Phototherapy For Jaundice In Newborns

WHAT YOU SHOULD KNOW:

• Jaundice (JON-diss) is a yellowing of the skin and whites of the eyes. It is also called hyperbilirubinemia (hi-per-bil-e-roo-bi-NEE-me-uh). Jaundice is most common in newborns and usually happens during the first week of life. Jaundice is caused by too much bilirubin (bil-e-ROO-bin) in the blood. Bilirubin is a yellow pigment (coloring) released during the normal breakdown of red blood cells. Bilirubin stays in the bloodstream until your baby's liver takes it. The liver sends bilirubin to your baby's intestines. Bilirubin leaves your baby's body through his bowel movements (BMs).
  
  
• Jaundice happens when your baby's liver cannot remove bilirubin from the blood fast enough. Extra bilirubin that cannot leave the body stores itself in (soaks into) the skin and whites of the eyes. If your baby is premature, has health problems, or has jaundice that gets worse, he may need treatment. Treatment for jaundice is usually phototherapy (fo-toe-THAIR-uh-pee). Phototherapy or "bili lights" are placed over or under your baby. Bili lights break down bilirubin in your baby's skin, eyes, and mucus membranes. The broken down bilirubin can then go out of your baby's body in his urine and BMs. Bili light treatments can be done in the hospital or in your home.

AFTER YOU LEAVE:

Medicines:

• Keep a written list of what medicines your baby takes, the amounts, and when and why they are taken. Bring the list of your baby's medicines or the pill bottles when you visit your baby's caregivers. Ask your baby's caregiver for more information about the medicines. Do not give any medicines to your baby without first asking your baby's caregiver. This includes prescriptions, over-the-counter drugs, vitamins, herbs, or food supplements.
  
  
• Always give your baby's medicine as directed by caregivers. Call your baby's caregiver if you think your baby's medicines are not helping. Call if you feel your baby is having side effects. Do not quit giving the medicines to your baby until you discuss it with your baby's caregiver. If your baby is taking antibiotics (an-ti-bi-AH-tiks), give them until they are all gone. Even if your baby seems to feel better.
  
  
• Never give aspirin to your baby without first asking your baby's caregiver. Giving aspirin to your baby when he is ill may cause a very serious illness called Reye's syndrome. Read medicine labels to see if your baby's medicine has aspirin.

When is my baby's medical appointment?

Ask for more information about where and when to take your child for follow-up visits:

For continuing care, treatments, or home services for your child, ask for information.

What can I feed my baby?

Give your baby breast milk or the formula your baby's caregiver tells you to use. Ask your baby's caregiver how much your baby should drink each day. More frequent breast feedings or bottle feedings may help your baby get rid of the bilirubin and jaundice. Some breastfed babies may have jaundice for more than a week. These babies may need to breast feed more often during the day to get rid of their jaundice.

How can I check my baby for jaundice?

You can check for signs of jaundice by gently pressing on your baby's nose or forehead. If the area you gently pushed on is not yellow when you remove your finger, there is no jaundice. If the area is yellow after you push on it, then your baby may have jaundice. Also look for a yellow color of the face, chest, stomach, legs, feet, or whites of the eyes. The best way to check for jaundice is in the natural daylight.

What happens if my baby's jaundice is not going away or is getting worse?

Your baby's caregiver will examine your baby and look for jaundice. Your baby may have blood and urine taken for testing. If your baby's bilirubin level is too high, his caregiver may order treatment in the hospital or at home. For in-home treatment, your baby's bili lights will be delivered to your home. You will be taught how to use the bili lights. Your baby's caregiver may ask you to sign an informed consent before starting the bili light treatment.

• Informed consent:
  
  
  • You have the right to understand your baby's health problem. You should understand what tests, treatments, or procedures may be done to treat your baby's problem. Your baby's caregiver should also tell you about the risks and benefits of each treatment.
    
    
  • You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for your baby. A consent form is a legal paper that gives caregivers permission to do tests, treatments, or procedures. This form should tell you exactly what will be done to your baby. Your baby's caregiver should explain what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered. This way you will understand what may happen to your baby.
  
  

How are home bili light treatments given?

A home health caregiver will teach you about the bili lights and your baby's care during the treatment. The caregiver will also give you a daily chart to fill out. It may include feeding times and amounts, your baby's temperature, and how many BMs he has. It is important to fill out your baby's chart completely. During each visit, the caregiver will do a "heel stick" by pricking your baby's heel with a tiny blade. The caregiver will gently squeeze your baby's heel and collect his blood. Here are some directions on caring for your baby during a bili light treatment. You may need to record these on your baby's chart:

• Check the room temperature. The temperature in your baby's room should be between 68° and 75° F (20° to 24° C). Check the room temperature each time you take your baby's body temperature. While he is having the bili light treatment, keep your baby away from drafts (wind). Make sure your baby's bedding is always dry. This will help him stay warm.
  
  
• Undress your baby except for his diaper. Do not put lotion on your baby's skin. This may decrease the ability of the bili lights to move bilirubin out of your baby's skin.
  
