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Phototherapy for the jaundiced baby - the use of lights and biliblanket

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For information on the management of neonatal jaundice, see Newborn Clinical Guideline on jaundice

Giraffe Blue Spot PT Lite (GE Healthcare)

Follow the steps below to ensure that phototherapy is delivered safely:

  1. Position phototherapy unit 38cm from baby. The light diameter will be 35.5cm. 
  2. Baby is nursed undressed with the nappy covering as little skin as possible, to achieve maximum skin exposure to the therapeutic light. 
  3. Eye protection should be used during phototherapy to protect the baby's eyes. Use the appropriate eye shields (size and type)
     a) Argyle phototherapy eye protectors small and large - use hydrogel adhesive to position on baby 
     b) Eye Max (term infants) 
  4. Eye protection should be removed 4 hourly and eye cares performed. 
  5. Feeding /IV Fluids:
    a) Monitor accurate fluid intake and output.
    b) The infant's feeding/IV fluid requirements may need to be adjusted based on the gestation and jaundice level/clinical picture.
  6. Use the phototherapy light meter to confirm the therapeutic light output each duty. Output should be over 10mcw/nm/cm2 on all body surfaces.
  7. Do not use baby lotions or creams on baby's skin whilst on phototherapy
  8. Monitor the baby's temperature closely when commencing phototherapy and adjust incubator temperature as required to avoid overheating.
  9. Monitor serum bilirubin levels as required by the physician responsible for the infant who will then enter the result into the NICU database. For infants on the postnatal ward the result will be plotted on the appropriate neonatal bilirubin guideline chart CR5643 and decision on phototherapy treatment will be made by the paediatric team (baed on NICE guidelines).

Ohmeda Biliblanket

Biliblankets have been found to be as effective as conventional phototherapy lights in treating mild to moderate Neonatal Jaundice. It may be used in conjunction with the Giraffe Blue Spot PT Lite when SBR levels are very high or rising rapidly.

  1. The fibre optic pad must be used with a fresh disposable cover and secured with the self-adhesive tapes.
  2. Set the brightness selector switch to high.
  3. Ensure the air circulation vents on the top and bottom of the illuminator are unobstructed at all times and that the blocked air circulation indicator is not on.
  4. Use the Ohmeda biliblanket meter II to confirm the therapeutic light output each duty. Output should be over 10mcw/nm/cm2 on all body surfaces.
  5. Place covered light pad directly under baby with the white illuminating side facing up, ensuring that the maximum area of illumination is in contact with the baby's skin. The baby, along with the light pad, may be covered or wrapped in a thin blanket. It is possible to hold and feed the baby while delivering treatment, as long as the skin remains in direct contact with the covered light emitting section of the pad.
  6. Use appropriate sized eye protectors to shield eyes.
  7. Monitor serum bilirubin levels as required by the physician responsible for the infant who will then enter the result into the NICU database. For infants on the postnatal ward the result will be plotted on the appropriate neonatal bilirubin guideline chart CR5643 (or printed from NICE guidelines).

Instructions for use of Minolta/Airshields Fluoro-Lite Meter 451/Ohmeda Biliblanket Meter II

Both light meters are located in the work room.

  1. Place cap firmly over the receptor head dome.
  2. Set the on/off switch to on. The letters 'Cal' should appear in the display window.
  3. The 'Cal' display will be followed by a zero level display. This indicates that the meter is calibrated.
  4. If the display window is blank, or three decimal points (…) appear, this indicates a weak battery.
  5. Hold receptor level with the upper surface of baby. Read the digits displayed. If <10mcw/nm/cm2 remove the phototherapy unit and send to electronics for evaluation
  6. If no measurement is recording, press the hold/run measuring switch (on the side). This will allow the measurement to be displayed
  7. Wipe down meter with Clinell wipe after use.

References

  1. Mills, J.F. & Tudehope, D. (Updated October 31, 2009). Fibreoptic phototherapy for neonatal jaundice. [Cochrane Review]. In Cochrane Database of Systematic Reviews, 2009 (1). Retrieved October 12, 2010 from The Cochrane Library, Wiley Interscience.
  2. Neonatal Jaundice Guideline. (n.d.) Retrieved October 12, 2010, from http://www.sswahs.nsw.gov.au/rpa/neonatal/html/newprot/jaund2.html
  3. GE Healthcare Giraffe Blue spot PT lite Phototherapy System Users Guide.
  4. Wong, R J & Bhutani V K) Treatment of Unconjugated hyperbilirubinemia in term and late preterm infants. Retrieved from Up To Date 10 Sept 2018

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Document Control

  • Date last published: 17 August 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years