1. Phototherapy
" Phototherapy" is a therapy based on exposure of the skin to a light source. It is very efficient to reduce bilirubin levels of newborns.
1.1 History
Phototherapy's positive effects have been discovered by coincidence, like so many scientific inventions, by a group of doctors in Rochford General Hospital during the fifties.
The head nurse had the idea to place the premature babies with jaundice into the open air exposed to the sun. The undressed children covered with only a light sheet, were exposed to the sunlight intermittently for 15 minutes at a time. This practice was not considered medical nor official, so the nurse would stop treatment before the doctors arrived.
During these visits the doctors noticed that these babies had a yellow skin in areas that were covered by the sheet. After repeated quesitioning the nurses finally confessed. Phototherapy was born...
1.2 When to start Phototherapy treatment?
The best moment for starting a phototherapy treatment will depend on blood levels of bilirubin. The unit for measuring the levels of bilirubin is micromole (µMOL ).
Risks for neurological complications exist as of 300 µMOL for the term baby. This level is a lot lower for the premature baby. Taken into account that no treatment can be considered having no risk at all, therapy must start at the right time, not too early, not too late.
Phototherapy is the best response to a newborn icterus. The only remaining questions are when the treatment should begin. Quality of the phototherapy lights is also a major factor to phototherapy efficiency and results.
1.3. Conventional Phototherapy vs intensive phototherapy
Conventional phototherapy devices develop an energetic illumination between 0.5 and 3,0 mW/cm². An efficient treatment needs to achieve at least 1,6 mW/cm². The energetic illumination of intensive phototherapy needs to be superior to 3,0 mW/cm².
It is imperative for conventional phototherapy lights to treat the baby on a longer period(36 to 48 hours consecutive) than intensive phototherapy. This long exposure time can entail irreversible damages such as severe neurological problems because of the emitted ultraviolet and infrared. Even more, because of heat, the baby has to be placed far enough from the source of light. He has to be placed on its back and front to flood the whole body with light. The newer machines permit a total exposure under the light source because the baby is placed on a transparent hammock with a reflector on top so the whole body of the baby is irradiated.
Intensive phototherapy allows a much higher energetic level of irradiation than the conventional phototherapy.