  
• Put an eye mask over your baby's eyes. Not all bili light treatments require eye masks. Ask your baby's caregiver if your baby needs eye protection. Your baby's caregiver will show you the right way to put a mask over your baby's eyes. An eye mask will protect your baby's eyes from being damaged by the bili lights.
  
  
• Turn on the bili lights. There are many different types of home bili lights. Some come inside a case that can be propped open. Others may come as a pad that your baby lies on or a "bank" of lights that your baby lies under. Follow the caregiver's directions closely. The caregiver will tell you how many hours your baby should have the bili light treatment each day. The caregiver will instruct you about turning the lights on and off for feedings, cuddling, or diaper changes.
  
  
• Take your baby's temperature every 3 to 4 hours. Ask your baby's caregiver if you need to do this more often. Put the thermometer in your baby's armpit while the bili lights are on. A normal body temperature for your baby is 97° to 100° F (36.1° to 37.8° C).
  
  
  • If your baby is too warm: Remove the curtains or cover from around the bili light set. You may also decrease the room temperature by 1 or 2 degrees. Check your baby's temperature every 15 minutes until your baby's temperature is lower.
    
    
  • If your baby is too cold: Wrap him in warm blankets. Check your baby's temperature in 15 minutes. If he is still cold, keep your baby wrapped in the blankets. Feed him warm breast milk or formula. Make sure your hands are warm when you hold your baby. Check his temperature again in 15 minutes.
    
    
  • Tell your baby's caregiver: If your baby's temperature continues to be over 100.4 °F (38.0 °C) after 30 to 45 minutes. Also call if you cannot raise your baby's temperature above 96 °F (35.6 °C) with warmth and blankets.
  
  
• Feed your baby often.
  
  
  • Drinking enough liquids is very important for your baby during his bili light treatment. Your baby will need to drink more since he will be losing more body fluids than usual. He will lose body fluids through his breathing, skin, urine, and BMs. You may breast feed or bottle feed your baby. Ask your baby's caregiver if you need to turn off the bili lights during the feedings.
    
    
  • If your baby has a bili pad or bili blanket, you may be able to wrap baby and the pad into a warm blanket. Then, you can feed your baby while the bili lights stay on. Sometimes, babies with bili lights vomit (spit up). This may be caused by being fed more often than usual. It may be a sign of a feeding problem. If your baby begins to vomit forcefully or his vomit is yellow, tell your baby's caregiver.
  
  
• Keep careful track of diaper changes. Your baby's urine may be darker because bilirubin is leaving his body through his urine. Your baby should have at least 6 to 10 wet diapers each day. Tell your baby's caregiver if your baby is not urinating this much while he is having bili light treatments. Your baby's BMs may change from yellow to green as bilirubin leaves his body through his BMs. They may be loose, runny, and seedy-looking. His BMs may cause him to have a diaper rash. Keep your baby's bottom clean and dry. Ask the caregiver if you should put cream on the diaper rash to protect your baby's skin.
  
  
• Change your baby's position every 1 to 2 hours. Bili lights work by causing bilirubin to break down and leave the skin. Changing your baby's position helps to expose all areas of your baby's skin. This will help the bili lights break down the bilirubin as quickly as possible. Ask your baby's caregiver about the best ways to position your baby.
  
  
• Your baby may get a skin rash. Some babies develop a red skin rash while they are getting bili light treatments. It may cover a small or large area of the skin. This rash will go away on its own in a few days.
  
  
• Call your baby's caregiver if you have problems with the bili lights. Call if you have questions or concerns about how your baby is doing during the treatment. This includes body temperature problems, and how much your baby is feeding, urinating, and having BMs.

What if my baby does not like having the home bili light treatment?

Your baby may be fussy during the bili light treatment. Bilirubin in your baby's skin can cause him to feel itchy and uncomfortable. Bili lights help the bilirubin leave the skin so that your baby can feel more comfortable. Also, your baby may not like lying undressed during the treatment. If your baby is fussy, try giving him a pacifier. Sing and talk softly to your baby, or give him a gentle massage. Do not turn off the bili lights just because your baby is fussy. Talk to your baby's caregiver for more ideas on comforting your baby.

When will my baby stop needing home bili lights?

When your baby's blood bilirubin level is low enough, the caregiver will turn off the bili lights. The caregiver may draw your baby's blood one more time. If the bilirubin level stays low enough, your baby's treatment will be finished. The bili lights will be removed from your home.

CONTACT A CAREGIVER IF:

• Your child has a fever.
  
  
• Your baby is not drinking enough formula or breast milk each day.
  
  
• Your baby has jaundice within 24 hours after he is born.
  
  
• Your baby looks more yellow after 7 days old.
  
  
• Your baby's jaundice is not gone by 14 days old.
  
  
• Your baby's BMs are a pale, white, or gray color.
  
  
• You have questions or concerns about your baby, his jaundice, or the bili light treatment.

SEEK CARE IMMEDIATELY IF:

• Your baby is acting or looking very sick.
  
  
• Your baby is difficult to wake up.
  
  
• Your baby's jaundice comes back after treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Phototherapy For Jaundice In Newborns (Discharge Care)