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Photo-Therapy Treatment For Jaundice in New Born Baby 

Rent Bili-Blanket in India for New Born Baby Jaundice Treatment

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Bili Blanket Do's & Dont's

August 16, 2016

 

DO make sure the light source box is on a flat, non-absorbent surface. Do not place on carpet or sit on the crib mattress.
DO make sure as much of the infant’s skin is in direct contact with the light pad. Diapers should be worn.
DO have the disposable cover as the ONLY material between the light-emitting side of the pad and infant’s skin. Clothing may be worn over the pad.
DO leave the light pad on when holding or feeding your baby.
DO turn off light when bathing your infant.
DO change the disposable cover if it becomes soiled.
DO use a 3-prong plug for safety.
DO set the intensity knob on the light box to the highest setting.

DON’T use the light-emitting pad without a disposable cover.
DON’T directly expose your baby’s eyes to the covered light pad.
DON’T sit anything on top of the light source box or the fiber optic cable.

Your Baby, Jaundice, and Phototherapy

August 16, 2016

Your Baby, Jaundice, and Phototherapy

What is Jaundice?  

Jaundice is a common, temporary. and usually harmless condition in newborn infants. It affects both full-term 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.

Technical Considerations

August 16, 2016

Phototherapy Dose

The effectiveness of phototherapy at converting bilirubin into configurational isomers, structural isomers, and photooxidation products is determined by the dose of phototherapy provided to the infant. The dose of phototherapy depends on several factors, including the spectral wave length of light, the spectral irradiance delivered to the infant’s skin, and the total spectral power (average spectral irradiance delivered across the surface area of the infant). Factors that affect phototherapy are described in the image below.

Factors that affect phototherapy: The 3 factors thFactors that affect phototherapy: The 3 factors that affect the dose of phototherapy include the irradiance of light used, the distance from the light source, and the amount of skin exposed. Standard phototherapy is provided at an irradiance of 8-10 microwatts per square centimeter per nanometer (mW/cm2 per nm). Intensive phototherapy is provided at an irradiance of 30 mW/cm2 per nm or more (430–490 nm). For intensive phototherapy, an auxiliary light source should be placed under the infant. The auxiliary light source could include a fiber-optic pad, a light-emitting diode (LED) mattress, or a bank of special blue fluorescent tubes. Term and near-term infants should receive phototherapy in a bassinet and the light source should be brought as close as possible to the infant, typically within 10-15 cm. However, if halogen or tungsten lights are used, providers should follow the manufacturer recommendation on the distance of the light from the infant to avoid overheating. Preterm infant can be treated in an incubator, but the light rays from the phototherapy device should be perpendicular to the surface of the incubator to minimize light reflectance. Adapted from Maisel MJ, McDonagh AD. Phototherapy for Neonatal Jaundice. N Engl J Med. 2008;358:920-928.

Light in the blue region of the spectrum, near 460 nm, is most strongly absorbed by bilirubin. However, only light that penetrates the skin and is absorbed by bilirubin provides the needed photochemical effect. Tissue penetration increases as the wavelength of the light increases. Thus, one must balance the use of a higher wavelength of light, which more readily penetrates tissue, with the use of a wavelength that is more readily absorbed by bilirubin, which may penetrate less deeply. With this in mind, light in the 460-490 nm wavelength is probably the most effective for use during phototherapy.[1]

Spectral irradiance is measured in watts per centimeter, or microwatts per square centimeter per nanometer (mW/cm2 per nm) over a wavelength band. Higher spectral irradiance results in a more rapid decline in the bilirubin levels.[10] Spectral irradiance increases as the distance from the light source to the infant’s skin deceases.[6] Different phototherapy devices deliver significantly different levels of irradiance. The American Academy of Pediatrics defines standard phototherapy as 8-10 mW/cm2 per nm and intensive phototherapy as more than 30 mW/cm2 per nm in the 430-490 nm band.[6]

Spectral power increases as the amount of skin exposed to phototherapy increases. Ways to increase surface area exposure include removal of clothing and increasing the number of lights/lighting devices used to deliver phototherapy. Infants receiving phototherapy should be left only in their diaper, allowing adequate surface area exposure for phototherapy. The use of lights both above and below an infant effectively doubles the area of exposure. Several manufacturers produce fiberoptic pads that can be placed under the infant. The Bili Bassinet (Olympic Medical; Seattle, WA) is one commercial device that provides special blue fluorescent tubes that emit light in the 460-490 nm wavelength, both above and below the infant.

The dose of phototherapy, in mW/cm2 per nm, should be measured during phototherapy using a commercially available radiometer. These devices typically measure the spectral irradiance of phototherapy in the 425-475 or 400-480nm band wavelength. The radiometer used to measure irradiance should be the one recommended by manufacturer of the light source. Due to variance in the strength of phototherapy over the surface of the infant, and because measurements of spectral irradiance can differ greatly depending on where on the infant the measurement is made, taking several measures in different locations on the infant and averaging the values is important

Jaundice

August 16, 2016

Jaundice refers to the yellow appearance of the skin that occurs with the deposition of bilirubin in the dermal and subcutaneous tissue. Normally in the body, bilirubin is processed through the liver, where it is conjugated to glucuronic acid by the enzyme uridine diphosphate glucuronyl transferase (UGT) 1A1. This conjugated form of bilirubin is then excreted into the bile and removed from the body via the gut. When this excretion process is low following birth, does not work efficiently, or is overwhelmed by the amount of endogenously produced bilirubin, the amount of bilirubin in the body increases, resulting in hyperbilirubinemia and jaundice.

