Phototherapy is recommended for the treatment of jaundice in newborns, which can result from hemolytic disease of the fetus and newborn (HDFN). It is the first line of treatment for jaundice and is safe and effective in treating newborns.
HDFN can be diagnosed during pregnancy or after your baby has been delivered. Treatment in utero reduces the risk of severe anemia, jaundice, and other symptoms of HDFN. However, further treatment is sometimes required postnatally.
One of the symptoms of HDFN is hyperbilirubinemia, when there is a high level of bilirubin in your baby’s blood. This substance builds up when red blood cells break down, leading to jaundice. Phototherapy helps your baby’s liver break down the bilirubin and eliminate it from the bloodstream.
If severe jaundice is left untreated, your baby risks a condition called kernicterus. A type of brain damage, this is a rare complication of high levels of bilirubin in newborns.
What is phototherapy?
Phototherapy, a kind of light therapy, is a fluorescent man-made light in the blue-green spectrum. It is administered by exposing your baby to the light until bilirubin levels fall to a safe level.
How does phototherapy work?
Most commonly, a baby with jaundice is placed under light-emitting diode (LED) phototherapy devices. Another method is for the baby to lie on a blanket that emits a blue fiber-optic light, called a biliblanket. This blanket can also be used at home following discharge to prevent the return of your baby’s jaundice.
The light breaks down the bilirubin, converting it into a water-soluble form that can then be excreted by the body.
What is the procedure?
If your baby has been diagnosed with HDFN or shows signs of jaundice less than 24 hours postnatally, his or her serum bilirubin levels will be tested. Performed either by testing a small amount of blood, or through the skin without a needle, this test will determine the appropriate dose of light to be administered.
Your baby will be placed in a cot or incubator, usually wearing a diaper or with their genitals protected from the light. Phototherapy is most effective if skin surface area exposed to the light is increased.
The lights will be positioned at least 45 cm from your baby. This is to avoid the risk of overheating or burns to your baby’s skin.
To avoid damage to your baby’s eyes during light therapy, eye protectors are routinely used.
Therapy will be paused every 2 hours so you may feed and cuddle your baby and turn them over.
Your baby’s temperature and fluid levels will be regularly monitored. Serum bilirubin levels will be tested every 12 hours to assess the effectiveness of the treatment and its duration. In making the decision to stop phototherapy, your doctor will compare your baby’s bilirubin levels with a chart on maximum bilirubin levels vs gestational age.
Once light therapy has been stopped, your baby will continue to be monitored, in case their serum bilirubin levels increase. If this is the case, your baby will need to recommence therapy until levels fall.
Treatment can last from 24 hours to 5-7 days.
Is phototherapy safe?
Phototherapy is considered safe and effective for the treatment of hyperbilirubinemia. Only minor side effects, including skin rashes, diarrhea, overheating, and dehydration, have been reported. The American Academy of Pediatrics (AAP) recommends phototherapy in newborns in its clinical guidance on the diagnosis and management of hyperbilirubinemia in newborns.
