CLASSIFICATION OF NEONATAL JAUNDICE
PHYSIOLOGIC JAUNDICE NURSING CARE DURING PHOTOTHERAPY
- Appears after 24 hours - Position phototherapy units no more than 30.5cm
- Maximum intensity by 4th-5th day in term and 7th day from the patient. NeoBLUE LED phototherapy unit
in preterm. can be positioned as close as 15cm to patient. Refer
- TSB levels within normal centiles for age in hours to specific phototherapy units manufacturing
based on normogram. guidelines for more details.
- Clinically not detectable after 14 days - Expose as much of the skin surface as possible to the
- Disappears without any treatment. phototherapy light. To maximize skin exposure, dress
PATHOLOGIC JAUNDICE the baby in a nappy and their protective eye covers
- Appears within 24 hours of age only.
- Increase of bilirubin > 5 mg / dl / day or at a rate of > - Cover the eyes with appropriate opaque eye covers.
0.2mg / dl / hr - Ensure eye covers are removed 4-6 hourly for eye
- Serum bilirubin >95 percentile for age in hours care during infant cares or feeding. Observe for
based on normogram. discharge/infection/damage and document any
- Jaundice persisting after 14 days in full-term babies. changes.
- Stool clay / white colored and urine staining clothes - Daily fluid requirements should be reviewed and
yellow. individualized for gestational and postnatal age.
- Direct bilirubin > 2mg / dl / or >20% of TSB - Maintain a strict fluid balance chart.
- Breast feeds may need to be limited to 20 minutes if
PHOTOTHERAPY bilirubin level is high to minimize amount of time out
- Application of a special source of light (irradiance) to of the lights.
the infant’s exposed skin. - Monitor vital signs and temperature at least 4 hourly,
- Light promotes bilirubin excretion by more often if needed.
photoisomerization (alters structure of bilirubin to a - Cover lipid lines with light resistant, reflective tape to
soluble form called Lumirubin for easier excretion). avoid peroxidation.
- Best results occur within the first 4 to 6 hours of - Ensure that phototherapy unit is turned off during
phototherapy. collection of blood for TSB/SBR levels, as both
- Designed primarily for the treatment of moderate conjugated and unconjugated bilirubin are photo-
hyperbilirubinemia. oxidized when exposed to white or ultraviolet light.
Indication: - Observe for signs of potential side effects.
- Treatment of hyperbilirubinemia
- Helps liver in processing bilirubin POTENTIAL COMPLICATIONS
- Prevent kernicterus - Overheating – monitor neonate’s temperature
Factors affecting Efficacy of Phototherapy: - Water loss from increased peripheral blood flow and
- Type of light used (Blue fluorescent light or white diarrhea (if present)
fluorescent light – 430 – 490NM) - Diarrhea from intestinal hypermotility
- Light intensity (10 – 12 uW/cm2) - Ileus (preterm infants)
- Surface area of skin exposed to light - Rash
- Distance of light source from the baby (35cm – 50cm - Retinal damage
in conventional lights) - ‘bronzing’ of neonates with conjugated
hyperbilirubinemia
BENEFITS OF PHOTOTHERAPY - Temporary lactose intolerance
- The jaundice can be treated
- Preventing the need for more invasive treatment and
the serious complications, which can occur if
excessive levels of bilirubin develop.
- Phototherapy is safe
- Effective method of treatment
- It provides the highest level of therapeutic light
available to treat the baby. This is the same form of
light found in sunlight. This is safe than sunlight
though, because it filters out the harmful ultraviolet
and infrared energy.
PHYSIOLOGIC JAUNDICE NURSING CARE DURING PHOTOTHERAPY
- Appears after 24 hours - Position phototherapy units no more than 30.5cm
- Maximum intensity by 4th-5th day in term and 7th day from the patient. NeoBLUE LED phototherapy unit
in preterm. can be positioned as close as 15cm to patient. Refer
- TSB levels within normal centiles for age in hours to specific phototherapy units manufacturing
based on normogram. guidelines for more details.
- Clinically not detectable after 14 days - Expose as much of the skin surface as possible to the
- Disappears without any treatment. phototherapy light. To maximize skin exposure, dress
PATHOLOGIC JAUNDICE the baby in a nappy and their protective eye covers
- Appears within 24 hours of age only.
- Increase of bilirubin > 5 mg / dl / day or at a rate of > - Cover the eyes with appropriate opaque eye covers.
0.2mg / dl / hr - Ensure eye covers are removed 4-6 hourly for eye
- Serum bilirubin >95 percentile for age in hours care during infant cares or feeding. Observe for
based on normogram. discharge/infection/damage and document any
- Jaundice persisting after 14 days in full-term babies. changes.
- Stool clay / white colored and urine staining clothes - Daily fluid requirements should be reviewed and
yellow. individualized for gestational and postnatal age.
- Direct bilirubin > 2mg / dl / or >20% of TSB - Maintain a strict fluid balance chart.
- Breast feeds may need to be limited to 20 minutes if
PHOTOTHERAPY bilirubin level is high to minimize amount of time out
- Application of a special source of light (irradiance) to of the lights.
the infant’s exposed skin. - Monitor vital signs and temperature at least 4 hourly,
- Light promotes bilirubin excretion by more often if needed.
photoisomerization (alters structure of bilirubin to a - Cover lipid lines with light resistant, reflective tape to
soluble form called Lumirubin for easier excretion). avoid peroxidation.
- Best results occur within the first 4 to 6 hours of - Ensure that phototherapy unit is turned off during
phototherapy. collection of blood for TSB/SBR levels, as both
- Designed primarily for the treatment of moderate conjugated and unconjugated bilirubin are photo-
hyperbilirubinemia. oxidized when exposed to white or ultraviolet light.
Indication: - Observe for signs of potential side effects.
- Treatment of hyperbilirubinemia
- Helps liver in processing bilirubin POTENTIAL COMPLICATIONS
- Prevent kernicterus - Overheating – monitor neonate’s temperature
Factors affecting Efficacy of Phototherapy: - Water loss from increased peripheral blood flow and
- Type of light used (Blue fluorescent light or white diarrhea (if present)
fluorescent light – 430 – 490NM) - Diarrhea from intestinal hypermotility
- Light intensity (10 – 12 uW/cm2) - Ileus (preterm infants)
- Surface area of skin exposed to light - Rash
- Distance of light source from the baby (35cm – 50cm - Retinal damage
in conventional lights) - ‘bronzing’ of neonates with conjugated
hyperbilirubinemia
BENEFITS OF PHOTOTHERAPY - Temporary lactose intolerance
- The jaundice can be treated
- Preventing the need for more invasive treatment and
the serious complications, which can occur if
excessive levels of bilirubin develop.
- Phototherapy is safe
- Effective method of treatment
- It provides the highest level of therapeutic light
available to treat the baby. This is the same form of
light found in sunlight. This is safe than sunlight
though, because it filters out the harmful ultraviolet
and infrared energy.
