FAQs About Phototherapy | Newborn Nursery

Phototherapy lights emit light in the blue-green spectrum (wavelengths 430-490nm).  It is NOT ultraviolet light.

“Intensive phototherapy” means the irradiance of the light is at least 30µW/cm2 per nm as measured at the baby’s skin below the center of the phototherapy lamp.  A hand-held radiometer can be used to measure the spectral irradiance emitted by the light.  Because measurements taken directly under the lights will be higher, measurements should ideally be made at several locations and averaged.  The appropriate radiometer will vary based on the phototherapy system used, so manufacturer recommendations should be followed.

With “Conventional phototherapy” the irradiance of the light is less, but actual numbers vary significantly between different manufacturers.  In general, it is not necessary to rountinely measure irradiance when administering phototherapy, but units should be checked periodically to ensure that the lamps are providing adequate irradiance, according to the manufacturer’s guidelines.

In adults, prolonged exposure to blue light can cause retinal damage.  Although retinal damage from phototherapy has not been reported, eye covers for newborns are standard prophylaxis.

A rare complication (bronze baby syndrome) occurs in some infants with cholestatic jaundice when treated with phototherapy.  With  exposure to phototherapy lamps, these infants develop a dark, gray-brown discoloration of skin, urine, and serum.  Although the exact etiology is not understood, this effect is thought to be the result of an accumulation of porphyrins and other metabolites.

Another possibility is the development of purpura or bullae in infants with cholestatic jaundice or congenital erythropoietic porphyria.  Because the photosensitivity and blistering can be severe in infants with porphyria, infants who have this diagnosis or a positive family history for this disorder, have an absolute contraindication for phototherapy.

No, although some people who are around blue lights for prolonged periods will feel nauseated. Yellow plastic placed on the outside of the isolette may mitigate this effect.

There are no specific guidelines for when to discontinue phototherapy.  Evidence of hemolysis and age of the infant will impact the duration.  In some cases, phototherapy will only be needed for 24 hours or less, in some cases, it may be required for 5 to 7 days.  The AAP Guidelines suggest that an infant readmitted for hyperbilirubinemia, with a level of 18 mg/dL or more, should have a level of 13 – 14 mg/dL in order to discontinue phototherapy.  In general, serum bilirubin levels should show a significant decrease before the lights are turned off. 

Physical examination for jaundice is not helpful once treatment has started as the yellow color of the skin is temporarily “bleached” by the phototherapy.

The effectiveness of phototherapy is determined largely by the distance between the lamps and the infant, so phototherapy can easily be intensified by bringing the lamps closer to the infant. Because a closed isolette does not allow the lamps to be moved in close, if there is a concern about the effectiveness of phototherapy, an isolette should not be used.

With the infant in an open bassinet, it is possible to bring the lamps to within 10 cm of the infant. An undressed term infant with not be overheated with this arrangement, however, is is important that halogen spotlights NOT be used. Halogen lights can get hot, and burns may result if used this way.  Special blue, regular blue, and cool white lights are all acceptable alternatives.

Increasing the skin surface area exposed to phototherapy will also maximize treatment.  Commonly, an overhead phototherapy unit is combined with a bili blanket that can be place under the infant. Some of these blankets or pads are rather small, so 2 or 3 of these units may be needed to supply more complete coverage from below. Lining the sides of the bassinet with white blankets or aluminum foil can also increase the effectiveness of phototherapy.

Jaundice in newborns | Raising Children Network

About jaundice in newborns

Jaundice in newborns happens when there’s an overload of bilirubin in a baby’s blood. This can make the baby’s skin and eye whites go yellow.

Bilirubin is a waste product that’s produced when old red blood cells break down. Usually, the liver processes bilirubin and mixes it into bile. Bile then goes from the liver to the digestive tract and finally comes out of the body in poo. In newborns, several things can stop this happening properly, which leads to a bilirubin overload.

Types of jaundice in newborns

Physiological jaundice
In physiological jaundice, babies’ livers aren’t yet developed enough to get rid of bilirubin.

