Phototherapy is a therapeutic measure in which electromagnetic radiation (light) is used to treat neonatal hyperbilirubinemia. Phototherapy allows the transformation of bilirubin into water-soluble photoisomers that can be excreted in the feces and urine, without the need for conjugation in the liver.
What is neonatal jaundice?
Jaundice refers to the yellowish discoloration of the skin and mucous membranes caused by the accumulation or deposit of bilirubin. Physiological jaundice is a common condition in full-term newborns, and is characterized by being monosymptomatic and fleeting (day 2 to day 7), mild when there is hyperbilirubinemia between 12.9-15 mg/dL and predominantly indirect, pathological ( 6% of neonates) when it begins in the first 24 hours, is accompanied by other symptoms, there is an increase of more than 5 mg/dL daily in bilirubin, exceeds the limits defined for physiological jaundice, the direct fraction is higher at 2 mg/dL, last more than a week in term neonates.
In neonates, the increase in bilirubin is secondary, most of the time, to the destruction or lysis of red blood cells, since the concentration of these cells is higher in the fetus in order to make better use of the scarce amount of oxygen. available inside the uterus. After the baby is born, that amount of red blood cells is no longer needed, so a large number of them are destroyed naturally, thus causing an increase in the release of hemoglobin into the bloodstream, which will later be converted to indirect bilirubin or unconjugated (lipid soluble) by a series of biochemical reactions.
Free bilirubin can cross the blood-brain barrier causing neuronal damage when it is found in excessive amounts due to its effect of neuronal toxicity, which can lead to permanent neurological sequelae in the patient. That is why this pathological picture must be prevented by maintaining safe levels of bilirubin in the blood, phototherapy being one of the most used techniques for this purpose.
What does the neonatal phototherapy protocol consist of?
The treatment of neonatal jaundice is a simple protocol that consists of placing a light at a distance of 30-40 cm from the bare body surface of the newborn, after placing radiopaque glasses and removing any cream or lotion from the skin. . The administration of phototherapy will depend on the bilirubin levels, the age of life, the gestational age at birth and the clinical status of the neonate.
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