Phototherapy may prevent severe jaundice, a common symptom of hemolytic disease of the fetus and newborn (HDFN), in infants, according to a study recently published in the American Academy of Pediatrics.
In their technical report, the authors conducted a literature review to identify phototherapy practices that align with the American Academy of Pediatrics’ 2022 guidelines on managing jaundice in infants at least 35 weeks of gestation. The report provided an overview of several key aspects of phototherapy, along with its application in a clinical setting.
“Phototherapy is prescribed for treating neonatal hyperbilirubinemia and is performed by exposing newborn infants to light in the blue-green wavelength range,” the authors wrote.
Jaundice, also known as hyperbilirubinemia, is caused by the buildup of a pigment called bilirubin in the blood. Phototherapy treats hyperbilirubinemia by helping the body to more easily break down and remove this excess bilirubin. This prevents severe complications such as bilirubin neurotoxicity.
The authors found that the safest and most effective phototherapy devices are diode lamps that emit light in the blue-green spectrum, are placed at a safe distance and orientation as recommended by the manufacturer and target 35% to 80% of the infants’ body surface area.
Read more about HDFN therapies
Although phototherapy can be used to treat hyperbilirubinemia in infants with HDFN, the authors caution that it may not be effective in newborns experiencing hemolysis who have substantially elevated rates of bilirubin production. Therefore, infants who have HDFN may not respond to phototherapy if they are undergoing active hemolysis.
In terms of clinical considerations, infants receiving phototherapy should be placed in a supine position with an eye mask to prevent possible retinal damage. Treatment can be interrupted for short periods of time for feedings and bonding with parents.
The review also offers a brief overview of alternative therapies to traditional phototherapy. Although the sun does emit light in the blue-green spectrum, unfiltered-sunlight phototherapy exposes infants to damaging ultraviolet and infrared radiation and cannot be administered in prescribed doses. Thus, the authors do not support this method to treat hyperbilirubinemia.
The authors emphasized that many knowledge gaps in the field of phototherapy remain, including the efficacy of home phototherapy, the efficacy of intermittent phototherapy and the development of equipment that can measure the total dose of phototherapy administered.
“When implemented in a timely manner and performed with standardized procedures, phototherapy is a predominantly safe and noninvasive modality that will minimize risk of neonatal brain injury,” they stated.