This type of jaundice is very common. It occurs in about 3 in 5 newborns. It usually gets better when your baby’s liver is mature enough to process bilirubin properly.

Breastmilk jaundice
Breastfed babies often get breastmilk jaundice. This is when a chemical in the mother’s breastmilk interferes with the baby’s ability to get rid of bilirubin. This type of jaundice often happens a few days after birth.

Breastmilk jaundice isn’t harmful and usually sorts itself out after several weeks.

Breastfeeding jaundice
Breastfeeding jaundice happens when babies get dehydrated because of problems with breastfeeding. They need fluids to reduce bilirubin levels.

Breastfeeding jaundice usually gets better when babies get more fluids.

Jaundice from delayed cord clamping
Babies can get jaundice if there’s been a delay in getting their umbilical cord clamped and cut. Delayed clamping can cause there to be too many red blood cells in a baby’s blood. It means that there are more red blood cells than normal for the liver to process, so the bilirubin builds up.

This type of jaundice usually just needs monitoring and gets better by itself after 1-2 weeks.

Jaundice from birth interventions
Babies can get jaundice when they’re bruised because of interventions at birth, like forceps birth. The red blood cells from this bruising break down and bilirubin builds up.

This type of jaundice usually just needs monitoring and gets better by itself after 1-2 weeks.

Blood type incompatibility jaundice
This is a rare type of jaundice, which happens when the mother’s and baby’s blood groups are incompatible.

This isn’t usually a problem during a first pregnancy because the mother’s and the baby’s bloodstreams don’t mix. But during the delivery, some of the baby’s blood might mix with the mother’s blood. The mother then develops antibodies that become active during her next pregnancy and cross the placenta to attack a second baby’s red blood cells.

The destruction of these red blood cells in the second baby releases bilirubin into that baby’s bloodstream, which results in jaundice. If this happens, you usually see it in the first 24 hours after birth.

Babies with this kind of jaundice need treatment.

Biliary atresia
Biliary atresia is a rare cause of jaundice in babies.

It happens when the tiny tubes that carry bile from the liver to the intestine don’t work. Babies with this condition usually grow as expected and look well at first, but they get very ill with serious liver disease if they aren’t diagnosed and treated early.

Babies with this kind of jaundice usually start to show signs at 2-8 weeks of age.

Babies with this kind of jaundice need surgical treatment.

Symptoms of jaundice in newborns

Newborn jaundice causes your baby’s skin and the whites of their eyes to go a yellow colour.

The jaundice typically starts on the face and head. If the level of bilirubin increases, the colour spreads to the body.

Babies might also be drowsy and have feeding difficulties.

Babies with biliary atresia also have pale-looking poo and darker urine.

Medical help: when to get it for newborns who have jaundice

Your child and family health nurse, midwife, GP or paediatrician should check and monitor your newborn for jaundice.

You should take your baby to the GP if your baby:

• is unwell, feeding poorly and not gaining enough weight
• has pale poo or dark wee
• looks jaundiced.

Tests for jaundice in newborns

Medical staff might measure the level of your baby’s jaundice using a bilirubinometer, which is a special machine that’s briefly placed on your baby’s skin. But they might also need to do a heel prick test to get a more accurate measurement of the level of bilirubin in your baby’s blood.

Sometimes if the levels of jaundice are high or medical staff are worried that your baby has a more serious condition, your baby will need other tests to find the cause.

Treatment of jaundice in newborns

Treatment for newborn jaundice depends on how serious it is and what has caused it.

Physiological jaundice and jaundice from delayed cord clamping or birth interventions
Babies who develop jaundice several days after birth usually just need careful monitoring by their parents. These babies don’t usually have to stay in hospital.

If your baby’s bilirubin levels are high, they might have phototherapy treatment for a few days. This treatment uses a special type of blue light that helps break down the bilirubin overload.

