Jaundice is a temporary, common, and usually harmless condition that affects most newborn babies. It can affect both premature and full-term babies and the condition goes away on its own during the first week after birth. Jaundice is the yellowing of the skin and eyes, and it is caused when the bilirubin levels in the blood are too high. Bilirubin is a yellow substance present in the red blood cells and is released during the time the body breaks down the red blood cells. This will then leave the body through bowel movements. However, when the body breaks down the red blood cells correctly but cannot remove the bilirubin, it causes jaundice. Phototherapy lights can help the baby’s body and remove the extra bilirubin.
What Is Phototherapy?
Usually, jaundice would disappear within a week or two and would not require any specific treatment in some babies. In some cases, babies might require treatments because of the cause of jaundice, its severity or how old the baby is when jaundice appeared.
Phototherapy is a light treatment that can treat newborn jaundice. It is the process of using light to eliminate the bilirubin in the blood. Phototherapy can be done at home but if jaundice in the newborn is severe, then they would require phototherapy in the hospital.
How Does Phototherapy Help Neonatal Jaundice?
When the baby has normal jaundice, they would not require any special treatment. However, if the bilirubin levels in the baby’s body are high, most healthcare providers would recommend phototherapy (sometimes known as bright light therapy). The blue lights for babies are safe and effective and would not harm the baby’s skin.
The baby will be placed under this light. The light rays would be absorbed by the baby’s skin and blood. Phototherapy works by changing the bilirubin in the baby’s skin into a form that will not cause brain damage or deafness- into a form that can easily pass through their system. Phototherapy must be done until the bilirubin levels in the baby’s body have dropped to the normal level.
How to Prepare an Infant for Phototherapy
Your healthcare provider will provide clear instructions on how to prepare your baby, so there is nothing to worry about. In order to check the baby’s bilirubin levels, healthcare providers may need to take a sample of the baby’s blood. Blood may be drawn more than once from the baby.
Process of Phototherapy in Treating Newborn Jaundice
Sessions for phototherapy for jaundice at home will have the following procedures:
- One or more lights for the procedure will be placed above the baby. The baby will be undressed and only wear a diaper and will be placed on his back so that the most light is absorbed. The healthcare provider may also place the baby on a flexible light pad or wrap him in the light pad. To protect the baby’s eyes from the light, eye covers will be used.
- Your baby has to be comforted during phototherapy sessions, since some babies may feel irritable. You can try anything that would calm your baby down.
- During phototherapy, the baby may feed during his usual timing. Sometimes, the baby may have to be fed more often in order to help remove the bilirubin through his bowel movements. During feeding sessions, healthcare providers usually leave the lights on.
- During phototherapy treatment, your healthcare providers would want to know how much the baby is feeding. This would include formulas, breast milk, or, IV liquid. Therefore, note down how much formula your baby is eating or how long he is being breastfed and tell your healthcare providers. Also, note down how often your baby urinates and the bowel movements and provide that information to your healthcare providers. Sometimes, they may ask you to save the diapers you change in order to measure and weigh them.
- The healthcare providers will closely monitor the baby and keep checking the bilirubin levels. When the levels are low enough, they would turn off the lights. Another blood test will be done within 24 hours to check whether the bilirubin levels are stable. Your baby’s treatment would be over if the levels stay low enough.
Risks and Complications
A rare complication, known as the bronze baby syndrome, may occur when babies with cholestatic jaundice are treated with phototherapy. Since they are exposed to phototherapy lamps, these babies may develop a grey-brown, dark discolouration of urine, skin, and serum. Although the reason for this is not exactly understood, this is believed to be the result of the accumulation of various metabolites.
Another complication is the development of bullae or purpura in babies with congenital erythropoietic porphyria or cholestatic jaundice. Since the blistering and photosensitivity can be extreme in babies with porphyria, babies with a positive family history for this disorder or babies who have already been diagnosed with this would have an absolute contraindication for phototherapy.
