II. Indications: Preterm Infant
- Weight <1250 grams
- Uncomplicated: Total Bilirubin > 13 mg/dl
- Complicated: Total Bilirubin > 10 mg/dl
- Weight <1500 grams
- Uncomplicated: Total Bilirubin > 15 mg/dl
- Complicated: Total Bilirubin > 13 mg/dl
- Weight <2000 grams
- Uncomplicated: Total Bilirubin > 17 mg/dl
- Complicated: Total Bilirubin > 15 mg/dl
- Weight <2500 grams
- Uncomplicated: Total Bilirubin > 18 mg/dl
- Complicated: Total Bilirubin > 17 mg/dl
- Weight >2500 grams
- Uncomplicated: Total Bilirubin > 20 mg/dl
- Complicated: Total Bilirubin > 18 mg/dl
III. Indications: Term Infant Overview
- Age <24 hours
- Age 25-48 hours
- Uncomplicated: Total Bilirubin 15-25 mg/dl
- Complicated: Total Bilirubin 12 mg/dl or higher
- Exchange Transfusion for Bilirubin 25 mg/dl or higher
- Age 49-72 hours
- Uncomplicated: Total Bilirubin 18-30 mg/dl
- Complicated: Total Bilirubin 15 mg/dl or higher
- Exchange Transfusion for Bilirubin 30 mg/dl or higher
- Age >73 hours
- Uncomplicated: Total Bilirubin 20-30 mg/dl
- Complicated: Total Bilirubin 17 mg/dl or higher
- Exchange Transfusion for Bilirubin 30 mg/dl or higher
IV. Indications: Phototherapy in term infants (>36 weeks and >2 kg, or >35 weeks and >2.5 kg)
- See Severe Neonatal Hyperbilirubinemia Risk Factor
- Phototherapy is indicated when a threshold is crossed based on an infants Hyperbilirubinemia risk factors
- High Risk Infant
- Gestational age >35 weeks AND <38 weeks AND Severe Neonatal Hyperbilirubinemia Risk Factor
- Intermediate Risk Infant
- Gestational age >38 weeks AND Severe Neonatal Hyperbilirubinemia Risk Factor OR
- Gestational age >35 weeks AND <38 weeks AND No Risk Factors
- Low Risk Infant
- Gestational age >38 weeks AND No Risk Factors
- High Risk Infant
- Age 12 hours of life
- High risk Infant: Serum Bilirubin >3.9 mg/dl
- Intermediate risk Infant: Serum Bilirubin >5 mg/dl
- Low risk Infant: Serum Bilirubin >7.1 mg/dl
- Minimal risk transcutaneous Bilirubin <4 mg/dl
- Age 24 hours of life
- High risk Infant: Serum Bilirubin >4.9 mg/dl
- Intermediate risk Infant: Serum Bilirubin >6 mg/dl
- Low risk Infant: Serum Bilirubin >7.7 mg/dl
- Minimal risk transcutaneous Bilirubin <5.5 mg/dl
- Age 36 hours of life
- High risk Infant: Serum Bilirubin >7 mg/dl
- Intermediate risk Infant: Serum Bilirubin >9 mg/dl
- Low risk Infant: Serum Bilirubin >11 mg/dl
- Minimal risk transcutaneous Bilirubin <8 mg/dl
- Age 48 hours of life
- High risk Infant: Serum Bilirubin >8.6 mg/dl
- Intermediate risk Infant: Serum Bilirubin >10.8 mg/dl
- Low risk Infant: Serum Bilirubin >13.1 mg/dl
- Minimal risk transcutaneous Bilirubin <9 mg/dl
- Age 60 hours of life
- High risk Infant: Serum Bilirubin >9.6 mg/dl
- Intermediate risk Infant: Serum Bilirubin >12.7 mg/dl
- Low risk Infant: Serum Bilirubin >15.2 mg/dl
- Minimal risk transcutaneous Bilirubin <10 mg/dl
- Age 72 hours of life
- High risk Infant: Serum Bilirubin >11.2 mg/dl
- Intermediate risk Infant: Serum Bilirubin >13.4 mg/dl
- Low risk Infant: Serum Bilirubin >16 mg/dl
- Minimal risk transcutaneous Bilirubin <12.5 mg/dl
- Age 84 hours of life
- High risk Infant: Serum Bilirubin >11.6 mg/dl
- Intermediate risk Infant: Serum Bilirubin >14.7 mg/dl
- Low risk Infant: Serum Bilirubin >16.7 mg/dl
- Age 96 hours of life
- High risk Infant: Serum Bilirubin >12.4 mg/dl
- Intermediate risk Infant: Serum Bilirubin >15.2 mg/dl
- Low risk Infant: Serum Bilirubin >17.4 mg/dl
- Age 108 hours of life
- High risk Infant: Serum Bilirubin >12.9 mg/dl
- Intermediate risk Infant: Serum Bilirubin >15.5 mg/dl
- Low risk Infant: Serum Bilirubin >17.6 mg/dl
- Age 120 hours of life
- High risk Infant: Serum Bilirubin >13.3 mg/dl
- Intermediate risk Infant: Serum Bilirubin >15.8 mg/dl
- Low risk Infant: Serum Bilirubin >17.7 mg/dl
- Age 132 hours of life
- High risk Infant: Serum Bilirubin >13.2 mg/dl
- Intermediate risk Infant: Serum Bilirubin >15.6 mg/dl
- Low risk Infant: Serum Bilirubin >17.5 mg/dl
- Age 144 hours of life
- High risk Infant: Serum Bilirubin >13.2 mg/dl
- Intermediate risk Infant: Serum Bilirubin >15.3 mg/dl
- Low risk Infant: Serum Bilirubin >17.3 mg/dl
- References
- AAP: Management of Hyperbilirubinemia in Infant > 35 weeks
V. Monitoring: During intensive Phototherapy in hospital
- Monitor with Serum Bilirubin
- Do not use transcutaneous Bilirubin meter to monitor while on Phototherapy