Jaundice occurs in as many as 60% of all normal newborns within the first week of life.[1] Jaundice in the newborn can occur from an underlying pathological condition, such as isoimmune hemolysis or an RBC enzyme deficiency. However, it is more commonly due to the normal physiological inability of the newborn infant to process bilirubin adequately due to the combined effects of increased RBC turnover and a transient deficit in bilirubin conjugation in the liver.[1] This type of nonpathologic jaundice is referred to as physiologic jaundice of the newborn.[2]

In most infants with physiologic jaundice, bilirubin concentrations do not rise to a point that requires treatment. However, in some infants with exaggerated physiologic jaundice, and in many infants with pathologic jaundice, bilirubin in the blood reaches very high concentrations that put the infant at risk for acute and chronic bilirubin encephalopathy (kernicterus). In these cases, treatment aimed at decreasing bilirubin concentration is required in order to avoid kernicterus. Etiologies of hyperbilirubinemia in newborns are provided in the image below.

Causes of hyperbilirubinemia in newborn infants. ACauses of hyperbilirubinemia in newborn infants. Adapted from Maisel MJ. Neonatal Jaundice. Pediatrics in Review. 2006; 27: p. 445.

Effective treatments to decrease bilirubin levels in infants with severe jaundice include phototherapy and exchange transfusion.

The effect of light on jaundice in neonates, and the ability of light to decrease serum bilirubin levels, was first described by Cremer et al in 1958.[3] This observation led to the development of light sources for use in the treatment of infants with hyperbilirubinemia, a treatment now referred to as phototherapy. Since its inception, phototherapy has been effectively used as a relatively inexpensive and noninvasive method of treating neonatal hyperbilirubinemia.[4, 5] The decline in the number or exchange transfusions in recent years is, at least in part, likely a direct reflection of the effectiveness of phototherapy at treating hyperbilirubinemia. In modern neonatal ICUs (NICUs) exchange transfusions are rare and are only used as a rescue therapy to avoid kernicterus in newborns with severe jaundice when phototherapy is inadequate.

At its most basic, phototherapy refers to the use of light to convert bilirubin molecules in the body into water soluble isomers that can be excreted by the body. The absorption of light by normal bilirubin (4Z,15Z-bilirubin) results in the creation of 2 isomeric forms of bilirubin: structural isomers and configurational isomers. The main structural isomer of bilirubin is Z-lumirubin. The main configurational isomer of bilirubin is 4Z,15 E -bilirubin. Configurational isomerization is reversible, and structural isomerization is irreversible. Both the configurational and structural isomers of bilirubin are less lipophilic than normal bilirubin and can be excreted into bile without undergoing glucuronidation in the liver. Some of the configurational isomers of bilirubin, however, revert back to the native form after excretion into bile and can be reabsorbed via enterohepatic circulation in the gut. Structural bilirubin isomers, like Z-lumirubin, can also be excreted in the urine.

The absorptions of light by bilirubin also results in the generation of excited-state bilirubin molecules that react with oxygen to produce colorless oxidation products, or photooxidation products. This process occurs more slowly than configurational or structural isomerization. Photooxidation products are primarily excreted in the urine. The image below provides a schematic of the conversion of normal bilirubin to configurational isomers, structural isomers, and photooxidation products and the respective routes of excretion from the body.

Mechanism of phototherapy: Blue-green light in the
 

Bili-Blanket

May 10, 2016

Any of you ever rented a bili blanket to do phototherepy at home?

Friday I had a doctor appointment for Mya and her bilirubin numbers jumped 8 points (18.3) from when she was being observed in the hospital Wednesday.  We rented a biliblanket (the wallaby) Friday night and have had her on it none stop, except feedings, since Saturday morning at about 12am.

So, have you done this before?  And did it work?

I have a doctor appointment tomorrow and just want to hear that my LO is looking wonderful.  Seems like it's been a long week for her.

Bili Blanket Do's & Dont's

April 16, 2016

 

DO make sure the light source box is on a flat, non-absorbent surface. Do not place on carpet or sit on the crib mattress.
DO make sure as much of the infant’s skin is in direct contact with the light pad. Diapers should be worn.
DO have the disposable cover as the ONLY material between the light-emitting side of the pad and infant’s skin. Clothing may be worn over the pad.
DO leave the light pad on when holding or feeding your baby.
DO turn off light when bathing your infant.
DO change the disposable cover if it becomes soiled.
DO use a 3-prong plug for safety.
DO set the intensity knob on the light box to the highest setting.

DON’T use the light-emitting pad without a disposable cover.
DON’T directly expose your baby’s eyes to the covered light pad.
DON’T sit anything on top of the light source box or the fiber optic cable.

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