Babies most commonly get phototherapy by being placed naked in a cot under a phototherapy lamp for 2-3 days in hospital. Some hospitals offer a biliblanket. This is a special blanket for wrapping your baby. You can use a biliblanket to give your baby phototherapy treatment at home. It’s important to supervise your baby when they’re wrapped in a biliblanket.

Most babies cope well with phototherapy treatment. Phototherapy has minimal side effects, although your baby might have a mild rash and runny poo for a few days. Some babies have small fluid losses during phototherapy, so they might need extra feeds.

Breastmilk jaundice
If your baby has breastmilk jaundice, you can keep breastfeeding. This type of jaundice is usually mild and should get better by itself with time. Talk with your child and family health nurse or doctor if you’re worried about what to do.

Breastfeeding jaundice
Babies with breastfeeding jaundice get better when they have more feeds. Your child and family health nurse or a lactation consultant can help with breastfeeding.

Severe or blood type incompatibility jaundice
Severe jaundice, in which bilirubin levels are very high, might need treatment with an exchange transfusion. This is when a baby’s own blood is replaced with compatible fresh blood. This is usually a treatment for blood type incompatibility jaundice, but it isn’t common.

Biliary atresia jaundice
If your baby has jaundice caused by biliary atresia, they’ll need an urgent operation to help with bile drainage.

If severe jaundice isn’t treated, it can cause brain damage.

Prevention of jaundice in newborns

Only jaundice caused by a certain type of blood incompatibility is preventable.

If your doctor or health professional thinks this type of jaundice might be a problem, you’ll get an anti-D injection immediately after delivery. This can prevent complications in subsequent pregnancies.

Breastfeeding with jaundice | how to do it right

The experience of generations shows that it is quite possible to cure the jaundice of a newborn only by sunbathing. After all, this is how our grandmothers and their grandmothers, and many people before us, were treated. The sunbathing method is old, so it seems tried and true. And mothers today do not see the need for phototherapy, believing that lying in the sun for a child will be much more useful than under the light of complex medical devices.

However, modern research shows that sunbathing is not only ineffective, it is also dangerous. Of course, it is possible to cure jaundice with their help, but only in theory. In practice, the child must be healthy as an ox to survive such therapy. Let’s see why.

Ultraviolet exposure

Many doctors recommend avoiding sun exposure even for adults, let alone a child. During sunbathing, not only useful, healing light, but also harmful ultraviolet radiation enters the skin. It is carcinogenic and causes cancer.

Unlike solar treatments, phototherapy involves the use of soft blue light, without any ultraviolet light. It best breaks down bilirubin molecules and is safe for the child.

Burns and overheating

Coming south, we try to avoid long exposure to the sun until the skin tans. However, we consider it normal to place the baby in direct sunlight as a treatment. Meanwhile, the delicate skin of a child is not yet able to defend itself from the aggressive effects of the heavenly body. Yes, and thermoregulation in a newborn is poorly developed. As a result, during “useful baths”, the baby will easily get burned or sunstroke.

Certified phototherapy equipment goes through many tests to ensure that the baby is safe. The thermal effect there is minimal, so burns are excluded, as well as overheating.

Unfortunate climate

Children are born all year round, and the climate in many places on the planet is far from sunny. In winter, the healing sun still needs to be caught. However, in summer the number of clear days also depends on the location of the windows, the weather. At the same time, the treatment of neonatal jaundice requires an almost continuous presence of the child in the light. To provide it with the help of sunbathing is simply impossible.

Restrictions on treatment time

Due to the risk of burns, heat stroke, the harmfulness of ultraviolet radiation, it is impossible to organize sunbathing for longer than 15 minutes. But, even if it is possible to organize several sessions a day, this is not enough to cure jaundice. The minimum rate is 96 hours, and the faster they pass, the less the risk of complications from elevated bilirubin. Phototherapy makes it possible to treat the baby with long sessions at any time of the day. At the same time, he is comfortable and calm.

