What is Phototherapy? what are the precautions needed to follow when a baby is under Phototherapy?

Phototherapy significantly reduces the bilirubin level content and has been found to be effective in  treating hyperbilirubinemia . This decline is dependent upon the dosage of irradiance and area of skin exposed. Exposure to Phototherapy at particular wavelengths (or colors of light) result in the conversion of unconjugated bilirubin into water soluble photoproducts.These photoproducts are water soluble and non toxic and are excreted in the intestine and urine . The most effective lights for Phototherapy are those with a high energy output near the maximum absorption peak of bilirubin. Special blue light with a peak output of 425-475nm are the most efficient, and yet do not emit harmful ultraviolet (UV ) Ray's.

Following precautions must be taken when a baby is under phototherapy:

•cover infants eyes and genitals. The infants eyes must be covered whenever the phototherapy light is in use . phototherapy uses high intensity lights, and eye coverage is critical to protect against possible retinal damage. Medical experts also recommend that the infants genitals be covered during phototherapy treatment.

• adjust bed height for effective treatment. The distance between surface of infants bed and surface of the units light panel on head unit should be 45 cm.

• Monitor infants bilirubin level. Proper tests should be conducted to measure the bilirubin level in infants blood. It is advised to monitor the infants bilirubin level regularly during treatment, at least every 24 hours.

• monitor infants temperature. Exposure to phototherapy can cause severe hyperthermia. The infants temperature should be monitored every 30 minutes.

•monitor water balance. Prolonged exposure to phototherapy causes dehydration.

•check infants water balance frequently.

•monitor skin reddening. Porphyrins are the by-product of the photochemical breakdown of the bilirubin molecule. In some cases, exposure of porphyrins to phototherapy may result in a localized reddening of the infants skin . These photoisomers of bilirubin may cause toxic effects . Therefore, check for skin reddening frequently.

• The colour of the infants skin is not a direct measure of the bilirubin Contentbin the blood of the infant. Proper clinical tests should be conducted to monitor the bilirubin level in the infants blood.

•donot place any blankets or covers over the infant. Covering the infant with blankets or other insulating objects reduces the effectiveness of the phototherapy treatment and poses a possible risk of overheating of the infant due to heat accumulation.

• when using phototherapy unit with a radiant warmer , make sure the unit is not in the path of the radiant heat rays since this will block heat to the infant , and may damage the phototherapy device.

• protect adjacent patients. Patients near to those being treated by phototherapy should be protected from the phototherapy light . Such protective measures include eye and genitals covering or a protective shield.

• avoid looking directly at the lights on the phototherapy unit. Prolonged exposure to this light may harm the unprotected eyes of the caregiver. For safety , avoid looking directly at the light and inform all caregiver the same.

• protect drugs from light. Light can adversely affect drugs and other infusion liquids. When using intravenous delivery systems during phototherapy, take suitable measures to protect the drugs and liquids.

• donot store drugs near the path of phototherapy light . Donot store drugs, infusion  liquids, flammable solutions or combustible gases within the treatment area.

•donot place any material below the baby . The phototherapy efficiency will be affected if any opaque/cloth material is kept between the baby and acrylic bed.

• inspect regularly. Regularly inspect the bed side panel hinge mechanism and the bed side locking mechanism for proper operation and hence ensure infant safety.

•change the infants position frequently for effective exposure to phototherapy light .

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