an infant with significant hyperbilirubinemia (1,2,11).

f. These devices are often used as an adjunct to conventional overhead application of phototherapy to

provide “double” phototherapy (circumferential

phototherapy), which has greater efficacy because

greater body surface area is exposed to the light

(10,16).

7. Gallium nitride light-emitting diodes (LEDs)

a. These systems are semiconductor phototherapy

devices capable of delivering high spectral irradiance levels of >200 μW/cm2

/nm with very little generation of heat within a very narrow emission spectrum in the blue range (460 to 485 nm), with low

infrared emission and no ultraviolet emission

(10,17,18).

b. LEDs have a longer lifetime (>20,000 hours) and

have become cost-effective for use in phototherapy

devices. LEDs and compact fluorescent tubes are

equally efficacious in the management of hyperbilirubinemia (19).

D. Technique (Conventional

Phototherapy)

Intensive phototherapy is defined as the use of light in the

430- to 490-nm band delivered at 30 mW/cm2

/nm or higher

to the greatest body surface area possible (1,10).

1. Position the phototherapy unit over the infant to obtain

desired irradiance (10 to 40 μW/cm2

/nm). The maximal amount of irradiance achieved by the standard

technique is generally 30 to 50 μW/cm2

/nm. The distance of the light from the infant has a significant effect

on the intensity of phototherapy, and to achieve maximal intensity, the lights should be positioned as close as

possible to the infant. Fluorescent tubes may be

brought within approximately 10 cm of term infants

Table 49.2 Phototherapy Devices Commonly Used in the United States, and Their

Performance Characteristics

Device Manufacturer

Distance to

Patient (cm)