Phototherapy for CAs 2025

Phototherapy

Complete this activity to learn about caring for infants admitted for phototherapy treatment for hyperbilirubinemia

Accurate as of October 2025, check policy for current practices

Definitions

An elevated bilirubin level beyond the expected normal range. Bilirubin is a byproduct of red blood cells breaking down

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Yellowing of the skin and sclera caused by the buildup of bilirubin

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Jaundice

Hyperbilirubinemia

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What is the risk of untreated hyperbilirubinemia?

• High levels of bilirubin can cross the blood brain barrier and cause a kind of brain damage called kernicterus (or bilirubin encephalopathy)

• Kernicterus is a permanent and disabling neurologic condition that can lead to:
• Cerebral palsy
• Hearing loss
• Developmental delays
• Seizure disorders
• And more

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Treatment for Hyperbilirubinemia

Phototherapy and feeding!

Phototherapy uses UV light to break down bilirubin to a form that can be excreted (pooped out). The best way to reduce bilirubin levels is to have the baby under phototherapy lights and to support feeding to increase pooping! If severe, or phototherapy is ineffective, may require an exchange transfusion, which removes the infant's blood and replaces it with blood that doesn't have high bilirubin. This would occur in the NICU or PICU.

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Phototherapy Basics at CHCO

• Therapy is most effective when most of the infant's body surface is exposed!
• Keep the infant undressed except a diaper and eye protection (otherwise corneal injury can occur)
• Monitor the infant's temperature closely!
• Axillary temperatures are preferred for this population.

• Support feeding and hydration to aid in bilirubin elimination

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Skin Considerations

• Ensure the baby is repositioned frequently to prevent pressure injuries.

• No lotions, creams, or oils on the exposed skin - they can lead to burns from the lights!
• Newborn skin is naturally dry and may be peely - this is because they've been floating in liquid for months and are working on building their own oil glands!

• Diaper cream/barrier protection is still required per the Skin Care policy

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Bili Blankets

• A bili blanket is used to provide phototherapy to the baby's back and allows for phototherapy to continue during feeds/while held
• The bili blanket should always be covered with the nest

• Use the bili nest to "swaddle" the infant to provide a bit more warmth and comfort
• Ensure the side of the blanket with the baby graphic is facing the infant (this is the side that emits light)

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Bili pad nest

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Bili Lights/Giraffe Lights

• Always keep light 38cm above the baby
• Too far away and the baby will not receive enough phototherapy
• Too close and you risk burning the baby!
• Measure each time baby is placed back in crib or if the lamp gets bumped!
• Reach out to your nurse if you're not sure the light is in the right place
• Position the baby in the crib to maximize light exposure

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Thermoregulation

• As of now, infants on Level 8 will not be in a warmer while receiving phototherapy
• The infant must be only clothed in a diaper and eye protection to maximize skin under the lights
• To keep the infant warm, consider turning up the temperature in the room and use the bili nest
• The normal temperature for an infant is 36.5 - 37.5 C
• If cold, infants are at risk of "cold stress" which can lead to low blood sugars!
• Closely monitor the patient's axillary temperature and notify the nurse if the patient's temperature is too low or too high!

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Feeding and Fluid Status

• Breastfeeding fewer than 8 times in a 24-hour period is associated with higher bilirubin levels.
• Provide support so the infant gets fed at least every 3 hours as delegated. This could include breastfeeding, human milk in a bottle, or formula in a bottle.
• Unless otherwise ordered, infants under phototherapy may have a 30-minute break from lights each feed to encourage breastfeeding, skin-to-skin, and caregiver connection.
• Turn off lights and uncover patient's eyes during feedings.
• If phototherapy cannot be interrupted (your nurse will tell you if this is the case), either feed the infant with a bottle while under the lights or help caregivers to do this.
• Monitor I/Os to make sure the infant is hydrated.
• Notify the RN for low or no urine output, or if the infant is not pooping!

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Eye Protection

Eye protection is needed to prevent light-induced damage to the retinas, which can lead to long-term vision problems. Ensure eye protection is on without being too tight.Unless otherwise ordered, infants can take a break from the bili lights for up to 30 minutes at each feeding, in which case the lights are turned off and the eye protection is removed. Hot tip: if the eye patches aren't staying on with the provided adhesive stickers, you can use Wigglepads (from the heated high flow cannulas, obtained in the respiratory supply area) to keep them attached. Let your nurse know if you're having trouble with this!

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Family Support

• Babies receiving phototherapy can be very irritable, which can understandably be emotional for caregivers. They can't be swaddled or held as much as families would like.
• What can we do to help?
• Remind family that the most time under the lights will decrease the amount of time they need to be admitted.
• Encourage caregivers to be nearby and interact with baby by talking, singing, or light touch.
• Utilize the 30 minutes around each meal for skin-to-skin and other interactions.
• Encourage caregivers to take breaks and/or utilize the Family Resource Center.

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Risks of Phototherapy

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Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.

Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.

Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.

Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.

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Loose Stools

Skin Rashes

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Imbalances in Fluid Status

Redness, dryness, itching, burns, and blisters can occur - ensure the lights are 38cm away from baby and no lotions or creams are used.

Corneal Injury

Temperature Instability

As bilirubin is broken down and removed from the body, stooling can be increased and more watery - another reason to monitor fluid status!

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If eye protection isn't used, the infant's eyes can be irreparably damaged.

The lights can increase fluid loss and potentially cause dehydration, so close I/O monitoring and feeding is needed

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Because the babies must be uncovered, pay close attention to their temps!

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Next Steps

You're finishing this portion of this quarter's COTF - you must also complete a skills check-off. You must complete the QR code at the end of this activity before attending the skills check-off.

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Pre-Work Completed!

You must complete this forms survey before you attend your in-person skill check-off you will not be allowed to complete your check-off without the completed survey

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