Jaundice is one of the most common conditions in newborn babies needing medical attention. Jaundice refers to the yellow colour of the skin and the whites of the eyes caused by excess bilirubin in the blood, also known as hyperbilirubinaemia. Bilirubin is produced by the normal breakdown of red blood cells and is excreted as bile through the intestine. Jaundice occurs when bilirubin builds up faster than a newborn’s liver can break it down and pass it from the body. Jaundice can affect both term and pre-term newborns, however, the pre-term infants are at higher risk due to the pre-maturity of their organs, especially the liver. In most babies, jaundice is harmless, however, if the bilirubin is unconjugated (bilirubin which is not water-soluble, hence not excreted in the urine), then using phototherapy can be beneficial in treating these infants.

Phototherapy refers to treatment with light. The equipment consists of a number of fluorescent light tubes which emit light in the blue-green band of the visible spectrum (425–475 nm). The blue-green light converts the unconjugated bilirubin to a harmless isomer which can easily be excreted in water.

• Conventional phototherapy: Phototherapy given using a single light source (not fibre optic) that is positioned above the baby.
  
• Fibre optic phototherapy: Phototherapy given using a single light source that comprises a light generator, a fibre optic cable through which the light is carried and a flexible light pad, on which the baby is placed or that is wrapped around the baby.

• Appropriate light source: overhead lamps/fibre optic light source is bilisoft.
  
• Eye-shield: with appropriate size to suit the pre-term/term infants.
  
• Tape measure: to adjust the distance of the light from the infant as per manufacturer’s guidelines.
  
• Appropriate phototherapy charts for the gestation of the infant (refer to NICE treatment threshold graphs). Check the bilirubin levels and plot them on the correct chart.

Ensure all phototherapy equipment is maintained and used according to the manufacturer’s guidelines.

• Explain the need for phototherapy to parents and obtain consent. Additional information can be supplied with information leaflets.
  
• Wash hands.
  
• Remove all of the baby’s clothing except for the nappy.
  
• The baby should wear the smallest appropriate nappy to maximize skin exposure.
  
• Remove any lotions or creams applied to the baby as this will cause the treatment to be ineffective and create skin irritation.
  
• If possible, cleanse the skin with warm water prior to the procedure to ensure good skin integrity is maintained and the treatment is effective.
  
• Apply the eye-shield prior to commencing the light.
  
• If the overhead light is used, then adjust the distance as per manufacturer’s instruction and turn the lights on.
  
• Check the body temperature prior to the treatment and monitor the baby’s temperature three-hourly and ensure the baby is kept in a thermo-neutral environment (36.8–37.2°C).
  
• Ensure the infant has good fluid intake. Monitor hydration by daily weighing of the baby and assessing wet nappies.
  
• Change position with nappy care to obtain effective phototherapy to cover whole body.
  
• Monitor bilirubin regularly.
  
• Document time of commencement and completion of phototherapy in the neonate’s health care records and on the phototherapy chart.
  
• Support parents and carers and encourage them to interact with the baby.
  
• When serum bilirubin is 50 micromol/litre below the threshold, stop the phototherapy.
  
• Check serum bilirubin for rebound 12–18 hours after ceasing phototherapy.

• Hypo/hyperthermia: The infants who are nursed in a cot have a high risk of developing hypothermia (low temperature). Bilisoft (fibre optic) pads can be a solution to this as the infant can be further wrapped with a blanket. An incubator would be better for ideal phototherapy as it can ensure light and thermoregulation.
  
• Risk of eye damage: Radiation from the phototherapy light can cause retinal damage, hence eye protection with the eye-shield is necessary. This should be checked at least every 4–6 hours to check for any corneal skin breakdown. Also ensure that the eye-shields do not occlude the nares as this can interfere with breathing.
  
• Insensible loss/dehydration: Phototherapy may decrease the bowel transit time and result in diarrhoea, probably as a result of bowel wall irritation caused by the presence of photo-isomers of bilirubin. Jaundiced infants are commonly drowsy and may not wake up for feeds. An increase in the fluid requirement of 10–25% may be considered.
  
• Skin irritation and damage: Deposits of bile salts in the skin can cause irritation and itching. Redness and inflammation can occur from a photosensitive reaction. Avoid using lotions and creams, inspect the skin regularly, and a position change is recommended.
  
• Parental anxiety and separation from the baby: Parents are in a vulnerable state usually post-natally and the infant having jaundice and phototherapy with eye coverage can upset them. If possible, nurse the infant with the mother in a post-natal ward.