NEC and phototherapy?

dawngloves, BSN, RN · Nov 7, 2003

No. :confused: Would it be from, I don't know, overheating?? Ya got me!

TiffyRN, BSN, PhD · Nov 9, 2003

Please forgive me if I am wrong, I'm just brainstorming. I would be very interested if someone could find a research reference to this but I've never heard of it before but I wonder. . .

I'm sure someone out there has heard the urban legend about the woman who dies of "cooked" intestines from tanning salons? Look it up on any good urband legend site. Please don't be offended it just sounded so similar.

http://urbanlegends.about.com/library/bltan.htm

NICU_Nurse, BSN, RN · Nov 9, 2003

Sorry, I didn't have much time online the other day.

Okay, we had a 35 weeker who had a bili level of >15.5 (can't remember exactly) on phototherapy x1. MD's were aware of the level and the need for phototherapy, but for some reason (this is the dilemma I'm trying to figure out) decided to d/c the phototherapy. So, p/t dc'd for about 24 hours. In the am, another bili level was drawn and it was slightly higher than the last level (say, 16...again, close but not exact, just to give you an idea). Seeing as it was nearing the weekend, we had a moonlighting doc on call instead of the staff. When he heard the level was that high, he flipped out and demanded that the p/t be turned back on (sheesh, man, you don't have to YELL, but I digress...).

I was confused as to why the p/t was turned off in the first place, seeing as the level was so high and they knew about that and they were the ones who initiated the p/t in the first place. The moonlighting doc says, "Oh, yes, they probably turned it off because of the increased risk of developing NEC." I said, oh, I've never read/heard that...is that true? He says yes and rushes off to the next disaster.

So I ask another nurse, she doesn't know. So here we are. I did a google search but came up with nothing.

I'm just trying to figure out why p/t could lead to this...does it have something to do with dehydration from the lights and electrolyte imbalance and its effect on the bowel?

To paint a bigger pic, baby was 35 weeks post PPHN and was still NPO, but on TPN/Lipids to a UVC. Not that that helps.

Any suggestions, even urban legends, are welcome.

NICU Newbie · Nov 9, 2003

OK, so since I am NOT experienced, laugh at me if I am completely wrong. (I have pulled out my old peds book). Once the conjugated bilirubin is in the intestine, bacterial action breaks it down....maybe something goes wrong when all of this conjugated bilirubin plus the bacteria in the intestine,(overload? an overproduction of bacteria?), leading to increased chance of NEC. Just a thought.

Jolie, BSN · Nov 9, 2003

I've never heard of this, and can't offer any reasonable explanation of why it might be true. I wonder if he is mistaking coincidental factors as having a cause-effect relationship.

For example, sick babies have a higher incidence of jaundice (and phototherapy) than healthy babies. And sick babies have a higher incidence NEC than healthy babies. So is he therefore (wrongly?) concluding that phototherapy contributes to NEC?

Jolie, BSN · Nov 9, 2003

Just another thought. It seems more than a little foolish to turn off the phototherapy and risk a significantly higher bili, which would lead to the necessity for an exchange transfusion to prevent kernicterus, than to continue phototherapy, a safe procedure, with a possibly miniscule increased risk of NEC.

dawngloves, BSN, RN · Nov 9, 2003

Kristy, I hope you grabbed this guy and asked his rationale. We've got some good guesses here, but I still think he's full of it.

NICU_Nurse, BSN, RN · Nov 10, 2003

Unfortunately, this happened in the AM as I was ready to go (and I'm sorry, but after the night I'd had, I hightailed it...). He ran off to take care of something else, and I was left standing alone with another nurse who, as mentioned before, was as lost as I was. I was hoping to ask someone last night, but it was Sunday and our docs were all tucked sweetly in their beds. So, tonight a friend of mine is working and I'm going to ask her to grab the neonatologist (who is BOUND to know- this woman is a genius) and I'll let you all know as soon as I find out if this is hooey or not.

Thanks for speculating with me.

Sometimes if I wonder if they just throw things out there because they think we won't know any better.

Or maybe they just think we'd never question THE DOCTOR.

(said in my best SUNDAY!SUNDAY!SUNDAY! MONSTER TRUCK RALLY! voice)

NicuGal, MSN, RN · Nov 12, 2003

OMG...in my unit, we would have been writhering on the floor laughing at that poor soul Sometimes we aren't too kind with things that are thrown out like that :roll

Back on subject...I asked at work and our attending and fellow were like...and where did you hear that? Guess that answered the question :rolleyes:

prmenrs, RN · Nov 16, 2003

What was the DIRECT bili? NPO, on hyperal, s/p being very sick--I'd worry about cholestasis. If you put a kid w/a high direct under a bili light--you get a 'bronze' baby--the light discolors the bilirubin in their skin. Not a good plan.

How old was the kid?--that makes a difference, too.

There is probably a coincidental finding of prematurity, photoRx, and NEC. How many premies have you met that DON'T get 'lit'? Since NEC is most often found in premies also, if you study a group of pts who had NEC, a lot of them will have rec'd photoRx. That doesn't mean bili lights cause NEC.

Just getting back to the boards after my vacation--wonder what you found out?

Charming moonlighter, by the way, I'll bet he makes lots of friends! :rolleyes: