PHOTOTHERAPY

PRESENTED BY; Kevin Raiyani

What is phototherapy?
• Phototherapy (light therapy) is a way
of treating jaundice. Special lights
help break down the bilirubin in your
baby's skin so that it can be removed
from his or her body. This lowers the
bilirubin level in your baby's blood.
What is phototherapy?
Application of fluorescent light to the
infant’s exposed skin used to
breakdown the bilirubin in the skin
Indication of phototherapy
• Treatment of Hyperbilirubinemia
• The phototherapy will help the liver to
process bilirubin, bringing your baby's
level down to normal
• Prevent Kernicturus
Causes of Jaundice
• Breast-feeding jaundice: Breast-
feeding jaundice may occur when your
baby does not drink enough breast milk.
It occurs in 5% to 10% of newborns. The
jaundice symptoms are similar to those
of physiological jaundice, just more
pronounced. The jaundice indicates a
need for help with breast-feeding Care
for the infant under phototherapy
Causes of Jaundice

• Physiological jaundice This is the

most common cause of newborn
jaundice and occurs in more than 50%
of babies. Because the baby has an
immature liver, bilirubin is processed
slower. The jaundice first appears at 2 to
3 days of age. It usually disappears by 1
to 2 weeks of age, and the levels of
bilirubin are harmless
Causes of jaundice
• Breast-milk jaundice Breast-milk
jaundice occurs in 1% to 2% of breast-
fed babies. It is caused by a special
substance that some mothers produce
in their milk. This substance causes your
baby's intestine to absorb more bilirubin
back into his body than normal. This
type of jaundice starts at 4 to 7 days of
age. It may last 3 to 10 weeks. It is not
harmful.
Causes of Jaundice
• Blood group incompatibility (Rh or ABO
problems If a baby and mother have different
blood types, sometimes the mother produces
antibodies that destroy the newborn's red
blood cells. This causes a sudden build-up of
bilirubin in the baby's blood. Rh problems
formerly caused the most severe form of
jaundice. However, they are now preventable if
the mother is given an injection of Rho GAM
within 72 hours after delivery. This prevents
her from forming antibodies that might
endanger other babies she has in the future
History of PHOTOTHERAPY
• The use of phototherapy was first
discovered, accidentally, at Rochford
Hospital in Essex, England. The ward
sister (Charge Nurse) of the premature
baby unit.
Mechanism of action
• Bilirubin is a naturally occurring
molecule of the red blood cells. It is
released into the bloodstream when the
red blood cells break down. This is
normal and occurs often. Our livers
break down the bilirubin and it is
excreted.
Mechanism of action-Continue
• Phototherapy (light treatment) is the
process of using light to eliminate
bilirubin in the blood. Your baby's skin
and blood absorb these light waves.
These light waves are absorbed by your
baby's skin and blood and change
bilirubin into products, which can pass
through their system.
What are the benefits of
phototherapy?
• The jaundice can be treated
• preventing the need for more invasive
treatment and the serious complications,
which can occur if excessive levels of
bilirubin develop
Benefits of phototherapy
• Phototherapy is a safe.
• Effective method of treatment.
• It provides the highest level of
therapeutic light available to treat
your baby. This is the same form of
light found in sunlight This is safer
than sunlight though, because it
filters out the harmful ultraviolet and
infrared energy.
FACTORS AFFECTING EFFICACY OF
PHOTOTHERY
• 1-TYPE OF LIGHT USED
• 2-LIGHT INTENSITY
• 3-SURFACE AREA OF SKIN EXPOSED
TO LIGHT
• 4- The distance of the light source
from the baby, the optimum distance
being 35 - 50 cm in conventional
lights.
Assessment should be Before
Phototherapy
• GA Of the baby
• Weight The baby
• Postnatal Age
• Types of Jaundice
• the level of jaundice
Nursing Care for
Infant Receiving
Phototherapy
Distance Between phototherapy
light and baby
 10 cm to 50 cm
Nursing Care for Infant Receiving
Phototherapy
• Baby will need to be in an incubator
whilst under photo therapy to keep
warm,
• The photo therapy unit will be placed
over the top of the incubator
occasionally more than one unit may be
used. This can be switched off when
your baby needs to come out to be fed
Nursing Care for Infant Receiving
Phototherapy
Assess and adjust thermoregulation
device .

Promoting elimination and skin

integrity .

Hydration.
Nursing Care for Infant Receiving
Phototherapy.
-Assure effective of phototherapy

-provide eye protection Eyes are covered

with eye patches to prevent damage to
the retina by the .
Nursing Care for Infant Receiving
Phototherapy
• Baby is placed naked 45 cm away from
the tube lights in a crib or incubator.

