Phototherapy and Jaundice

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“Phototherapy” is the medical term used for treating disorders of the skin such as jaundice by using ultraviolet and infrared radiation. “Photo” is from the Greek word “photos” meaning light, and “therapy” is from the Greek word “therapies” meaning to treat medically

By Sjona Lindquist

“Phototherapy” is the medical term used for treating disorders of the
skin such as jaundice by using ultraviolet and infrared radiation.
“Photo” is from the Greek word “photos” meaning light, and “therapy” is
from the Greek word “therapies” meaning to treat medically. A premature
baby often needs this special kind of light treatment because preemies
are frequently afflicted with jaundice. Jaundice is a condition that
must be treated by medical interventions such as bililights,
biliblankets and exchange transfusion. If severe jaundice is left
untreated, it causes brain damage to the premature baby.

“Jaundice” is a yellowish discoloration caused by bile salts depositing
in the tissues of the whites of the eyes, skin, and mucous membranes.
It is a normal process for the body to break down red blood cells

bilirubin. However, a premature baby will develop jaundice when their
bilirubin level is too high, and the immature liver of a preemie is not
efficient enough to remove the bilirubin from the bloodstream. Special

lights (bililights) are able to penetrate a preemie’s skin and break down the
bilirubin in the blood turning it into lumirubin.

“Phototherapy lights” (bililights) are lights specifically designed to
put out wavelengths of light from the blue part of the light spectrum.
The chemical reaction occurring changes bilirubin to lumirubin, and
this changed

form is harmless to the premature baby allowing it to pass from her
body. While your premature baby is receiving phototherapy light
treatments, her eyes will be covered by a mask or cloth shielding them
from direct exposure to light that may not be good for her eyes.
Phototherapy treatment usually lasts from a week to ten days.

A “Biliblanket” is a fiber optic blanket that may be used instead of
bililights and is just as effective. The biliblanket has a fiber optic
pad delivering microwatts of therapeutic light, and it can be taken
home to use

if necessary. The advantage of using a biliblanket for your premature
baby is that it allows more surface exposure to the lights, it is
easier to use, eye covering is not necessary, and phototherapy is not
interrupted during feeding and bonding.

“Exchange transfusion, substitution transfusion, or total transfusion”
is the process of removing most of the blood from your premature baby’s
body, while at the same time substituting it with equal amounts of
donor blood. When bilirubin levels are too high, it becomes very
dangerous for your baby. The best course of action is to replace your
premature baby’s blood with donor blood having no bilirubin in it.

Sjona Lindquist is a mom of 6 (1 angel) and she owns and operates ~ Preemie Store. ~ Preemie Store is a
resource site and specialty shop for parents of premature babies.
Lindquist’s daughter was stillborn from a Strep B infection due to PROM
(Premature Rupture of Membranes). In honor of her daughter, Michaela,
she offers preemie support, bereavement support, and preemie clothes.
Some of the products include micro preemie clothes, preemie bereavement gowns, and Preemie
. If a new preemie has entered your life or someone
you love, drop by and visit us! ~ Preemie Store 

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One Response to “Phototherapy and Jaundice”

  1. Donna Fox Says:

    I am sorry this is lengthy, but it is very, very important. It is concerning my Grandson’s eyes not being properly protected during phototherapy to treat jaundice.

    I am a Grandmother looking for some answers. I have written many letters to many places asking for help with some very important questions I have. In most of the replies I’ve receive I was told to speak with the Dr. Can you PLEASE HELP ME?

    I wrote the letter below to the hopsital where my grandchild is at and received a response from the NICU and was then able to speak with one of the neonatologists this morning. Although I keep reading online, including in the New England Journal of Medicine that babies eyes must be protected during phototherapy because it can cause retinal damage, the hospital staff continues to tell me that it cannot cause any problems at all and that basically the only reason they put the mask on is so that the infant doesn’t have the annoying light in his eyes and as far as it being a concern whenever the eye mask fell off the Dr. told me that if a nurse had different things going on all at once, that the eye mask would be the last to be dealt with, that it basically would not even be a concern if a baby’s mask was off. Obviously that’s why my Grandson was never checked to see if his mask was on, it did not matter if the nurses were busy or not, as most of the time when I went to visit and the mask was off they were not busy at all.

