Introduction to Home Phototherapy

Congratulations on your new baby! We are sure you will find that bringing a new baby home will be a joyful experience. Throughout this document we will be reviewing certain instructions to make sure that you understand how to care for your baby during the home phototherapy treatment. Your careful adherence to the following guidelines will assure a safe home phototherapy experience.

Normal Newborn Jaundice

‘Normal’ newborn jaundice, also called physiologic jaundice, is a temporary condition that causes a baby's skin and whites of the eyes to become yellow. During the first week of life, there is a breakdown of red blood cells that forms a waste product known as bilirubin. Jaundice is caused by excessive levels of bilirubin which accumulates in the baby's skin and other tissues. It is the excess buildup of bilirubin in the blood that produces the baby's yellow appearance.

In most babies, jaundice occurs because the liver and other organs are not yet fully mature. This is particularly true in very small or premature babies. Phototherapy is the safest, most widely used treatment for jaundice in newborns. Phototherapy simple means ‘treatment with light’. This treatment uses special therapeutic light that is directed over the baby's body. This light speeds up the removal of the bilirubin form the body by breaking bilirubin down into a harmless waste product that can be excreted by the small intestines. After a few days of treatment, the baby's liver is able to handle waste products, bilirubin contact comes down to an acceptable level, and phototherapy is discontinued. Fiber optic phototherapy equipment produces light energy in the proper wavelength to break down the bilirubin in the bloodstream rendering it nontoxic. Fiber optic phototherapy units deliver the same amount of light with the proper wavelength as hospital units.

Description of Fiber Optic Phototherapy Equipment

Fiber optic phototherapy systems consist of three components:

• Illuminator - Compact in size, and weighing less than 15 pounds, the illuminator contains the light source and a cooling fan.
• Fiber Optic Cable and Panel - Plugs into the illuminator. The cable contains a bundle of plastic fibers that transmit light. At the other end of the cable the fibers fan out to create a flat, flexible band of light that wraps around the baby's torso. This flexible band or blanket is the panel.
• Disposable Panel Covers - Adjustable covers that are used with a supply of tape tabs to allow you to wrap the fiber optic panel around the baby. The disposable wrap is hypo allergenic. It is soft and cushion like, and if worn properly, should be very comfortable for the baby.

Placement and Setup

1. Place the illuminator on a sturdy flat surface no more than three feet away from where the baby will be lying. Make sure the equipment is set up in a place that is quiet and convenient to the parents/caregivers.
   1. Do Not place the unit on/in a bed, crib, drawer or carpeted floor
   2. Do Not stand the unit on its end
   3. Do Not block the units cooling fan
2. Insert the collar of the fiber optic panel completely into the insert of the illuminator. Make sure it is securely in place.
3. Switch on the illuminator to check that the system is working, then turn off the illuminator. 
   1. Note - Proper placement of the fiber optic panel will prevent possible skin irritation under the baby's arms. Follow the directions below to assure proper placement.
4. Put a t-shirt on the baby and roll the t-shirt from the bottom up until it fits comfortably under the baby's arms. This provides a cushion of fabric between the edge of the panel and the baby's armpits.
5. Insert the fiber optic panel into the disposable cover. If applicable, make sure that the light faces the fabric side of the disposable cover, not the plastic side. These covers are changed daily, or as necessary if soiled.
6. Place the covered panel around the baby positioning it under the baby's armpits. Make sure that the fabric side of the cover is touching the skin.
7. Using the tape tabs, fasten the panel in place by affixing the tabs on the plastic side of the cover at the open end where you inserted the fiber optic panel. Making sure the tape tabs attach only to the cloth cover and are not in contact with the fiber optic panel. Do not wrap the baby too tightly; a good rule of thumb is to be able to insert one or two fingers between the baby and the pad at both the top and bottom of the pad. In a larger or more active baby you may also want to tape down the panel to the baby's diaper. This will prevent it from riding up under the baby's armpits.
8. Wrap the baby in a blanket to block the light coming from the outside of the fiber optic panel.
9. Switch the illuminator on and start treatment.
10. Because the light emitted by the fiber optic panel does not reach your baby's field of vision when the panel is wrapped around their torso, there is no need for the baby to wear protective eye patches. Remember that you must always secure the lights around the baby before you switch on the illuminator. Likewise, you must always switch off the illuminator before you remove the wrap around the baby.

Baby Positioning

Several recent studies have led to some questions about the best way to position an baby in their bed for sleeping. This is a matter that should be discussed with your baby's physician as soon as possible, if you have not done so already.

Bowel Movements

When your baby is taking adequate fluids, they should urinate frequently. If the number of wet diapers is decreasing, the baby may not be getting enough fluids. A significant change in the frequency of urination should be reported to your physician.

In the first few days of phototherapy, your baby may produce a ‘bili’ stool (green and mucousy in appearance) when they have a bowel movement. This indicates that the body is eliminating the bilirubin. If the baby should have an insufficient number of bowel movements, the bilirubin level may remain high. Notify your physician if you notice a decrease in the number of bowel movements or if the baby would develop diarrhea.

Blood Tests

When the baby begins receiving phototherapy their skin may no longer indicate how severe the jaundice is. To monitor the progress of the infant's treatment, the baby will require blood tests (usually daily) as ordered by the physician. The blood sample may be obtained by your homecare nurse or other agency health professional; or you may be asked to take the child to the doctor's office for this. The blood tests provide the doctor with the information on the bilirubin level and other indications of the baby's condition.

