Phototherapy

It is important to note that a rebound increase in the bilirubin levels is common when phototherapy is ceased, and that the increased insensible water losses - for example from the skin from vasodilation and increased blood flow - should be compensated for with increased fluid input.

Measuring and monitoring bilirubin thresholds before and during phototherapy

Before starting phototherapy

In babies who are clinically well, have a gestational age of 38 weeks or more and are more than 24 hours old, and who have a bilirubin level that is below the phototherapy threshold but within 50 micromol/litre of the threshold (see the threshold table and the treatment threshold graphs), repeat bilirubin measurement as follows:

• within 18 hours for babies with risk factors for neonatal jaundice (those with a sibling who had neonatal jaundice that needed phototherapy or a mother who intends to exclusively breastfeed)
• within 24 hours for babies without risk factors

In babies who are clinically well, have a gestational age of 38 weeks or more and are more than 24 hours old, and who have a bilirubin level that is below the phototherapy threshold by more than 50 micromol/litre (see the threshold table and the treatment threshold graphs), do not routinely repeat bilirubin measurement.

Do not use phototherapy in babies whose bilirubin does not exceed the phototherapy threshold levels in the threshold table and the treatment threshold graphs.

Type of phototherapy to use

• do not use sunlight as treatment for hyperbilirubinaemia.
  
  
• use phototherapy to treat significant hyperbilirubinaemia (see the threshold table and the treatment threshold graphs) in babies.
  
  
• consider intensified phototherapy to treat significant hyperbilirubinaemia in babies if any of the following apply:
  
  
  • the serum bilirubin level is rising rapidly (more than 8.5 micromol/litre per hour)
    
    
  • the serum bilirubin is at a level within 50 micromol/litre below the threshold for which exchange transfusion is indicated after 72 hours (see threshold table and the treatment threshold graphs)
    
    
  • the bilirubin level fails to respond to initial phototherapy (that is, the level of serum bilirubin continues to rise, or does not fall, within 6 hours of starting phototherapy)
    
    
• if the serum bilirubin level falls during intensified phototherapy to a level 50 micromol/litre below the threshold for which exchange transfusion is indicated reduce the intensity of phototherapy

Phototherapy given using an artificial light source with an appropriate spectrum and irradiance. This can be delivered using light-emitting diode (LED), fibreoptic or fluorescent lamps, tubes or bulbs.

Intensive phototherapy - given with an increased level of irradiance with an appropriate spectrum. Phototherapy can be intensified by adding another light source or increasing the irradiance of the initial light source used.

Monitoring the baby during phototherapy

During phototherapy:

• using clinical judgement, encourage short breaks (of up to 30 minutes) for breastfeeding, nappy changing and cuddles
• continue lactation/feeding support
• do not give additional fluids to babies who are breastfed.

Maternal expressed milk is the additional feed of choice if available, and when additional feeds are indicated.

During intensified phototherapy:

• do not interrupt phototherapy for feeding but continue administering intravenous/ enteral feeds
• continue lactation/feeding support so that breastfeeding can start again when treatment stops.

Maternal expressed milk is the additional feed of choice if available, and when additional feeds are indicated.

Reference:

• NICE (May 2016). Jaundice in newborn babies under 28 days - update.