    Below the letter I wrote to the hospital is an email that I received from the nurse manager in the NICU. Her text is black and mine is in red. I received the email last night, before I spoke with the Dr. this morning.

    The Dr. told me that there were no studies on phototherapy damaging the eyes of newborns. I certainly would hope there were not any studies like that done. There were studies done in monkeys and rats, however that show that the lights can cause retinal damage.

    Are these people not taking this issue seriously enough, or is it not a serious issue to begin with, and am I taking it too seriously?

    Begin letter to hospital ————————————————————————————————————————————————–

    Preemies eyes not being protected properly during phototherapy

    I am continually reading online about the importance of keeping an infant’s eyes covered during phototherapy to treat jaundice.

    Even one of the companies that promote the neoBLUE phototherapy lights (Natus) recommends the use of proper eye protection and have masks that when used properly, and are of correct size do not allow light to leak in from under the mask.

    My Grandson was born 2 months early, at 32 weeks gestation, weighing 3 lbs. 9 oz. and had quickly dropped to 3 lbs. 5 oz. and had been treated for jaundice for a total of approx. 5 or 6 days.

    An eye mask that was obviously too large for him was initially put on, but really did absolutely no good, as it was either totally off, or coming off and completely exposing his eyes. You can see the eye masks in these photos:

    In the very beginning of the start of the phototherapy EVERY TIME I went to see him his mask was off, or coming off. The same with the child’s parents, EVERY TIME. When he was just two and a half days old my son and his wife went to see the baby who was under the phototherapy lights. His eye mask was completely off of his eyes and up on his head. My son apparently did not realize the danger (after all, the baby was in the N.I.C.U.) and took a couple of photos and emailed them to me. I went completely berserk when I saw them.

    Each time I went to visit my Grandson I saw a different nurse and questioned her about the eye mask and each time I was told “oh, it’s just a precaution”, “oh, we just put the mask on so the light doesn’t bother his eyes, as long as he keeps his eyes closed it won’t hurt him”, or “well, the masks are just too large, you can’t really expect them to stay on, they never do”, etc. etc. One nurse was commenting about people getting on the internet, saying “that’s all people do is scare themselves”. I had more than one nurse tell me that “the babies have never had any problems at all with the bili lights” when I mentioned that his mask is always coming off. How can they say that? Many problems won’t even begin to surface for years. I did mention to one nurse that I’ve read online that it can cause retinal problems and she said that she’s “never heard of that”. Then it was “well, he may have to wear glasses, but lots of kids wear glasses”. That’s not the point! If something can be prevented then it should be. And these lights can do much more harm than just cause the children to have to wear glass. I just cannot understand the complacency of these nurses. These are little human beings, not guinea pigs.

    I finally pleaded with the nurse on duty one day to please, at least just walk by now and then to make sure his mask was on and maybe one of the other 6 or 7 nurses sitting at the desk could look in on him as well whenever they were up and about, or hopefully more often then that, as whatever damage that had been done, is done, and all I can hope for now is to prevent anymore.
    She said she’d make sure of it, but he was taken off the lights very soon after that conversation, so there was no longer any need to follow through with my request.

    I even had one nurse that appeared to get upset when we told her that another baby’s eyes were totally uncovered the other day. He was in the isolette next to my grandson and I noticed that his eye mask was completely off, no big surprise there. It took awhile to find a nurse (as all but one was in the next room over), but when I saw one walk by my daughter in law told her about the other baby’s eye mask. It wasn’t that baby’s nurse and I don’t think she really wanted to be bothered. But she did put his eye mask back on and then totally covered his isolette so that his eye mask could not even be monitored by anyone. Basically, unless his monitors starting going off for too long, he was fine.

    Part of the Dr.’s orders included with the phototherapy, also consist of EYE PROTECTION. Although the Dr.’s may presume the nurses are following their instructions that may not necessarily be the case.

    It certainly makes one wonder just how much the improper eye care received by some N.I.C.U.’s can greatly affect the outcome of R.O.P. since a very, very large percentage of preemies tend to have R.O.P. and also have to undergo phototherapy.

    What kind of training, if any, do these nurses receive regarding the proper care and protection of the baby’s eyes while undergoing phototherapy treatment? Maybe retraining is in order?