Other common risks would include babies getting too warm or too cold during the treatment. He may spit up more or maybe tired and irritable. Dehydration during the sessions is also possible. Babies may get a skin rash or skin burn from the therapy lights. If the baby is not wearing the eye mask, then it could damage the eyes of the baby.
Can You Give Phototherapy to Your Baby at Home?
You can have the lights for the phototherapy delivered to your home and you can ask the providers to teach you how to use them. In order to check the baby’s bilirubin levels, you could have a healthcare provider conduct the required blood tests. The phototherapy lights can be turned off when the level is low enough. Another blood test has to be conducted within 24 hours to check the level of bilirubin in the baby’s body. If the bilirubin level stays low enough, the treatment would be finished. You can remove the lights from your home and consult your paediatrician to know how many hours a day this has to be done. You can keep your newborn warm and safe during this light therapy for babies through the following steps:
1. Keep the room warm
It is best to keep the temperature in your baby’s room between 20°C and 24°C (68°F and 75°F). Decrease the drafts in the room by closing all the doors and windows and make sure the baby is lying in a dry area. This will help the baby stay warm throughout the session.
2. Let the baby only wear a diaper
Before the sessions start, undress the baby except for the diaper. Also, cover the baby’s eyes using an eye cover to protect the eyes from the lights.
3. Place the baby under, or on the lights
Change the baby’s position every 1-2 hours. This will make sure that all the areas of the skin are exposed to the lights. This will also allow the light to break down the bilirubin in the baby’s body as quickly as possible. You could ask your paediatrician about the best ways to position the little one during the phototherapy sessions.
4. Comfort the little one
You will have to comfort the baby during the treatment when he gets irritable or fussy. Talk or sing softly to calm the newborn down. Give him gentle massages or try offering a pacifier. You could also try other relaxing techniques that will help calm your baby down.
5. Feed the newborn in the usual way
During the phototherapy session, the baby may need to feed more often. This will help the body get rid of the bilirubin through bowel movements or urination. Therefore, formula-feeding or breastfeeding during phototherapy can be done.
6. Check the baby’s temperature every 3-4 hours
While the phototherapy lights are on, place a thermometer in the baby’s armpit, and check if the temperature is between 36.1°C and 37.8°C (97°F and 100°F).
If the baby gets too warm, remove the cover from around the lights or open the curtains. Try and decrease the room temperature and check the baby’s temperature every 15 minutes until it becomes normal.
If the baby gets too cold, then wrap him in a blanket and hold the baby close to you. Feed warm formula or breast milk and check the baby’s temperature every 15 minutes until it becomes normal.
7. Record the number of wet or soiled diapers
It is important to record the baby’s temperature and how many soiled or wet diapers he has each day. Your baby should have at least 1 soiled diaper and 6 wet diapers in one day. If the urine levels seem darker, do not worry since this is the bilirubin leaving the baby’s body. The bowel movements may change from yellow to green.
How Long is Phototherapy Generally Needed?
There are no specific guidelines or a certain amount of time when the treatment should be discontinued. The age of the baby and the evidence of hemolysis will impact the duration of phototherapy. In some cases, phototherapy will be needed for 5-7 days while in some cases, it may be required only for about 24 hours or lesser.
The AAP Guidelines recommend that a baby with hyperbilirubinemia, having a level of 18 mg/dL or more, can discontinue phototherapy only when the levels decrease to 13-14 mg/dL. Usually, significant decreases can be seen in the serum bilirubin levels before the phototherapy lights are turned off.
Physical examination, however, is not helpful once phototherapy for infants has started since the yellow colour on the baby’s skin would be temporarily bleached during the process.
Usually, phototherapy is the only procedure required to get rid of the condition. Only a very small number of babies having severe jaundice would require blood transfusions in order to replace the used up red blood cells and dilute the bilirubin.