Eye and Skin Color

The baby's skin and the sclera or ‘white part' of the baby's eyes may appear yellowish. You must be aware that an increased yellow color of the sclera and/or skin may indicate increasing jaundice.

A daily check of the baby's skin color must be entered on the Parent Record Sheet. Turn off the illuminator and remove the wrap momentarily while the skin color is checked. Use adequate house or sunlight to determine the baby's skin color. Also check under the baby's arms for any possible skin irritation from the fiber optic panel. Umbilical cord care can also be done at this time.

Be sure to replace the wrap and continue with the phototherapy treatment while feeding the baby.

Plan of Care

1. Parents/caregivers express agreement with the plan of care proposed by the physician.
2. Parents/caregivers understand that the physician may feel it is necessary to re-admit the baby to the hospital if the serum bilirubin level fails to fall within an acceptable range during the home phototherapy treatment period.

Feeding and Bonding

The feeding frequency, the type of feeding (breast or bottle), and the need for any supplement is determined by your baby's physician.

The baby should be fed every three to four hours around-the-clock unless otherwise directed by the physician. The feedings should be breast, bottle, or a combination of both as discussed with the physician.

• The order for frequency, amount, and supplement is reviewed with the parents/caregivers and they agree with, and understand, the feeding plan.
• Parents/caregivers agree to document feedings, vomiting, and amounts. Babies sometimes spit up. However, excessive vomiting should be reported to your physician.
• Parents/caregivers understand that the phototherapy treatment should continue during feeding and they recognize the importance of holding and bonding with the baby.

Safety Precautions

• Turn the illuminator off when the wrap is not around the baby.
• Always position the baby and the pad so that there is slack in the cable with no sharp bends or kinks in the cable. Also maintain slack in the cable if you move around with the baby wrapped in the fiber optic panel. Never pull on the light box.
• Do not leave the power cord exposed so that you or other family members could trip and fall or possibly pull the illuminator which might result in injury to the baby.
• After turning the illuminator off wait 20 minutes before attempting to move it. Failure to do so could result in damage to the lamp.
• Do not place anything on the illuminator that will block the fan.
• Do not place the illuminator on a bed, crib, or carpeted floor
• Do not stand the illuminator on its end or place it in a drawer.

If Light Does Not Operate

• Turn illuminator off.
• Wait 20 minutes for the phototherapy unit to cool. Then push the lamp change button (located on the left side of the unit). Turn illuminator on. If light remains out, follow the below instructions:
  • Plug the illuminator into a different outlet and try turning it back on (remember, wait 20 minutes before moving the unit.)
  • If the light still does not operate, remove baby from the fiber optic panel and dress baby to assure they remain warm.
  • Check home circuit breaker or fuse box and reactivate or replace as needed.
  • If there is power to the unit and the lights still do not work, call MedCare. Do not attempt to service the unit yourself.

Instructions for Use with Model #MD-510 Disposable Covers
(For use only with Fiber optic Panel  
Model #FOP-500, EG-2000 or EG-2000-R)

1. The illuminator should only be placed on a hard, flat surface, no more than four feet from where the baby will by lying or held. To insure proper air flow, do not block any of the air vents that surround the illuminator. Place the illuminator on a stand or table next to the baby’s bed or near where you will be sitting to nurse your baby. Do not place the illuminator next to or on a radiator or heater. Insert the metal collar of the fiber optic panel completely into the opening in front of the illuminator. The end of the metal collar of the fiber optic panel is designed to be even with the opening in the front of the illuminator. Turn the metal collar of the fiber optic panel clockwise about a quarter of a turn. Then turn the panel one complete revolution. This movement will lock it in place. Plug the illuminator into an electrical outlet. You will need a three-pronged plug (grounded) outlet close by for the electrical cord.
    
2. Insert the fiber optic panel into the disposable cover, ensuring that the bright light faces the sheer side of the cover. If a disposable cover becomes soiled, discard it and replace it with a new one. Repeat Steps 3 and 4.
    
3. NOTE: Proper placement of the fiber optic panel will prevent possible skin irritation under the baby’s arms. Follow the directions very carefully to insure proper placement.
   
   Put a t-shirt on the baby and roll it from the bottom up until it fits comfortably under the baby’s arms. This pro vides a cushion of fabric between the edge of the panel and the baby’s armpits. With a larger or more active baby, you may also want to tape down the panel to the baby’s diaper.
    
4. Place the covered panel around the baby, positioning it so the cushioned bumper guard is under the baby’s arm pits. Ensure that the sheer side of the disposable cover is touching the skin. Using two of the tape tabs provided, fasten the panel in place by affixing the tabs onto the disposable cover at the open end where you inserted the fiber optic panel.
    
5. Do not wrap the baby too tightly. A good rule of thumb is to place one finger between the panel and the baby’s body to insure proper ventilation. Remember, with a larger or more active baby, you may want to tape the fiber optic panel down to the diaper which will prohibit it from riding up under the baby’s armpits.
    
6. You may swaddle your baby in a blanket or put a sleeper on your baby.
    
7. You may now turn on the illuminator and begin phototherapy treatment.
    
8. You may pick up your baby at any time during phototherapy treatment. You may rock, cuddle, or feed your baby without any disruption in treatment. Do not walk around with your baby while treatment is underway. Stay close enough to the illuminator so it is not pulled off its stand or table.