phototherapy

cindyln · Jan 22, 2003

Our babies getting phototherapy are always inpatients

OBNURSEHEATHER · Jan 22, 2003

We sometimes send patients home on a bili blanket. The light itself is a flexible rectangular object that fits along the front or back side of the baby. Once the baby is swaddled in it's blanket, you don't see anything except the "tubing" coming out of the blanket. It's difficult to describe, perhaps someone else here will do better!

I'm not totally sure if eye protection is still required? We actually have a home health nurse in the hospital that comes and does the consultation and teaching once home phototherapy is ordered. She then delivers, sets up, and reinforces the teaching at home.

Heather

SmilingBluEyes · Jan 22, 2003

it's very rare babies go home on bili therapy. but there ARE bili blankets, forget what the brandname is. I think some peds do get these for home-use with close follow-up w/dr and/or home health care.

OBNURSEHEATHER · Jan 22, 2003

Ahhh.... when all else fails, find a picture.

It is not rare at my hospital at all to send these babies home. Keeps health care costs down, and lets mom and baby do their bonding business. Our census is too high to allow moms to stay as patients because baby is jaundiced. They would have to be discharged.

Of course, this is only done if the doc, home health nurse, and nurses involved directly in their care are all confident in the patients ability to seek help if needed, use the equipment properly, and have adequate follow up. If any of these conditions aren't met, then they'd keep the baby as an inpatient.

Heather

researchrabbit · Jan 22, 2003

My first child was born back in the Dark Ages, I guess; her "bili therapy" after hospital discharge was sunlight through a window for 10 minutes 3x a day until the first checkup....no kidding, that's what the MD ordered.

Jolie, BSN · Jan 22, 2003

As a NICU nurse, I was not about to leave my baby in the hospital for phototherapy! She was a healthy, breastfeeding 36 weeker with a bili of 18+, and went home on phototherapy.

The unit we used was called a "Wallaby". It was a fiberoptic "blanket" which wrapped around her midsection and was in continuous use. Eye protection was not needed. I kept a log of temperature, I&0, and activity levels. A home care nurse came for daily assessments including weight and heel-stick bili.

After 3 days, the lights were DC'd and we continued daily bili levels for another day or two. It was an easy course of therapy for us, but it has its limitations.

Babies who are poor feeders and/or dehydrated need IV therapy and nursing interventions aimed at improving feeding skills. (My little one was a chow hound, so this was not a problem.) Also, the "blanket" illuminates a relatively small surface area of skin, so babies with higher bili levels will not respond adequately to this treatment, needing standard lights, possibly in addition to lying on a bilil blanket.

My daughter is now almost 5 years old, so home phototherapy is old news to me. I'm surprised it's not more common in your areas. We were in Philadelphia, and I had 2 co-workers who did home phototherapy visits, so I know it was pretty widespread there. Maybe it's a regional thing.

SmilingBluEyes · Jan 22, 2003

The reason it is rare where I am, is cause bili's are often WAY high and they are getting double therapy, e.g. light PLUS blanket. And what happens after they go home, I don' t know. I am sure some jaundice is caught and treated at home...many DO get re-admitted to our floor for tx, tho, if it's high enough.

Mimi2RN, ASN, RN · Jan 22, 2003

You're right, Heather, you don't need eye protection with a bili blanket. It's a fiberoptic light, works well on many babies but we usually use it with an overhead bililight.

Seems to me any pt good enough to treat at home can't have a very high bili.

memphispanda, RN · Jan 22, 2003

My daughter had a Wallaby. I was a rather PITA patient with her, and was somewhat uncooperative with the attempts to bottlefeed my baby (they put down an NG tube instead)...This was over 6 years ago. It was super, except for having to go daily for 10 days to have bili levels drawn at the lab.

OBNURSEHEATHER · Jan 22, 2003

Thanks Mimi!

Heather

mother/babyRN, RN · Jan 23, 2003

We sometimes keep them as inpatients under the lights, or combine the light therapy at night when mom wants to sleep and then send them out to nurse of feed on the wallaby..At home they are encouraged to keep the kids in the sunshine...