- Initial monitoring
- Anticipate total Serum Bilirubin decrease by 6-20%
- Total Bilirubin >25 mg/dl: Recheck every 2-3 hours
- Total Bilirubin 20-25 mg/dl: Recheck every 3-4 hours
- Total Bilirubin 14-20 mg/dl: Recheck every 4-5 hours
- Total Bilirubin <14 mg/dl: Stop Phototherapy and recheck Bilirubin within 24 hours
- Further hospital observation for repeat Serum Bilirubin is not needed
- Significant rebound Hyperbilirubinemia is rare
- Maisels (2002) Arch Pediatr Adolesc Med 156(7): 669-72 [PubMed]
- Later monitoring once Bilirubin level is trending downward
- Recheck Total Bilirubin every 8-12 hours
VI. Contraindications
-
Conjugated Hyperbilirubinemia
- Risk of bronze baby syndrome (see adverse effects)
VII. Mechanism
VIII. Technique
- Standard Phototherapy light configuration
- Conventional light source (halogen or fluorescent) or light emitting diode (LED)
- Four overhead centrally placed blue bulbs (F20T12/BB)
- Two daylight fluorescent bulbs on each side of infant
- Double Phototherapy light configuration
- Light configuration above and
- Fiber-optic pad (e.g. bili-blanket) beneath infant
- Infant protocol
- Place each light 15-20 cm from newborn (except pad)
- Infant naked except for eye shields and diaper
- Concurrent Bilirubin monitoring
IX. Adverse Effects
- Loose stools
- Skin Rashes
- Overheating
- Dehydration
- Insensible water loss
- Diarrhea
- Electrolyte disturbance
- Chilling from exposure of infant
- Bronze baby syndrome
- Dark, grayish brown discoloration of skin
- May persist for months
- Associated with Conjugated Hyperbilirubinemia
X. Resources
XI. References
- Behrman (2000) Nelson Pediatrics, Saunders, p. 518
- Muchowski (2014) Am Fam Physician 89(11): 873-8 [PubMed]
- Porter (2002) Am Fam Physician 65:599-614 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | The treatment of a disorder by exposure to light, including ultraviolet and infrared radiation. (Bartleby.com) |
Definition (NCI_NCI-GLOSS) | The treatment of disease with certain types of light. Phototherapy can use lasers, LED, fluorescent lamps, and ultraviolet or infrared radiation. |
Definition (MSH) | Treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. |
Definition (CSP) | treatment of a disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. |
Concepts | Therapeutic or Preventive Procedure (T061) |
MSH | D010789 |
ICD10 | GZJZZZZ |
SnomedCT | 182666000, 266696001, 363724006, 150903009, 150911004, 182672000, 266798006, 31394004 |
English | Photoradiation Therapies, Photoradiation Therapy, Phototherapies, Phototherapy, Therapies, Photoradiation, Therapy, Photoradiation, Phototherapy/radiation therapy, Radiation/phototherapy NOS, PHOTORAD THER, PHOTOTHER, THER PHOTORAD, phototherapy, phototherapy (treatment), Actinotherapy, Mental Health @ None @ Light Therapy @ None @ None @ None @ None, Light Therapies, Light Therapy, Therapies, Light, Therapy, Light, phototherapies, photoradiation therapy, actinotherapy, light therapy, Phototherapy/radiation therapy (procedure), Phototherapy &/or radiation therapy (procedure), Phototherapy &/or radiation therapy, Radiation/phototherapy NOS (procedure), Light therapy, Light therapy (procedure), Phototherapy, NOS, Light |
Dutch | lichttherapie, fototherapie, Fotoradiatietherapie, Fototherapie, Lichttherapie, Therapie, foto- |
Italian | Fototerapie, Fotoradioterapia, Terapia della luce, Fototerapia |
Spanish | Fototerapias, radiación/fototerapia, SAI (procedimiento), radiación/fototerapia, SAI, Radiation/phototherapy NOS, fototerapia (procedimiento), fototerapia, Fototerapia, Terapia por Luz, Terapia por Fotorradiación |
Japanese | 光療法, ヒカリリョウホウ, コウセンリョウホウ, 光線療法 |
Swedish | Ljusterapi |
Czech | fototerapie, Léčba světlem, Fototerapie, léčba světlem, léčení světlem, terapie světlem |
Finnish | Valohoito |
Russian | FOTOTERAPIIA, SVETOLECHENIE, FOTORADIATSIONNAIA TERAPIIA, СВЕТОЛЕЧЕНИЕ, ФОТОРАДИАЦИОННАЯ ТЕРАПИЯ, ФОТОТЕРАПИЯ |
French | Traitement à la lumière, Traitement par la lumière, Photothérapies, Photothérapie |
Croatian | FOTOTERAPIJA |
Polish | Fototerapia, Światłolecznictwo, Leczenie światłem |
Hungarian | Phototherapia, Phototerápiák |
Norwegian | Lysterapi, Lysbehandling, Fototerapi |
Portuguese | Fototerapias, Fototerapia, Terapia por Fotorradiação, Terapia por Luz |
German | Phototherapien, Lichtstrahlentherapie, Lichttherapie, Phototherapie |