Introduction
Phototherapy, a commonly utilized modality in neonatology, has revolutionized the treatment of jaundice in babies. About 60 percent of term and 80 percent of preterm infants experience jaundice in their first week of life, a common ailment in newborns caused by high bilirubin levels causing yellow coloring of the skin and sclera. While moderate jaundice usually goes away on its own, severe hyperbilirubinemia (increased buildup of bilirubin in the blood) can cause dangerous side effects such as kernicterus, a neurological disorder brought on by bilirubin poisoning. Phototherapy is essential in preventing and treating severe jaundice in neonates because it can change bilirubin into isomers that are soluble in water and may be eliminated by the body.
What Is Jaundice in Newborns?
Jaundice in newborns is a frequent, transient, and often benign illness. Both full-term and premature babies are affected, and it typically manifests itself in the first week of life. A build-up of bilirubin, a naturally occurring chemical in the blood, results in jaundice. The orange or red pigment in blood is called bilirubin. Red blood cells normally break down to create bilirubin. Everyone has low blood bilirubin levels, which is typical. The baby's skin and the whites of their eyes turn yellow when bilirubin builds up and accumulates on the fatty tissue beneath the skin.
What Is Phototherapy?
Some "normal" jaundice will go away in a week or two without therapy. Because of the intensity of their jaundice, the reason behind it, or the age at which it first manifests, certain babies will need medical attention. In phototherapy, or "light treatment," bilirubin in the blood is removed through light. The baby's skin and blood absorb these light waves, which convert bilirubin into products that can go through their system.
A row of lights or a spotlight hanging at a distance from a baby has been used in hospitals for phototherapy treatments for more than 30 years. Wavelengths 430 to 490 nanometers, or the blue-green spectrum, are emitted by phototherapy lights. It is usually not ultraviolet light. An infant in its undressed diaper would be exposed to light, which would require the application of soft eye patches to shield their eyes. Modern technological developments have produced a novel phototherapy system that provides efficient treatment without the drawbacks of traditional phototherapy.
What Distinguishes Intensive Phototherapy From Conventional Phototherapy?
Intensive phototherapy is defined as a light intensity measured at the baby's skin below the phototherapy lamp's center that is at least 30 microwatts per square centimeter per nanometer. The light's spectrum irradiance can be measured with a handheld radiometer. Ideally, readings should be obtained at multiple locations and averaged, as measurements taken immediately under the lights will be higher. The phototherapy system will determine which radiometer is suitable, so adhering to the manufacturer's instructions is important.
Although figures vary greatly across manufacturers, "conventional phototherapy" uses less light. When delivering phototherapy, it is often optional to monitor irradiance regularly. However, units should be frequently checked to ensure the lamps provide adequate irradiance, according to the manufacturer's instructions.
Are Eye Covers Necessary for Babies?
Prolonged exposure to blue light in adults has been linked to retinal damage. While phototherapy-induced retinal damage has not been documented, eye coverings are a typical preventive measure for babies.
What Are the Risks of Phototherapy?
When phototherapy is used to treat cholestatic jaundice in neonates, an uncommon consequence known as bronze baby syndrome might happen. These infants get a dark, gray-brown discoloration on their skin, urine, and serum after exposure to phototherapy lamps. This effect is believed to be caused by an accumulation of porphyrins and other metabolites, although the precise etiology is unknown.
Another possibility is that infants with congenital erythropoietic porphyria or cholestatic jaundice will develop purpura or bullae. It is strictly forbidden to utilize phototherapy on infants with porphyria or a positive family history of the disorder due to the extreme photosensitivity and blistering that can occur in these cases.
How Long Is the Phototherapy Needed for the Newborn?
When to stop phototherapy is not specified in any particular way. The length of time will depend on the infant's age and any hemolysis evidence. Phototherapy may be necessary for a day or less in certain situations, or it may be needed for five to seven days. According to the AAP Guidelines, a baby who has been readmitted due to hyperbilirubinemia and whose level is 18 milligrams per deciliter or more should have a level between 13 and 14 milligrams per deciliter before phototherapy is stopped. Serum bilirubin levels should typically significantly drop before the lights are turned off.
As the yellowing of the skin is bleached momentarily by phototherapy, physical examinations for jaundice become ineffective once treatment commences.
How to Maximize the Effectiveness of Phototherapy?
The distance between the lamps and the baby determines how effective phototherapy is. Thus, increasing the intensity of phototherapy by moving the lamps closer to the baby is simple. If there is doubt regarding the efficacy of phototherapy, an isolette should not be utilized since it prevents the lamps from being moved in close.
It is possible to get the lamps within 10 centimeters of the baby in an open bassinet. With this setup, an undressed-term baby will not be too hot, but avoiding halogen lighting is crucial. When halogen lights are utilized this way, they can get hot and cause burns. Cool white lights, standard blue lights, and special blue lights are all suitable substitutes.
Enhancing the area of skin exposed to phototherapy will also optimize treatment efficacy. Usually, a bili blanket that can be placed under the baby is paired with overhead phototherapy equipment. Since some of these pads and blankets are tiny, two or three units could be required to provide more thorough coverage from below. Additionally, lining the bassinet's sides with aluminum foil or white blankets can improve the efficacy of phototherapy.
Conclusion
In conclusion, phototherapy has drastically decreased the prevalence of kernicterus (bilirubin-induced neurological damage) and the neurological consequences that are linked to it, revolutionizing the treatment of newborn jaundice. Improvements in treatment procedures and technology, along with our growing understanding of bilirubin metabolism and phototherapy mechanisms, should significantly improve the safety and effectiveness of this crucial intervention. Nonetheless, more study is required to maximize phototherapy tactics, reduce possible hazards, and enhance results for neonates with jaundice.
