WAHT-NEO-051 It is the responsibility of every individual to check this is the latest version of the document

NEONATAL PROCEDURE FOR THE CARE OF A BABY WHO REQUIRES PHOTOTHERAPY This guidance does not override the individual responsibility of health professionals to make appropriate decision according to the circumstances of the individual patient in consultation with the patient and/or carer. Health care professionals must be prepared to justify any deviation from this guidance.

Introduction This is a guideline for the Jaundiced baby requiring phototherapy. The treatment to reduce unconjucated bilirubin levels is extra fluids and phototherapy. The method used will depend on the actual level of bilirubin and how rapidly this rose, as well as the clinical condition, gestation, age in hours and the weight of the infant. The patients covered by this guideline are babies on Neonatal Unit / Special Care Baby Unit / Maternity Unit who have jaundice requiring treatment.

This guideline is for use by the following staff groups: This procedure may be undertaken by any nursery nurse or qualified nurse/midwife working on the Special Care Baby Unit/Neonatal Unit/Maternity Unit/Paediatric Ward

Lead Clinician(s) Vanessa Dobbs

Neonatal Unit Sister

Guideline approved by Quality Improvement Meeting on :

25th July 2014

This guideline should not be used after end of:

25th July 2016

Key amendments to this guideline Date

Amendment This guideline replaces the versions originally approved May 2003 and reviewed in July 2005 and March 2007. Reviewed by clinical lead and agreed to continue for a further period without amendment

By:

May 2012 08/04/2014

No changes made to guideline Lead clinician has reviewed document – no amendments made to content – recoded from WAHTPAE-023 to WAHT-NEO-051

V Bullock V Dobbs

11/04/2014

Guideline approved by Accountable Director

Andrew Gallagher

18/07/2014

Changes made regarding fluid requirements

V Weckemann

11/06/2009

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WAHT-NEO-051 It is the responsibility of every individual to check this is the latest version of the document

Neonatal Procedure for the Care of a Baby Who Requires Phototherapy Introduction This is a guideline for the Jaundiced baby requiring phototherapy. The treatment to reduce unconjucated bilirubin levels is extra fluids and phototherapy. The method used will depend on the actual level of bilirubin and how rapidly this rose, as well as the clinical condition, gestation, age in hours and the weight of the infant.

Guideline Equipment 

Phototherapy unit/Biliblanket/Bilibed



Eye cover



Thermometer/Tempadot



Specimen pot



Jaundice chart

Procedure 

Explain to parents the causes for jaundice and the need for adequate hydration and/or phototherapy, to allay any fears and worries. If possible, use the bilibed on the post natal ward.



It is important to maintain normal hydration and nutrition of the jaundiced newborn infant. This may be achieved by the encouragement of breastfeeding, the provision of additional oral fluids or may require the intravenous administration of fluid. There is no evidence to support the administration of excessive quantities of fluid and most infants will not need extra fluids.



If baby is receiving overhead phototherapy, baby will require eye protection either tinted shield or eye shield. Radiation from this light band has been shown to cause retinal damage.



Baby needs to be nursed exposed, without clothes or nappy, this is to ensure optimum treatment from phototherapy.



Incubators should be set in the correct thermoneutral range and the baby’s axilla temperature monitored regularly 3-4 hourly. Light at this wavelength does not emit much heat and the exposed infant can get cold.



Remove all vernix, oil and lotions from the skin prior to commencement of phototherapy. Skin care using warm water should be performed at “all care” times as deposits of bile salts in the skin can cause irritation and itching – redness and inflammation can occur.



Consider obtaining a urine specimen for Micro Culture and Sensitivity, ward testing/reducing substances to ensure cause of jaundice is not urine infection or galactocaemia



Turn baby regularly to ensure equal distribution



Teach parents how they can interact with their baby

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WAHT-NEO-051 It is the responsibility of every individual to check this is the latest version of the document

Documentation 

Chart bilirubin result on neonatal jaundice chart



Record presence and type of phototherapy on baby care charts



Plan timing of next serum bilirubin estimation

Additional Information Blue Light Phototherapy by Halogen Lamp 

Heat is generated by the radiant lamp and is removed by an axial fan. A thermal cut out switch turns off the lamp if the fan fails therefore it is important that the fan is switched on first before the lamp and left on all the time whilst the unit is in use. When the unit is no longer required, then the fan must be switched off after the lamp is switched off



The lamp itself is extremely bright and takes 3 minutes to achieve maximum output. If the lamp is switched off it should not be switched on for at least 10 minutes otherwise it may not ignite



The blue light gives the baby a mottled greyish appearance and care should be taken to assess the baby’s condition accordingly



Glare from the lamp can be difficult to work with. Using green sheets can reduce it. Particular care should be taken to cover the baby’s eyes

Monitoring Tool How will monitoring be carried out?

Audit of records

When will monitoring be carried out?

Before review of current guideline

Who will monitor compliance with the guideline? STANDARDS: Item Appropriate recording of serum bilirubin result Appropriate management undertaken where serum bilirubin abnormal

SCBU/NNU staff

% 100%

Exceptions

100%

References 

Kelnal C., Harvey D., Simpson C. (1995) The Sick Newborn Baby third edition London: Bailliere Tindall



Boxwell G. (2000) Neonatal Intensive Care Nursing: Routedge



Mupandemund R., Watkinson M. (1999) Key Topics in Neonatology – Bios Scientific Publishers



Levene M., Tudehope D., Thearle M. (2000) Essentials of Neonatal Medicine third edition London: Blackwell Science Ltd

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Contribution List Key individuals involved in developing the document Name Corenna Bowers Cee Sheridan Vicky Bullock Dr John Scanlon Dr Andrew Short Dr Andrew Gallagher

Designation Neonatal Practice Development Nurse Ward Manager ALEX Ward Manager WRH Clinical Director Neonatologist Neonatologist

Circulated to the following individuals for comments Name Designation All Consultant Paediatricians Circulated to the chair of the following committee’s / groups for comments Name Committee / group Mrs Jacqui Fernell Nursing Guidelines Group

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Supporting Document 1 - Equality Impact Assessment Tool To be completed by the key document author and attached to key document when submitted to the appropriate committee for consideration and approval. Yes/No 1.

Comments

Does the policy/guidance affect one group less or more favourably than another on the basis of:

Race

No

Ethnic origins (including gypsies and travellers)

No

Nationality

No

Gender

No

Culture

No

Religion or belief

No

Sexual orientation including lesbian, gay and bisexual people

No

Age

No

2.

Is there any evidence that some groups are affected differently?

No

3.

If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

No

4.

Is the impact of the policy/guidance likely to be negative?

No

5.

If so can the impact be avoided?

N/A

6.

What alternatives are there to achieving the policy/guidance without the impact?

N/A

7.

Can we reduce the impact by taking different action?

N/A

If you have identified a potential discriminatory impact of this key document, please refer it to Human Resources, together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact Human Resources.

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Supporting Document 2 – Financial Impact Assessment To be completed by the key document author and attached to key document when submitted to the appropriate committee for consideration and approval. Title of document:

Yes/No

1.

Does the implementation of this document require any additional Capital resources

No

2.

Does the implementation of this document require additional revenue

No

3.

Does the implementation of this document require additional manpower

No

4.

Does the implementation of this document release any manpower costs through a change in practice

No

5.

Are there additional staff training costs associated with implementing this document which cannot be delivered through current training programmes or allocated training times for staff

No

Other comments:

If the response to any of the above is yes, please complete a business case and which is signed by your Finance Manager and Directorate Manager for consideration by the Accountable Director before progressing to the relevant committee for approval

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