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Family Centered Care
This guideline applies to neonates within the first two weeks of life. Phototherapy is the use of visible light to treat severe jaundice in the neonatal period. Approximately 60% of term babies and 85% preterm babies will develop clinically apparent jaundice, which classically becomes visibly apparent on day 3, peaks days 5-7 and resolves by 14 days of age. Treatment with phototherapy is implemented in order to prevent the neurotoxic effects of high serum unconjugated bilirubin. Phototherapy is a safe, effective method for decreasing or preventing the rise of serum unconjugated bilirubin levels and reduces the need for exchange transfusion in neonates.
This guideline provides health care providers with information to understand the causes of neonatal jaundice, the rationale for the use of phototherapy and outlines the care of neonates receiving phototherapy in order to enhance effective phototherapy delivery and minimise complications of phototherapy.
Please note that when charting the TSB level onto the Phototherapy or Exchange Transfusion charts, in the presence of risk factors (sepsis, haemolysis, acidosis, asphyxia, hypoalbuminaemia) TSB values should be plotted on the range 1 lower than the neonate’s gestational age/weight. This is because the risk of developing kernicterus increases in the presence of the above risk factors.The Phototherapy and Exchange Transfusion charts onto which total SBR is plotted are for the first 7.5 and 5 days of life respectively. After the first 5-7 days continue utilising these charts, as levels plateau and can continue to be documented.
During phototherapy neonates require ongoing monitoring of:
Breastfed babies who require phototherapy should continue to breastfeed unless clinically contra-indicated due to other pathology; the neonate’s sucking, attachment and mother’s milk supply should be monitored.Neonates who are receiving enteral feeds of EBM or infant formula should continue to do so. The total fluid intake (TFI) for a 24 hour period may need to be increased by at least 10% to account for insensible fluid loss when a neonate is receiving phototherapy.Parenteral nutrition and IV fluids should continue as ordered and may also need to be increased by 10% to account for insensible fluid loss.
(link to phototherapy management document)
Documentation in the neonates discharge letter and Child Health Booklet should include details about TSB/SBR levels and duration of phototherapy treatment.
Explain to parents the need for and actions of phototherapy, particularly in relation to the need for skin surface to be exposed to the phototherapy light, and hence the need to care for neonates receiving phototherapy to be nursed in a neutral thermal environment. Potential complications of phototherapy and the need for protective eye coverings during phototherapy treatment should be explained. The need for measuring the TSB and need for blood sampling should also be explained. Neonates receiving phototherapy (where there are no other contraindications) can have brief periods where the phototherapy is ceased so that they can be cuddled/breastfed and have their eye covers removed for parent-baby interaction to occur.
Normal hand hygiene measures should be attended to during care of a neonate receiving phototherapy.
Click here to view the evidence table for this guideline.
Please remeber to read the disclaimer.
The development of this nursing guideline was coordinated by Jacquie Whitelaw, PIPER Nurse Educator, and approved by the Nursing Clinical Effectiveness Committee. Updated April 2015.