Jaundice is a common condition in newborns, marked by a yellowing of the skin and the whites of the eyes due to elevated levels of a substance called bilirubin in the blood. While mild jaundice often resolves on its own, higher levels of bilirubin can pose serious health risks and require medical intervention. Phototherapy is the most widely used and effective treatment for reducing high bilirubin levels in infants.
Understanding when phototherapy is needed is crucial for healthcare providers and parents alike to ensure the well-being of the newborn. This blog post explores the levels of jaundice requiring phototherapy to treat, the factors influencing these thresholds, and the importance of timely treatment.
What Is Bilirubin and Why Is It Important?
Bilirubin is a yellow pigment produced during the normal breakdown of red blood cells. In adults, the liver processes bilirubin efficiently, but in newborns – especially premature infants – the liver may not be mature enough to handle the bilirubin load. This can lead to an accumulation of bilirubin in the blood, known as hyperbilirubinemia. Elevated bilirubin levels can cross into the brain tissue, potentially causing a form of brain damage called kernicterus if not adequately managed.
Measuring Bilirubin Levels
To determine whether phototherapy is necessary, healthcare providers measure the total serum bilirubin (TSB) levels through a blood test. The TSB provides a precise measurement, which is essential for making informed decisions about treatment.
Determining the Need for Phototherapy
There is no single bilirubin level at which phototherapy is universally initiated. Instead, the need for treatment is determined by considering multiple factors:
Age in Hours
The infant’s age in hours since birth is a critical factor. Bilirubin levels naturally rise after birth, peaking between the third and fifth day of life. The risk associated with a specific bilirubin level changes as the newborn ages.
Gestational Age
Premature infants have lower thresholds for phototherapy because their livers are less developed and their brains are more vulnerable to bilirubin toxicity. For example, an infant born at 35 weeks gestation will require treatment at lower bilirubin levels than a full-term baby.
Risk Factors
Additional risk factors that can lower the threshold for phototherapy include:
- Hemolytic Disease: Conditions like ABO or Rh incompatibility causing rapid red blood cell breakdown.
- G6PD Deficiency: A genetic disorder affecting red blood cell stability.
- Asphyxia: Oxygen deprivation at birth.
- Sepsis: Infection increasing bilirubin production or interfering with elimination.
- Hypoalbuminemia: Low levels of albumin, reducing bilirubin binding capacity.
The Importance of Timely Intervention
Initiating phototherapy at the appropriate time is crucial to prevent bilirubin levels from reaching dangerous levels that could lead to kernicterus. Early treatment reduces the need for more invasive procedures like exchange transfusions and minimizes the risk of long-term neurological damage.
How Phototherapy Works
Phototherapy uses specific wavelengths of light, typically in the blue spectrum (460-490 nm), to convert bilirubin into water-soluble isomers that can be excreted without further metabolism by the liver. The infant is placed under phototherapy lights or on a fiber-optic blanket, like our BiliCocoon Kangaroo Care Fiber Optic Phototherapy System, with as much skin exposed as possible. Eyes are protected with products such as our WeeSpecs & WeeSpecs Supreme to prevent retinal damage.
Monitoring During Phototherapy
During treatment, healthcare providers regularly monitor:
- Bilirubin Levels: To assess the effectiveness of phototherapy.
- Vital Signs: Including temperature, heart rate, and respiratory rate.
- Hydration Status: Ensuring adequate fluid intake, as phototherapy can increase insensible water loss.
- Skin Condition: Watching for rashes or changes due to light exposure.
Phototherapy continues until bilirubin levels drop to a safe range and are stable without the lights.
Factors Influencing Phototherapy Effectiveness
Several factors can affect how quickly bilirubin levels decrease:
- Intensity and Spectrum of Light: Higher intensity and appropriate wavelengths increase efficacy.
- Surface Area Exposure: More skin exposure enhances treatment.
- Duration of Therapy: Continuous exposure is more effective than intermittent.
- Underlying Conditions: Ongoing hemolysis or liver dysfunction may prolong the need for phototherapy.
Parental Involvement and Concerns
Parents may have concerns about the impact of phototherapy on bonding and feeding. While continuous exposure is ideal, brief breaks for feeding and cuddling are typically allowed and encouraged. Breastfeeding should continue during phototherapy, as frequent feeding promotes bilirubin elimination through stools. Our BiliCocoon Kangaroo Care Fiber Optic Phototherapy System makes it easy for caregivers to continue bonding during treatment sessions. The Bili Pod Phototherapy Swaddle also promotes skin-to-skin contact and increased infant comfort during phototherapy treatment.
Treat Neonatal Jaundice with Infant Jaundice Management Products from International Biomedical
Determining when infant jaundice management products are needed involves a comprehensive assessment of bilirubin levels, the infant’s age, gestational maturity, and risk factors. There is no universal bilirubin level for initiating treatment; decisions are individualized based on established guidelines and clinical judgment. Timely phototherapy is essential in preventing serious complications associated with high bilirubin levels, safeguarding the infant’s neurological development and overall health.
At International Biomedical, we are dedicated to providing advanced phototherapy solutions that deliver safe and effective treatment for neonatal jaundice. Invest in excellence for your neonatal intensive care unit. Contact International Biomedical for innovative solutions that make a meaningful difference in the lives of infants and families.