• If using closer, monitor temperature of

the baby.

• Baby is turned every two hours or after

each feed.
Nursing Care for Infant Receiving
Phototherapy
• During phototherapy, the bilirubin
level in your baby’s blood will be
checked at least once every day.
Phototherapy is stopped when the
bilirubin level decreases.
Nursing Care for Infant Receiving
Phototherapy
• Temperature is monitored every two to four
hours.
– Weight is taken at least once a day.
– More frequent breastfeeding or 10-20%
extra fluid is provided.
– Urine frequency is monitored daily.
• Serum bilirubin is monitored at least every
12 hours.
• Phototherapy is discontinued if two serum
bilirubin values are < 10 mg/dl.
Nursing Care for Infant Receiving
Phototherapy
• Baby should spend as much time as
possible under the phototherapy lights for it
to be most effective, but your baby can
come out for feeding or cuddles if he or she
is upset.
• Baby will need to have regular (usually
daily) blood tests whilst under photo
therapy to assess the levels of bilirubin and
ensure the phototherapy is effective.

Promoting infant parent interaction.

Side effect of phototherapy
• Bronze – baby syndrome.
• Loss , greenish stool .
• Transient skin rashes.
• Hyperthermia .
• Increasing metabolic rate.
• Dehydration .
• Electrolyte disturbance .
Incubator
 Incubator is an apparatus for
maintaining an infant, especially a
premature infant, in an
environment of controlled
temperature, humidity, and
oxygen concentration.
 Incubators have simple alarm
system to alert the clinical staffs if
there is any danger of
overheating of the device. In
some cases power is reduced
automatically to prevent
overheating
Principle of Incubator
Infant incubator is in the form of
trolley normally with mattress on
the top covered by plastic cover.
This chamber provides a clean
environment and helps to protect
the baby noise, infection, and
excessive handling.
Principle of Incubator
A temperature sensor is tapped
into the baby’s skin and the
incubator heater adjusts to
maintain the baby at a constant
temperature or the temperature is
controlled by thermostat in the
heated air stream.
Purpose of Incubator

An infant may require an incubator for the

following reasons:
When they are not maintaining their own
temperature with clothing and wrapping.
When they are acutely unwell and close
observation is required.
When they are at risk of abnormal heat
loss.
They have a known infection/ or the
potential to develop sepsis.
Purpose of Incubator
1. Maintenance of temperature
2. Provision of desired humidity and
oxygenation
3. Observation of very sick neonates
4. Isolation newborn babies from
infections, unfavourable external
environment
 Main functions of infant incubators are:

1. Temperature control
2. O2 Concentration
3. Humidity control
4. Breathing gas filtration
Indications of incubator
 all premature babies
 babies with low birth weight(<1000g)
 hypothermic child
 Sick children
Types
1. Portable and non portable– Portable
incubation can be used to shift the
patient to another area of hospital as
needed.
2. Open box type- It is also known as
Armstrong, here neonate is keep on
the Plexiglas bassinet to keep unstable
babies or newly born babies. A radiant
warmer can be attached if child needs.
3. Close type - Close type of incubator
has special function to concentrate
fresh air after filtration. It prevents water
loss from radiation. As neonate remain
inside the box the risk of infection is
minimum.
4. Double walled- The incubator has
two walls. As air is not good conductor
of heat the incubator prevents heat and
fluid loss.
.Prepare the incubator
Pre-warmed to a temperature appropriate
to the infant’s age, size and condition.
Use in Air mode and must always be
switched on with the motor running if in
use for a baby.
Check and record the incubator
temperature hourly.
Position away from direct sunlight.
NURSING CARE OF
CHILD IN
INCUBATOR
 Ensure they are familiar with how to
access baby as it is optimal for parents
to continue to touch and provide
comfort.
Maintain a quiet environment
There is no tapping on the canopy.
No equipment is placed on top of the
canopy.
Careful opening and closing of doors.
Adjusting incubator temperature
Default incubator temperature in NICU is
35 degrees
Adjust the incubator temperature by no
more or less than 0.5 of a degree at a
time.
Re-check the temperature within half an
hour of making any adjustment.
Monitoring
Axilla temperature is taken on admission
into the incubator and rechecked in the
first hour.
Temperature is documented 4-6 hourly
as per the condition.
Use of Humidification

 incubator care of preterm babies

Cleaning and sterilization
When the incubator is occupied, it should
be cleaned daily with mild detergent.
Humidifier chamber must be emptied and
cleaned daily, fill with fresh distilled water.
After seven days neonate should be sifted
to another incubator and used incubator
should be cleaned with antiseptic solution.
antiseptic solution add water to prevent
bacterial growth.
THANK YOU