Word: Hyperbilirubinemia: Phototherapy

HYPERBILIRUBINEMIA: PHOTOTHERAPY

DOCUMENT TYPE: PROCEDURE

Site Applicability

This document is applicable in BC Women’s Hospital Neonatal Intensive Care and BC Children’s Hospital inpatient areas

Practice Level/Competencies

Physicians and Nurse Practitioners order phototherapy treatment of neonatal jaundice.Registered Nurses provide phototherapy as a treatment.

Equipment & Supplies

Irradiance Order µW/cm2/nmDeviceSettingApprox. irradiance in µW/cm2/nm10-29LED-Neoblue (Natus)Low setting ☼12-15Bili-Blanket Plus (Ohmeda)Low setting1930-49Giraffe Blue Spot PT liteOn30-40LED-Neoblue (Natus)High setting ☼☼30-35Bili-Blanket Plus (Ohmeda)Medium setting32Bilisoft Phototherapy system (Blanket, GE Healthcare)On3530-49 (1st surface: see above) and 50-70 (2nd surface: see right)Combination of biliblanket and lights; one each on front and back surface of infantBili-Blanket Plus (Ohmeda)High Setting45-70Combine Giraffe Blue Spot PT lite and LED-Neoblue (Natus) *depending on measured irradiance the LED neoblue may need to be on low setting high setting ☼OnHigh setting ☼☼This combination will provide 60-75 µW/cm2/nm

Gather EquipmentEye Shields (Biliband™ Eye Protector)Face mask for diapering – optionalLED Phototherapy Light and/or phototherapy blanket with disposable coverNeoblue™ Radiometer or Minolta or Joey Dosimeter maternal-newborn only)Optional:Joey Bed or IsolettePlexiglass shield

Procedure

PreparationNoteIdentify patient using two patient identifiers to confirm treatmenta) Adjust incubator air temperature (in 0.5ºC segments) up to 15 minutes before initiating or discontinuing phototherapyorb) Adjust Joey bed temperature (in 0.5ºC segments) starting at 37.0ºCMonitor infant’s temperature 30 minutes after initiation/discontinuation of phototherapy, then every 4 hours (minimum) or with infant’s feeds (in postpartum)Adjust incubator temperature until infant’s temperature is stable (36.5ºC to 37.0ºC)Monitor for loose stoolsorMonitor infant’s temperature Q1H x 3 after initiating phototherapy, and then with infant’s feeds (approximately Q3H)Adjust joey bed temperature until newborn’s temperature is stable (36.5ºC to 37.0ºCMonitor for loose stoolsPlace and secure eye shields on infantEye shields prevent injury to the conjunctiva and retinaRemove all clothing Infants greater than or equal to (≥) 35 weeks without threat of exchange transfusion, do not need the diaper removed Do not use emollients/creams on skin: Phototherapy may cause burns with use of emollients/creamsEnsure developmental care is provided throughout duration of phototherapy treatmentEngage parents to provide supportNest infantProvide comfort measuresUtilize phototherapy blankets to support skin-to-skinMonitor and record feeding/breastfeeding, urinary output and stools, daily weightObserve for good latch if infant is breastfeedingEnsure wet and soiled diapers are measured and documented (maternal-newborn program may not weigh diapers)Record a daily weight and document weight loss or gain (maternal-newborn program to calculate percentage of weight loss/gain)Initiation NoteChoose appropriate phototherapy equipment. Refer to Hyperbilirubinemia: Phototherapy: EquipmentMay need more than one deviceChoose Joey Bed TM if needed to maintain infant’s temperatureCan be requested from MED Equipment depot under “MEQ-Joey bed”Clean and return to Med Equip Depot soiledSee Joey Bed Warmer ProcedureObtain Radiometer and clean with disinfectant wipe (cavi-wipe)Select the appropriate radiometer to measure the phototherapy device’s irradiationMeasure and document irradiance with all lights upon initiation of phototherapy. In NICU also measure and document irradiance once every shift.Verify irradiance of light at torso skin level Verify irradiance for Biliblanket and Bilisoft by placing radiometer directly on the padPost ProcedureNoteWipe Radiometer with disinfectant wipe (cavi-wipe)Return to designated areaPhysician orders follow-up serum bilirubin level 12 to 24 hours after phototherapy is stoppedTurn phototherapy off when sampling serum bilirubinCheck placement of eye shields every hour and provide ongoing eye care (NICU only)Remove eye shields every 4 hours:Cleanse eyes with normal saline (NICU only)Examine for irritation/inflammation and drynessChange shields every 24 hours (NICU only)Monitor infant’s temperature 1 hour after discontinuation of phototherapyMonitor temperature Q1h x3 or until certain of temperature stability

Documentation

Document family explanation, irradiance level, time phototherapy initiated or discontinued, eye shield changes and eye care, repositioning, daily weight, and hydration assessment on Nursing Flowsheet in NICU and Newborn Clinical Path in postpartum.

References

American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. (2004). Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1), 297-316.

Bilisoft LED Phototherapy System. Retrieved January 2018, from https://www.gehealthcare.com/en/products/maternal-infant-care/phototherapy/bilisoft-phototherapy-system

Canadian Paediatric Society, Fetus and Newborn Committee. (2007)(reaffirmed Feb., 2016). Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks’ gestation). Pediatrics and Child Health, 12(5), 1B-12B.

Maisels, M.J>, Watchko, J.F., Bhutani, (V.K.) & Stevenson, D.K. (2012). An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks gestation. Journal of Perinatology, 32, 660-664

Muchowski, K.E. (2014). Evaluation and Treatment of Neonatal Hyperbilirubinemia. American Academy of Family Physicians, 89(11), 873-878

Neoblue LED phototherapy light and Neoblue LED phototherapy radiometer. Retrieved January, 2018, from https://newborncare.natus.com/products-services/newborn-care-products/jaundice-management/neoblue-blanket-led-phototherapy-system

Appendix

NICU Phototherapy Graphs: Infants of Gestational Age:· ≤24 +6/7 weeks

· 25-27+6/7 weeks

· 28-29+6/7 weeks

· 30-31+6/7 weeks

· 32-33+6/7 weeks

· 34-34+6/7 weeks

Canadian Pediatric Society Graphs:

· Nomogram for evaluation and screening TSB concentration in term and later preterm infants

· Guidelines for intensive phototherapy in infants of 35 or more weeks’ gestation

· Guidelines for exchange transfusion in infants of 35 or more weeks’ gestation

Developed By

Neonatal Program – Senior Practice Leader

Version History

DATE

DOCUMENT NUMBER and TITLE

ACTION TAKEN

18-Dec-2019

C-0506-12-60443 Hyperbilirubinemia: Phototherapy

Approved at: C&W Best Practice Committee

Disclaimer

This document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA. 

C-0506-12-60443 Published Date: 14-Jan-2020

Page 4 of 4 Review Date: 14-Jan-2023

This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current.