Phototherapy

Photo therapy:

DEFINITION:

 It is non invasive, inexpensive procedure and easy method of degradation of unconjugated bilirubin by photo-oxidation.

MECHANISM OF ACTION:

Geometric photoisomerization:The light waves convert the toxic bilirubin into water soluble non- toxic (lumirubin) form which is easily excreted from the blood in the bile, stool and urine by the process of photoisomerization . It enhances hepatic excretion of unconjugated bilirubin to the intestinal lumen.

Oxidation mechanism resulting in colorless buproducts and excreted by liver and kidney without need for conjugation. This is the least important mechanism.

Converting bilirubin to lumirubin through structural isomerization. Which can be excreted into the bile without the need for further hepatic conjugation.

INDICATION OF  PHOTOTHERAPY:

Infants weighing 1500g is at level of 5 to 8 mg/dl.

For those weighing 1500 to 1999g level\s of 8to 12mg/dl

For those weighing 2000 to 2499g, level of 11 to 14 mg/dl.

Prophylactic treatment of low birth weight baby, bruised babiesand preterm babies.

TECHNIQUES OF PHOTOTHERAPY:

1. Blue light is more effective for phototherapy. It interferes with  observation of skin color of the baby.

2. White day light lamps are also effective. A combination of white and blue lamps are prefered.

3. The wave length of the light should have in the range of 420 to 600 nm for maximum absorbtion of skin color of the baby.

4. A baby care unit with  to 8 light source or tube lights can be used which should be covered with plastic sheet or flexi glass. Light source is flexed over crib or incubator or it can be portable type.

5. A naked infant is lying on a fiberoptic blanket under the light source at a distance of about 45cm from the skin of the baby.

6. It can be reduced to 15 to 20cm for intensive phototherapy.

7. Best result occur with in the firt 24 to 48 hours of treatment.

TYPES OF PHOTOTHERAPY:

1. Single side phototherapy

2. Double side phototherapy

Depending upon the severity of the condition type of phototherapy will be selected.

AN ALTERNATIVE TO TRAITIONAL PHOTOTHERAPY:

Bililight is the fiberoptic blanket or panal. Which consist of light generating illuminator, a bundle of plastic fibers affixed to a panel that distributes the energy and a soft, disposable, light permeable cover to protect the infant. The blanket delivers therapeutic light consistently and continuously to the infant and achieve photoisomerization as conventionally phototherapy. The fiberoptic blanket is especially suited for home phototherapy.  

WHEN TO DISCONTINUE THE PTHOTOTHERAPY:

When serum bilirubin level are less than 10mg/dl for two times.

Intensive phototherapy usually reduce 1 to 2 mg/dl of serum bilirubin within 4 to 6 hours of exposure.

NURSING CARE:

NURSING ACTION

RATIONALE

1. Assess the need For phototherapy. Check level of bilirubin and skin color 2. Get consent from the parents Feed the baby before placing on the phototherapy 3. Check vitals and weight of the baby 4. Cover the eye of the baby 5. Cover the genetalia with diaper 6. Position the child every 2 hours or after each feed. 7. Temperature should be recorded every 2 hourly 8. More frequent breast feeding should be encouraged 9. Extra fluids should be administered through IV infusion or NG tube feeding. 10. Baby weight should be recoded once in a day. 11. Switch off the light every 2 hours 12. Constant supervision should be made for urine, stool, skin changes (cyanosis, pallor, and jaundice) and behavioral changes. 13. Serum bilirubin  level to be estimated every 12 hours. 14. Maintain records of frequency, length, duration of phototherapy and intake out put chart.

To know the indication for phototherapy For legal safeguard To prevent hypoglycemia and to know whether ptototherapy  is inducing hypothermia or any other condition.and to determine dehydration. To prevent retinal damage. To prevent gonadal damage. For maximum exposure to light. To determine hypothermia or hyperthermia. To prevent dehydration To prevent dehydration To calculate requirement of IV fluids and caloric. To prevent hyperthermia. To note for improvement or compication To terminate the phototherapy. To make evaluation

COMPLICATION OF PHOTOTHERAPY:

I.Short term complication:

Dehydration

Hypothermia

Hyperthermia

Loose stool or green stool

Bronze baby syndrome

Electric shock

Skin rash.

Hypocalcemia

II. Long term complication:

Disturbances of endocrine

Sexual maturation

Retinal damage

Skin cancer

BIBLIOGRAPHY:

Datta Parul (2007) “Pediatric Nursing” J.B. medical publication, new Delhi, Pp-100

Ghai .O.P (2004) “Essential Pediatrics”, 6^th edition, CSB publishers and distributors, Pp- 172-173

Wong’s( 2005) , “ Essentials of Pediatric Nursing” 7^th edition, Elsevier publication, New Delhi, Pp- 264 to 267.