Hypothermia and colds

Another risk of sunbathing is hypothermia. When lying in the sun, the child should be naked, which means that he can freeze. It is almost impossible to create a comfortable temperature during the procedure. But it is available to those who have chosen phototherapy: a heater can be placed near the lamp, and the device itself can be placed away from drafts and open windows.

Unpredictable effect

We cannot regulate the sun, so no one can guarantee the effectiveness of sunbathing. Sometimes the sun is too strong and burns the baby’s skin. On other days, on the contrary, it shines too weakly and does not help to remove toxic bilirubin. In general, even if the baby managed to lie in the sun for 96 hours, there is no guarantee that it will work. The photo lamp always shines in the same way with exactly the intensity that is needed. At the same time, its radiation is completely safe.

Discomfort for child and parents

Children do not like bright lights. Being under the sun, they cry, act up. Moms and dads also have to face inconvenience: they have to either bring the baby to the window, or rearrange the crib. Using a photo lamp, parents simply rock the baby in a special hammock, where he sleeps peacefully. The bed lamp is easy to move around the apartment, you can even take it with you to bed.

Complications and risk of hospitalization

Sunbathing is not effective enough, so the child needs additional treatment. As a rule, these are medicines, which, however, also do not always help to achieve the desired result. In the testimony of many, there is not even information that they can be used to treat neonatal jaundice. But there are side effects:

Why do doctors still use them? They follow outdated treatment standards that were developed in case the clinic did not have phototherapy lamps.

The higher the bilirubin level rises, the more the child’s condition worsens. As a result, the doctor may decide to put the baby in a hospital. Most often, a mother with a newborn will not be able to lie down together, because he will be placed in a special room under photo lamps. As a result, the child will still undergo phototherapy, but with stress for the whole family, interruption of breastfeeding and deterioration in the general condition of the body. The effects of stress at an early age will undoubtedly manifest a little later in adulthood in the form of weakness, morbidity, and sometimes deterioration in cognitive functions.

Phototherapy at home is no different from hospital phototherapy. But at home, the baby does not face stress, eats well, gains weight, recovers faster.

Having examined all the shortcomings of sunbathing, we can make an unambiguous conclusion: they are not suitable as the main method of treating jaundice. Moreover, it is better to exclude them altogether, limiting the time the child spends in the sun for a quarter of an hour.

How much sun is enough for your child? – Magazine

Bone health is essential for upright posture and stable walking. Only sunlight, more precisely, ultraviolet radiation, allows the children’s skeleton to develop. Most of the bones of a newborn are made up of cartilage, which undergoes gradual ossification. Bone mineralization itself begins when children receive calcium and phosphorus from their diet: both trace elements are then incorporated into bone development under the influence of vitamin D.

Most foods contain only small amounts of vitamin D, although fish oils and oily fish contain quite a lot. But thanks to UV radiation, we can produce the necessary amount of vitamin D ourselves: this happens when enough sunlight hits the skin.

If there is a lack of vitamin D, the bones cannot develop properly. In infants, acute vitamin D deficiency can lead to rickets, so taking this vitamin, for example, is recommended for babies in Germany. While breast milk, the best food for infants, contains relatively little vitamin D, commercial infant formula should be fortified with vitamin D (up to 15 micrograms or 600 IU/litre).

To ensure sufficient vitamin D in the skin, infants and older toddlers should be exposed to the sun for 30-60 minutes a day: enough if only the face is exposed and facing a clear sky. Babies don’t need direct sunlight, and they certainly shouldn’t be out in the open without clothes, losing body heat.

But too much sunlight can be harmful, especially for babies and young children. At a tender age, a baby’s skin is thin and has few melanocytes (skin cells that produce the protective pigment melanin). This means that even a relatively short period of sun exposure can cause sunburn. Like any other burn, it is manifested by reddening of the skin, and in severe cases leads to the formation of blisters. Sun exposure during childhood can greatly increase the risk of developing skin cancer. This is partly because the child’s immune system is not yet fully developed, so it cannot repair the cell damage caused by the sun’s rays.