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Definition of Terms
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 visible on day 3, peaks days 5-7 and resolves by 14 days of age in a term infant and by 21 days in the preterm infant. 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.
**All phototherapy units are to be set on high intensity at all times, regardless of the amount of units in use. This ensures delivery of adequate amounts of blue light via light emitting diodes (LEDs). Therefore, a single unit is classified as a single light and single, double or triple lights refers to the amount of units not the intensity setting. **As per Natus neoBLUE LED phototherapy in-service guide (available on the intranet), mini neoBlue LED phototherapy units deliver the same intensity as the standard unit set on high intensity; the only difference is in the surface area coverage.
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:
(link to phototherapy management document)
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. In the case of infants nearing exchange transfusion level, the infant should not come out of phototherapy to feed as this is a medical emergency. All feeds should be given via a bottle or NGT if feeding is deemed safe
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 however this should be guided by hydration status and electrolyte monitoring.Parenteral nutrition and IV fluids should continue as ordered and may also need to be increased by 10% to account for insensible fluid loss.
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.
More details on the neoBLUE LED lights can be found in the definition of terms.
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Please remember to read the disclaimer.
The development of this nursing guideline was coordinated by Jessica Smith, Clinical Nurse Educator, Butterfly, and approved by the Nursing Clinical Effectiveness Committee. Updated December 2018.