    Have there been any studies done to show what happens when nurses fail to follow preventative eye care measures during the use of phototherapy lights?

    I would like to know for how long can a preemie stay under the lights with very little to no eye protection and exactly what kind of retinal damage can happen and when will may show up?

    Could you please let me know how much damage could possibly have been done to my grandson’s eyes when he had protection less than 50% of the time.

    Although for my Grandson, what is done is done, but I would like to bring this to someone’s attention so that other baby’s, parents, and grandparents do not have to go through the same thing.

    Thank you for your cooperation and courtesy in this matter.


    On another note:

    I understand it is very important that a baby’s temperature be monitored during the use of phototherapy and also while being in the warmer.

    On numerous occasions when I went to the hospital with my daughter in law to see and care for the baby, she checked his temperature and it was 101.6, 101.5, etc. A couple of times it was when he was under the bili lights. Other times it was from the warmer being set too high and one time apparently the nurse said she swaddled him too tightly. The nurse on duty during those times didn’t seem to think his elevated temperature was of any concern though so we did not get alarmed by this because it wasn’t actually a fever or an infection. Is it normal for an infants temperature to be allowed to get so high?

    End letter to hospital ———————————————————————————————————————————–

    Begin Email from nurse manager along with my response back. —————————————————————————————–

    I was forwarded the email you sent regarding your concerns about photo-therapy your grandson received. Bili mask are used during phototherapy to protect the infant’s eyes. To protect their eyes from what? What kind of damage can the lights cause? I keep asking this question to no avail. The nurses are to apply the mask to adequately block the transmission of light. Every time I went up there his eyes were exposed do to the mask creeping up to his eyebrows. The current bili mask that we use do tend to slide off, but this doesn’t relieve the nurse from doing everything possible to keep the mask on. The mask that wraps around the head slides off because the hair makes the head slick. It is adjustable. I have photos of my grandson showing two different masks that were used on him, neither of which worked correctly. You are welcome to view them if you’d like:

    Complications can occur from the eye mask themselves such as eye irritation, corneal abrasion, blocked tear ducts, and conjunctivitis, so nurses are instructed to do eye care. We do not want the mask to be too tight. The problem was never being too tight, but way too loose and not doing enough to protect his eyes. If the baby is asleep sometimes the nurses will not disturb the baby to put the mask back on until they wake up since their eyes are closed. Unfortunately when he may have slept (or tried to sleep I should say) for 3 hours at a stretch then that was possibly 3 hours with no eye protection? His eyes may have been closed when I went to visit but I did not see restful, peaceful sleep when his eyes were exposed. Only when we covered them back up did he no longer seem restless. I can’t answer what happened in this particular instance. However, I do know that for some babies it is very difficult to keep their masks on. Obviously that would be when the infants would need to be checked on much more frequently, and by any nurse that happens to walk by, not just his nurse at the time. I will be more than willing to talk with the parents about any concerns they may have. Also, our neonatologist make rounds every morning they are more than happy to answer any questions they have. My daughter in law told me that she expressed concern to one of the Dr.’s and was told that the lights wouldn’t cause any harm. If they could give me the name of the nurse that did not seem attentive to their baby’s needs, that also will be addressed. There was no one nurse in particular, it was each and every one that I/we voiced concern to. Whomever was on duty at the time, as I’ve stated in my letter.

    We always have a charge nurse available 24/7 in the neonatal unit. They are available to answer any concerns that arise and can get in touch with me as needed. I absolutely should have spoken with the charge nurse instead of just dealing with his nurse’s.

    I cannot do anything about my Grandson’s eyes being exposed now, what is done, is done, but would hope that more care will be taken in the future by the nursing staff with other infants in the N.I.C.U. The eye masks coming off are of great concern and the nurses really need to take this issue very seriously.

    Is there anyone that can answer these questions that I had also asked in my letter.

    Have there been any studies done to show what happens when nurses fail to follow preventative eye care measures during the use of phototherapy lights?

    I would like to know for how long can a preemie stay under the lights with very little to no eye protection and exactly what kind of retinal damage can happen and when it may show up?

    Could you please let me know how much damage could possibly have been done to my grandson’s eyes when he had protection less than 50% of the time.

    Donna Ann Fox


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