Phototherapy

Specialties NICU

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:idea: does anyone use aluminum foil around infant cribs to increase the infants exposure to the phototherapy lights? if so does it really work?
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Specializes in Level II & III NICU, Mother-Baby Unit.

We have certainly done this before, but it was only for babies who had very, very high bilirubin levels and we needed to get as much light to them as possible. We only used it on the 4 sides of the radiant heat warmers and it really does help. When you need to give intensive phototherapy (phototherapy light readings over 30-40) anything you do can be helpful. The babies we used it for were nearing exchange transfusion bilirubin levels. If you are having trouble getting a high enough reading you can surround the baby's crib, radiant heat warmer or isolette with white blankets/sheets. The white is very reflective, similar to the brightness we get when looking at snow in sunshine. Still, the aluminum foil worked better for us when the baby is on a radiant heat warmer and in need of very intensive phototherapy.

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Specializes in NICU, Infection Control.

That's a new one on me.

Usually, I've seen "double bank", and/or a Wallaby pad under the baby.

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Specializes in Level II & III NICU, Mother-Baby Unit.

I should mention that when we have used aluminum foil we did not have access to biliblankets. We did however use the overhead phototherapy lights which are part of the radiant heat warmer and would add 2 to 3 bank lights around the bed along with the aluminum foil on the 4 "side rails". We would try to aim for a phototherapy light meter reading of 40 or more. This was most important during the beginning when the phototherapy was initiated as our neonatologists were looking for signs of a decent drop within 2 to 4 hours of starting the phototherapy as this would help them to decide if the lights were going to be enough. If the lights were not enough in that first 2 to 4 hour period we prepared the baby for a partial exchange transfusion. I'd say that about 2/3 of the time the lights worked and those babies did not require the exchange transfusion.

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Specializes in NICU.

Interesting, I can't say I've ever seen that used on our unit.

When we have critical bilis that need light readings of ~30-40 we just use a couple of banks and that always provides a reading of at least 30, and I've seen them use blankets in addition to that.

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Specializes in NICU.
:idea: does anyone use aluminum foil around infant cribs to increase the infants exposure to the phototherapy lights? if so does it really work?

we don't use them in our nicu, but i have read of them being advocated in an online article i read on phototherapy. also, placing white sheets around the bed reflect lights back onto the baby, as well as helping to protect nurses' eyes from exposure to the intense light.

the amount of skin exposed is important; if possible infants should have mimimal coverage of their diaper area. if you do not have biliblankets in your nicu, it helps to rotate the babies prone>supine position every 4 hours, as tolerated. if baby doesn't tolerate this, you could try moving him even slightly side-supine-opposite side every 4 hours.

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Specializes in ER, NICU.

Sorry, but I can't stop giggling..

I read this thread and the first thing that popped into my mind was how the baby must look like a Thanksgiving turkey with all the aluminum foil and all!

:devil:

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Photo readings of 30-40??? We get bilimeter readings of 80's to 90's with just a single Drager bank! What are you guys using???

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Specializes in NICU.
Photo readings of 30-40??? We get bilimeter readings of 80's to 90's with just a single Drager bank! What are you guys using???

30-40 is for our readings for our equipment, and it's within range for double/triple (I can't remember the exact numbers, as I'd have to look at the photometer paper to be exact).

I've never seen any of our meters read in the 80s-90s, so obviously we have different equipment with different ranges.

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Specializes in NICU, PICU, educator.

There is a lot of literature out there advocating white blankets and aluminum foil for those kids with super high bilis. One is from ANCC. We have done this with kids that are rH factors, those are the hardest kids to get down! The other thing is that the recommendation is to now go back to the blue lights instead of the white lights, go figure, we just bought a bunch of the white lights a few years back.

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Specializes in NICU.

We use double bank blue lights and blankets, white sheets on occasion, and then on to the exchange transfusion - usually double volume for the rH kids. We do have one or two of the white lights but they are only used as a last resort when none of the blues are available.

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there are several researches that explain the efficacy of using aluminum foil or white cloth at the sides of phototherapy unit, or even covering the incubator (for infants in incubator). here are the websites: http://www.ncbi.nlm.nih.gov/pubmed/6714261?dopt=abstract

http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2672760/

http://www.nejm.org/doi/full/10.1056/nejmct0708376#ref35#t=citedby

and there's a research that shows that turning of infants during phototherapy for

hyperbilirubinemia doesn't increase its efficacy. >>

http://www.ncbi.nlm.nih.gov/pubmed/11948386

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