Phototherapy is one of the most common treatments for newborns, especially in the first few days of life. It is a medical treatment used to treat jaundice in infants. Jaundice is a condition where a baby’s skin and the whites of their eyes turn yellow because of high levels of bilirubin in the blood. Bilirubin is a yellow pigment that forms when red blood cells break down. While jaundice is very common in newborns, it requires careful monitoring and treatment to prevent complications. Phototherapy helps break down this bilirubin in the baby’s body, allowing it to be excreted more easily.
In this article, we will discuss when phototherapy is indicated for newborns, how it works, and why it is necessary for the treatment of jaundice.
Understanding Jaundice in Newborns
Jaundice is very common among newborns, affecting about 60% of full-term infants and almost all premature babies. It occurs when there is too much bilirubin in the blood. Bilirubin is produced when the liver breaks down old red blood cells. In newborns, their livers are still developing and may not be able to process bilirubin efficiently, leading to a buildup of this substance in the blood.
While jaundice in newborns is typically mild and resolves on its own, in some cases, it can become severe and require treatment like phototherapy.
Types of Jaundice
There are two main types of jaundice that can affect newborns:
Physiological Jaundice: This is the most common type of jaundice in newborns. It usually appears on the second or third day after birth and often resolves by itself within one to two weeks. This type of jaundice is usually mild and does not require medical treatment, though it still needs to be monitored.
Pathological Jaundice: This type of jaundice occurs when there is an underlying condition that causes the bilirubin level to rise. Pathological jaundice can appear within the first 24 hours of life and may require treatment to prevent complications. This is when phototherapy is most commonly indicated.
Why is Phototherapy Used?
Phototherapy works by using light to break down bilirubin in the baby’s skin. The light changes the structure of the bilirubin molecules, making them easier for the liver to process and excrete. This helps to lower the bilirubin levels in the baby’s blood. Phototherapy is typically done using a special light or a light bed, and it is often used for newborns with jaundice who have higher-than-normal bilirubin levels.
The light used in phototherapy can be either blue or white, and it is emitted from special lamps that are placed over the baby. The baby is usually undressed to maximize the skin’s exposure to the light, though only the baby’s face and torso are typically exposed. The baby’s eyes are protected with special eye patches to prevent damage from the light.
Indications for Phototherapy in Newborns
Phototherapy is generally indicated when a newborn has jaundice and the bilirubin levels are high enough to pose a risk to their health. While mild jaundice usually resolves on its own, more severe jaundice can lead to complications if not treated. The key indicators for phototherapy include the bilirubin level, the baby’s age, and the presence of any underlying conditions.
1. Bilirubin Levels
The most important factor in deciding whether phototherapy is needed is the baby’s bilirubin level. The bilirubin level is measured in micrograms per deciliter (mcg/dL) and can be determined by a blood test. The higher the bilirubin level, the more urgent it is to begin treatment.
The decision to start phototherapy depends on the following:
Bilirubin levels above 12 mg/dL: In most full-term infants, phototherapy is usually recommended when the bilirubin level is above 12 mg/dL, especially if the levels continue to rise.
Bilirubin levels above 15 mg/dL: For infants who are more than 48 hours old, phototherapy may be considered when the bilirubin level is higher than 15 mg/dL.
Bilirubin levels above 20 mg/dL: If bilirubin levels reach this point, there is a high risk of serious complications like kernicterus (a form of brain damage caused by very high levels of bilirubin), and urgent phototherapy is necessary.
2. Age of the Newborn
The age of the newborn plays an important role in determining the need for phototherapy. Bilirubin levels typically rise within the first few days of life, and jaundice can become more pronounced in the first 48 to 72 hours.
Newborns less than 24 hours old: Jaundice that develops within the first 24 hours of life is more likely to be caused by pathological factors, such as blood group incompatibility or an infection. This type of jaundice requires careful monitoring and may require early intervention like phototherapy.
Newborns aged 24-48 hours: Jaundice that appears during this period is usually physiological, but if the bilirubin levels are high enough, phototherapy may be needed.
Newborns older than 48 hours: In older infants, jaundice is generally physiological, but if bilirubin levels continue to rise or reach dangerous levels, phototherapy is indicated.
3. Premature Babies
Premature infants, or those born before 37 weeks of gestation, are at a higher risk of jaundice due to their underdeveloped liver function. These babies are more likely to have higher bilirubin levels, and phototherapy may be required even if their bilirubin levels are slightly lower than in full-term infants. Phototherapy is often started at lower bilirubin thresholds for preterm infants to prevent complications.
4. Blood Group Incompatibility
One of the main causes of pathological jaundice in newborns is blood group incompatibility. If a mother and her baby have different blood types, such as the mother being Rh-negative and the baby being Rh-positive, the mother’s immune system may produce antibodies that attack the baby’s red blood cells. This leads to an increase in bilirubin levels. Phototherapy is commonly used to treat jaundice caused by this type of incompatibility.
5. Other Medical Conditions
In some cases, jaundice in newborns may be caused by other medical conditions, such as infections, enzyme deficiencies, or internal bleeding. If jaundice is caused by an underlying medical condition, phototherapy may be used as part of a broader treatment plan to manage the baby’s health.
How is Phototherapy Administered?
Phototherapy is typically done in a hospital setting, although it can be performed at home in some cases. The baby is placed under a special phototherapy light, either in a bassinet or a light bed. The baby is usually dressed in only a diaper to allow maximum skin exposure to the light, and their eyes are protected with eye patches or a mask to prevent retinal damage.
The treatment typically lasts for several hours a day, with the exact duration depending on the bilirubin levels and the baby’s response to the therapy. The baby’s bilirubin levels are closely monitored to ensure that the treatment is effective. In some cases, multiple sessions of phototherapy may be required.
Risks and Side Effects of Phototherapy
While phototherapy is generally safe and effective, there are some potential risks and side effects to be aware of. These may include:
Dehydration: Phototherapy can lead to dehydration, as the baby may urinate more frequently due to the breakdown of bilirubin. It is important to ensure that the baby is well-hydrated and fed regularly during treatment.
Skin Rash or Diaper Rash: The baby’s skin may become irritated due to prolonged exposure to the light. Applying a barrier cream or changing diapers frequently can help reduce the risk of skin irritation.
Temperature Regulation Issues: Newborns may have difficulty maintaining their body temperature during phototherapy. The room temperature is usually regulated, and the baby’s temperature is monitored to ensure it stays within a healthy range.
Eye Damage: To prevent retinal damage, the baby’s eyes must be protected during phototherapy. However, if the eyes are not properly shielded, there is a risk of harm to the eyes.
Conclusion
Phototherapy is an essential treatment for managing jaundice in newborns, particularly when bilirubin levels rise to dangerous levels. It is used to safely break down excess bilirubin and reduce the risk of complications, including brain damage. By understanding the indications for phototherapy, such as elevated bilirubin levels, the age of the newborn, and any underlying medical conditions, healthcare providers can ensure timely and appropriate treatment. While phototherapy is typically safe, close monitoring is necessary to minimize any risks or side effects. If you have concerns about jaundice in your newborn, it is important to discuss them with your pediatrician to ensure that the appropriate treatment is given at the right time.
Related topics:
