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Your Baby, Jaundice, and Phototherapy

What is Jaundice? Jaundice is a common, temporary. and usually harmless condition in newborn infants. It affects both fullterm and premature babies, usually appearing during the first week of the baby's life. Jaundice occurs when there is a build-up of a naturally occurring substance in the blood called bilirubin . Bilirubin is an orange/red pigment in the blood. Bilirubin is produced by the normal breakdown of red blood cells. It is normal for everyone to have low levels of bilirubin in their blood. As bilirubin begins to build up, it deposits on the fatty tissue under the skin causing the baby's skin and whites of the baby's eyes to appear yellow. What are the Causes of Jaundice? Jaundice can be caused by several different problems: Physiological jaundice: This is the most common cause of newborn jaundice and occurs in more than 50% of babies. Because the baby has an immature liver, bilirubin is processed slower. The jaundice first appears at 2 to 3 days of age. It usually disappears by 1 to 2 weeks of age, and the levels of bilirubin are harmless. Breast-feeding jaundice: Breast-feeding jaundice may occur when your baby does not drink enough breast milk. It occurs in 5% to 10% of newborns. The jaundice symptoms are similar to those of physiological jaundice, just more pronounced. The jaundice indicates a need for help with breast-feeding. Breast-milk jaundice: Breast-milk jaundice occurs in 1% to 2% of breast-fed babies. It is caused by a special substance that some mothers produce in their milk. This substance causes your baby's intestine to absorb more bilirubin back into his body than normal. This type of jaundice starts at 4 to 7 days of age. It may last 3 to 10 weeks. It is not harmful. Blood group incompatibility (Rh or ABO problems): If a baby and mother have different blood types, sometimes the mother produces antibodies that destroy the newborn's red blood cells. This causes a sudden buildup of bilirubin in the baby's blood. This serious type of jaundice usually begins during the first 24 hours of life. Rh problems formerly caused the most severe form of jaundice. However, they are now preventable if the mother is given an injection of RhoGAM within 72 hours after delivery. This prevents her from forming antibodies that might endanger other babies she has in the future

What is the Treatment? High levels of bilirubin can occur in the blood called hyperbilirubinemia. These high levels can be dangerous to a baby. It is important to obtain periodic blood samples to check the bilirubin levels and, if necessary, to treat jaundice to ensure the healthy development of your child. Feeding your baby every 2- 3 hours is recommended to reduce the jaundice levels. If you are breastfeeding, supplementation (ex. with formula via cup feeding, supplemental feeder, or bottle) may be recommended by your pediatrician if the bilirubin will not come down with frequent feedings. Phototherapy with or without a biliblanket is the most common form of treatment for jaundice. This treatment is used for a few days until the liver is mature enough to handle the bilirubin on its own. What is Phototherapy? Some normal jaundice will disappear within a week or two without treatment. Other babies will require treatment because of the severity of the jaundice, the cause of the jaundice, or how old the baby is when jaundice appears.

Phototherapy (light treatment) is the process of using light to eliminate bilirubin in the blood. Your baby's skin and blood absorb these light waves. These light waves are absorbed by your baby's skin and blood and change bilirubin into products, which can pass through their system. For over 30 years, phototherapy treatment in the hospital has been provided by a row of lights or a spotlight suspended at a distance form a baby. This would provide light shining directly on an undressed baby (with diaper on) whose eyes would need protection from the light with soft eye patches applied. Today, advancements in technology have led to a new phototherapy system which gives effective treatment without the inconveniences of conventional phototherapy treatment. Are there Side Effects of Using Phototherapy? Babies under any type of phototherapy treatment will have frequent and loose bowel movements that are sometimes greenish in color. This is normal since this is the way the body removes the bilirubin. This will be temporary and should stop when treatment is completed. Contact your doctor if it persists after treatment is completed. What is the BiliBlanket? Your doctor may prescribe the biliblanket as an alternative and/or additional treatment for you child's jaundice. This system uses fiber optics and represents advanced technology in phototherapy treatment given in the hospital or at home. The biliblanket provides the highest level of therapeutic light available to treat your baby. This form of light is also found in sunlight. The strength of light form the biliblanket is about the same, as you would get in the shade on a sunny day, yet is safer because the biliblanket filters out potentially harmful ultraviolet and infrared energy. A pad of woven fibers is used to transport light from a light source to your baby. This covered fiberoptic pad is placed directly against your baby to bathe the skin in light. Absorption of this light leads to the elimination of bilirubin. The biliblanket can be used 24 hours a day to provide continuous treatment if prescribed by your doctor. Blood may be drawn and tested during treatment to check bilirubin levels and determine when normal levels are reached and phototherapy is no longer needed. With this convenient form of phototherapy your child can be diapered, clothed, held, and nursed during treatment. Can my baby sleep on a biliblanket? Yes. Your hospital will outline the schedule for your child's treatment. However, the biliblanket can be used 24 hours a day for as long as necessary. Why is my baby's skin bleached or reddened' where the biliblanket pad has been in contact with the skin? The skin in direct contact with the pad is the first area where bilirubin is broken down. This breakdown process is not harmful; in fact, it contributes to the treatment of your baby and causes this portion of skin to turn to its normal color. As the treatment process continues, bilirubin is removed from the blood and the rest of the skin. As the bilirubin is lowered to acceptable levels, all of you baby's skin will return to its normal color.

Will my baby be rotated on the pad to treat all of his/her skin? No, only a small portion of the bilirubin is in the fatty tissue of the skin. The majority of the bilirubin is in the blood. The circulation of the blood will bring the bilirubin to the lighted area where it will be broken down. It is important that the plain lighted area of the covered pad-the area without writing- is against the baby's skin at all times during treatment. Clothing can then be applied over the system. How long will the biliblanket be used on my baby? The length of time phototherapy treatment is needed varies from one baby to the next as each baby's condition is different. Your health care provider will prescribe the amount of time your baby will be on the biliblanket each day. Most babies have phototherapy treatment for several days. Your baby's bilirubin level will be tested during treatment, usually by a small sample of blood taken from the baby's heel. These tests will determine when normal levels of bilirubin are reached and phototherapy is no longer needed. Reviewed by UMHS Newborn Care Committee, May 2005

Bilirubin Lights
What are bilirubin lights?
Bilirubin lights (often called bili lights) are used to shine a bluish light on a babies skin. This helps the baby get rid of bilirubin. Bilirubin is released into the blood when red blood cells break down. The liver uses bilirubin to make bile. Normally there is only a small amount of bilirubin in the blood. High levels may be caused by liver or blood problems. When the bilirubin level rises, it causes the skin and whites of the eyes to become yellow. This change to yellow is called jaundice. Bilirubin often builds up to higher levels in newborn babies. Usually this does not cause a problem. However, if a baby and mother have different blood types, sometimes the mother produces antibodies that destroy the newborn's red blood cells. This causes a sudden buildup of bilirubin in the baby's blood. This serious type of jaundice usually begins during the first 24 hours of life. Although jaundice is usually not harmful, when the bilirubin reaches very high levels, it can damage the brain. It is important to reduce high levels of bilirubin.

How does a bilirubin light work?


The bluish light (sometimes called phototherapy) changes the type of bilirubin into a form that is more easily dissolved in water. This type of bilirubin goes out of the body in the urine and stool. The bilirubin level then goes down.

How long will bili lights be used?


The amount of time a baby spends under the bili lights is different for different babies. It depends how much bilirubin is being made and how quickly the liver starts to take care of the bilirubin itself. Some babies are under the lights for a day or less, while others are under the bili lights for several days. If the bilirubin level goes very high and the bili lights cannot bring it down fast enough, a procedure may be needed to exchange the blood high in bilirubin with transfused blood that is low in bilirubin.

Are there any complications of bili lights?


The blue light is safe. A rare baby whose parents have a disorder called congenital erythrocytic porphyria should not be put under bilirubin lights. Rarely a baby under bilirubin lights will develop a color of the skin called bronzed baby syndrome. This problem usually gets better without specific treatment. Many babies under bili lights will get a little warmer, so some babies need to have their clothing and covers adjusted and drink a little more milk. Some babies may need IV fluids to avoid dehydration. Babies under bili lights have their eyes shielded from the bluish light to prevent harm to the back of the eyes. Goggles or patches may be used to shield their eyes. Babies that have been under bili lights have to have their bilirubin level measured intermittently. It is checked by a blood test.

When should I call my babys healthcare provider?


Call your babys healthcare provider if:

Your baby is getting a lot more yellow since the last time your baby saw a healthcare provider. You have noticed jaundice for the first time. The stools are white, pale yellow or light gray. Your baby has jaundice and is more than 2 weeks old.

Written for Relay Health by Robert Brayden, MD, Professor of Pediatrics, University of Colorado Pediatric Advisor 2012.2 published by RelayHealth. Last modified: 2011-02-10 Last reviewed: 2011-01-07 This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

Bili Light The challenge of an advanced technology. The BILI LIGHT phototherapy lamp, by means of a new fiber optic technology, performs a greater uniformity of radiation, concentrating the entire emission onto the patient. Thanks to the reduced size, with respect to conventional phototherapy lamps, the Bili Light allows to perform the treatment with phototherapy directly in the patient's cot, can be easily moved from one ward to another and can be used for home-care. The BILI LIGHT can also be used alongside a conventional radiant phototherapy system, thus increasing therapeutic efficiency and reducing exposure time. The optic assembly is provided with a halogen lamp and a special group of filters that generate a radiation with a wave-length between 425 and 475 nanometers for optimal therapeutic efficiency. The light beam is conveyed to the patient through a fiber optic cable and a pad which can be placed under the patient. The pad is sealed, waterproof and hygienic. It is inserted into a disposable protective cover which provides a soft comfortable and hygienic mattress for the patient. The BILI LIGHT lamp is also available with a trolley provided with pivoting castors and a basket for storing disposable articles, the optic fiber pad, etc.