THE TEN COMMANDMENTS OF PHOTOTHERAPY

Abstract

Thou shalt

1. Not use phototherapy prior to determination of etiology.^1,2

2. Not use phototherapy in infants with direct hyperbilirubinemia (conjugated direct bilirubin level > 2 mg/100 ml).^1,3

3. Not judge jaundice clinically in infants treated with phototherapy, but measure serum bilirubin level every 4 to 12 hours as indicated.^1,2

4. Monitor temperature of infants placed under phototherapy initially every hour for the first four hours and thereafter every four to six hours.^2,3

5. Weigh low-birth-weight infants receiving phototherapy twice daily. Increase their fluid intake above requirements by 2% to 10% depending on postnatal age, cardiac status, and whether the infant is under a radiant warmer or an adequately humidified incubator.^1,3

6. Protect eyes with adequately designed patches. Turn off light and remove eye patches when parents are visiting.^2,3

7. Monitor hematocrit value, particularly in hemolytic diseases.^1,2

8. Watch for rebound of bilirubin level following discontinuation of phototherapy. Delay discharge by about 6 to 12 hours till rebound can definitely be ruled out.²

9. Change the lamps after 20% decrease of original irradiance output. Consult with the manufacturer of the individual lamps used, or energy output in the blue spectrum (425 to 475 mm) every 200 hours of use.^1,2

10. Check all phototherapy units for proper electrical grounding.