Neonatal phototherapy care and exchange transfusion
THE CONTEXT
The passage covers care during phototherapy, monitoring and stopping treatment, and indications for exchange transfusion.
Positioning and feeding during phototherapy
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Ensure that the eye patch does not block the baby's nostrils.
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Place the naked neonate under the lights in a cot or bassinet if weight exceeds 2 kg, or in an incubator or radiant warmer if weight is below 2 kg.
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Keep the neonate 30–45 cm from the light, or follow the manufacturer's recommendation.
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The mother may remove the neonate from the bassinet for breastfeeding. Removing the eye patch can improve mother–infant interaction.
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Supplementation is unnecessary when breastfeeding is adequate.
Monitoring and stopping phototherapy
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Monitor temperature every 2–4 hours and total serum bilirubin (TSB) every 12–24 hours.
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Stop phototherapy when two TSB values measured 12 hours apart are below current age-specific cut-offs.
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In neonates with hemolytic disorders, monitor clinically for rebound bilirubin rise within 24 hours after stopping phototherapy.
Exchange transfusion
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Perform double volume exchange transfusion when TSB reaches the age-specific exchange cut-off or when signs of bilirubin encephalopathy appear, irrespective of TSB.
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At birth in infants with Rh isoimmunization, indications include cord bilirubin of at least 5 mg/dL or cord hemoglobin of 10 g/dL or less.
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At birth, hydrops or cardiac decompensation with a packed cell volume below 35% calls for partial exchange transfusion with 50 mL/kg of packed red blood cells to restore oxygen-carrying capacity quickly.