Phototherapy is a common treatment used in neonatal care to manage elevated levels of bilirubin in newborns. Bilirubin is a yellow pigment produced during the breakdown of red blood cells and is typically processed by the liver. In some infants, especially premature babies or those with certain medical conditions, bilirubin levels can become too high, leading to jaundice. Here’s a detailed exploration of when phototherapy is indicated for newborns:
Diagnosis of Jaundice:
Definition:
Jaundice in newborns is characterized by a yellowish tint to the skin and eyes due to elevated bilirubin levels.
Bilirubin Levels:
Phototherapy is usually considered when total serum bilirubin (TSB) levels rise above a certain threshold, which varies based on the infant’s age, gestational age, and risk factors.
Clinical Assessment:
Pediatricians assess jaundice through clinical examination and may use transcutaneous bilirubinometers or blood tests to measure bilirubin levels accurately.
Gestational Age and Birth Weight:
Preterm Infants: Premature babies are more prone to jaundice due to immature liver function and increased breakdown of red blood cells. They often require phototherapy at lower bilirubin levels than full-term infants.
Low Birth Weight: Infants with low birth weight, regardless of gestational age, may also require phototherapy at lower bilirubin levels.
Rate of Bilirubin Rise:
Rate of Increase: Rapidly rising bilirubin levels indicate an increased risk of severe jaundice. Phototherapy may be initiated promptly to prevent bilirubin levels from reaching harmful concentrations.
Monitoring: Close monitoring of bilirubin trends helps healthcare providers determine the appropriate timing and duration of phototherapy.
See also: How to Lower Jaundice in Newborns?
Underlying Conditions:
Hemolytic Disorders:
Infants with conditions such as Rh or ABO blood group incompatibility, glucose-6-phosphate dehydrogenase (G6PD) deficiency, or other hemolytic diseases are at higher risk of jaundice and may require phototherapy even at lower bilirubin levels.
Breastfeeding Jaundice:
Some newborns may experience exaggerated physiologic jaundice due to factors such as insufficient breastfeeding, which can delay bilirubin excretion. Phototherapy may be considered in such cases if bilirubin levels do not decrease with supportive measures.
Clinical Symptoms:
Signs of Acute Bilirubin Encephalopathy (Kernicterus): Although rare, severe jaundice can lead to kernicterus, a condition characterized by bilirubin deposition in the brain. Phototherapy aims to prevent neurotoxicity and long-term neurological complications.
Monitoring and Interventions: Healthcare providers closely monitor clinical symptoms, including lethargy, poor feeding, and abnormal muscle tone, to identify infants at risk of kernicterus.
Duration and Intensity of Phototherapy:
Light Spectrum:
Phototherapy utilizes specific wavelengths of light that convert bilirubin into a water-soluble form that can be excreted by the liver.
Treatment Duration:
The duration of phototherapy depends on the infant’s response to treatment, bilirubin levels, and underlying health conditions.
Intensity and Exposure:
Intensity of phototherapy and duration of exposure are tailored based on the infant’s age, gestational age, bilirubin levels, and clinical response.
Family-Centered Care:
Education and Support:
Healthcare providers educate families about jaundice, phototherapy, and signs of complications.
Breastfeeding Support:
Encouraging breastfeeding while managing jaundice is crucial, as breast milk helps promote bilirubin excretion and supports infant hydration.
Conclusion
Phototherapy is indicated for newborns when bilirubin levels exceed established thresholds based on gestational age, birth weight, rate of rise, and presence of underlying conditions. Early detection and timely intervention with phototherapy can effectively manage neonatal jaundice and reduce the risk of neurotoxicity. Close monitoring and family-centered care play pivotal roles in ensuring positive outcomes for newborns requiring phototherapy.
FAQs
What is the threshold for phototherapy in newborns?
Phototherapy is typically initiated when the total serum bilirubin (TSB) level reaches or exceeds specific thresholds based on the infant’s age, gestational age, and risk factors. Thresholds may vary, but generally, phototherapy is considered when TSB levels are:
Above 15 mg/dL (257 µmol/L) in preterm infants.
Above 18 mg/dL (308 µmol/L) in term infants.
What are the contraindications for phototherapy in newborns?
Contraindications for phototherapy include:
Severe hemolytic disease requiring exchange transfusion.
Conditions that increase the risk of phototherapy-induced complications, such as extremely low birth weight (<1000 grams) or critical illness.
What are the risks of phototherapy in newborns?
Risks of phototherapy include:
Skin Effects: Skin rash, skin irritation, and potential overheating.
Dehydration: Increased risk, especially if adequate hydration is not maintained.
Alteration of Metabolism: Potential for altered calcium and phosphate metabolism.
Bronze Baby Syndrome: Rare condition where prolonged exposure to phototherapy leads to a bronze discoloration of the skin.
Eye Damage: Potential risk if eyes are not adequately protected during treatment.
When to stop phototherapy in neonatal jaundice?
Phototherapy can be stopped when:
Bilirubin levels have decreased to below the threshold for treatment.
Bilirubin levels have reached a plateau and are expected to decrease without further treatment.
The infant shows clinical improvement, such as resolution of jaundice and normal feeding patterns.
