Phototherapy for Neonatal Jaundice

The use of phototherapy for neonatal jaundice is the first line of medical treatment for babies with hyperbilirubinemia (severe jaundice.) The purpose of phototherapy treatment is to prevent brain damage known as kernicterus.

It is essential that a child with excessive jaundice receive phototherapy as soon as possible. The failure to do so can change the trajectory of a child's life forever. If severe jaundice is allowed to progress, kernicterus can occur, causing permanent brain damage including cerebral palsy, long-term hearing loss and behavioral problems.

A baby with jaundice has too much bilirubin in their blood. Phototherapy is the most effective way of breaking down a newborn’s bilirubin into a form that the baby’s liver can process and eliminate. With phototherapy treatment, the newborn is placed under lamps referred to as “bili lights” or “bili lamps” so that the infant’s bare skin is exposed to specific wavelengths of light. This form of therapy has been used in hospitals for treating neonatal jaundice for over 40 years.

The methods and equipment have remained relatively unchanged until fairly recently. As the occurrence of kernicterus has become more prevalent, the technical advancements and latest recommendations in phototherapy for neonatal jaundice continue to be evaluated and published in efforts to help neonatal nurseries provide the best standard of care possible.

In the event their child is jaundiced at birth, expecting parents will benefit from knowing the procedures by which their hospital and doctors should be treating their baby.

What are the Guidelines for Phototherapy for Neonatal Jaundice?

On September 26, 2011, the American Academy of Pediatrics (AAP) issued guidelines to help standardize phototherapy for newborns with jaundice. The guidelines recommend that treating medical practitioners should

  • Make sure that maximum emission from the light source is within the blue to green range of the visible light spectrum (460 – 490 nm).
  • Use light-emitting diodes (LED) – these do not emit ultraviolet (UV) light, have low infrared and heat output, and last longer. The guidelines noted that if fluorescent lights are used, they should have a plastic cover or filter to prevent UV light from reaching the newborn.
  • Use a radiometer to measure irradiance at several places on the baby’s body. Specific irradiance levels should be reached.
  • Maximize the parts of the baby’s body exposed to the light source; change the baby’s position every 2 to 3 hours to help increase exposure. An eye mask and diaper may be worn, but are not necessary.
  • Check the serum bilirubin response within 4 to 6 hours of starting the phototherapy. In neonatal jaundice treatment, a specific decrease in serum bilirubin concentration (more than 2 mg/dL [34 μmol/L] should be observed.
  • Check the clinical improvement in jaundice and monitor signs of increased hyperbilirubinemia including altered behavior in sleeping and eating, and inconsolable crying.
  • Monitor the baby throughout phototherapy treatment for sufficient hydration, nutrition and temperature control.

A common misconception about phototherapy for neonatal jaundice is that ultraviolet light is preferred. The light frequency that is most effective for treating hyperbilirubinemia is from lamps with output in the 460 – 490 nm blue-green region of the spectrum. UV light is less than 400 nm.

In fact, phototherapy lights used in the past did not use the high light doses used today. Research has shown that when total serum bilirubin becomes elevated to the levels at which intensive phototherapy is recommended, it is particularly important to use lamps with blue emission.

Vigilance in Providing Phototherapy for Neonatal Jaundice

It is critical that a baby’s bilirubin levels do not escalate out of control. Phototherapy treatment to prevent kernicterus must be administered within hours after birth. The quality of the phototherapy administered is every bit as important as the timing. AAP states that the effectiveness of phototherapy in neonatal jaundice varies a great deal depending on the timing, the light source, and the arrangement and type of equipment used.

Most medical professionals and hospital nurseries treat jaundiced babies with great care. Yet, when a baby is not monitored or properly treated with phototherapy for neonatal jaundice, the condition can progress to kernicterus and medical negligence has occurred.

Ratzan Law Group is passionate about giving future parents the information they need to prevent this tragedy from occurring. We crave justice for the families who now live with children disabled by kernicterus, and will do all that we can to urge the medical community to prevent this tragedy from happening to another child.

Parents whose children are affected by kernicterus brain damage need to know that help is available to them through the support of our experienced kernicterus lawyers. Without legal and financial recourse, these families are on their own to bear the burden of a lifetime of exorbitant and desperately needed expenses. We give a powerful voice to these families by helping them to obtain fair compensation when the wrongdoing of others devastates their lives.

Kernicterus Information Center 


Additional recommendations about phototherapy for neonatal jaundice are provided in the AAP Guideline. The full report can be found here: http://aappolicy.aappublications.org/cgi/content/abstract/pediatrics;128/4/e1046