Appropriate Counselling in Phototherapy: The missing link in the management of Neonatal Jaundice

As per the latest published literature, neonatal jaundice affects one in two infants globally. The scenario may not be very different closer home in India. With 28 million children born in India annually, let us take this yardstick as an example for arriving at the number of children who may suffer from this condition, i.e. 14 million neonates. Agreed?

But, does your Pediatrician spend at least 14 minutes to explain the condition and its outcomes? As a doctor myself, I am aware of the answer. It’s really shocking!

Let me share a personal example. I was blessed with an angel last month. She was a premie at the time of her birth (35 weeks). Apart from a few respiratory issues at birth, the baby was absolutely normal.

The yellowish discoloration on her skin and eyes became quite discernible on the third day. The serum bilirubin was 16.5 mg%. No surprises, the Hospital Pediatrician suggested double surface phototherapy. 

The following advice is given:

  • Continue breastfeeding
  • Provide top feeds, if the mother cannot express breast milk
  • Watch out for hydration/dehydration

But what was critically missing was the counseling required during initiation and ongoing phototherapy session.

Challenges galore

I wonder how many healthcare centers appropriately counsel the anxious parents/caregivers before the initiation of Phototherapy.

The baby was stripped naked, and hushed on a transparent fiberglass cabin with intense blue light flashed from all directions.

The sister repeated the same instructions as given by the Pediatrician. We nodded our heads at their wisdom and waited with bated breaths for the magic to transcend when our baby would slip comfortably in the blue cabinet.

But, what we witnessed was pure discomfort and a shrill cry, reflecting a sense of utter discomfort.

Guys, come on. As a fetus, the baby was in a dark environment, blissfully bathing in the liquor amnii. But now? This feeling for the baby is absolute hell.

I called up all my Pediatrician friends to seek their opinion on how to make the baby comfortable during phototherapy. Almost everyone gave the same feudal reassurances like “You should do and you should try. It is very easy. Just place the baby in the cabinet. The sister will do her job”

But, all that I was expecting was “How should we try and how should we do”.

Finally, it was time to knock the doors of Google guru. However, my best web search utilizing the most advanced skills also couldn’t fetch me great and actionable insights.

A dawning of the Solution

Every problem is unique and so is every solution. I rolled up my sleeves and took up the mantle of starting the phototherapy session.

Let me explain to you the secret mantra:

1.Daytime, the Best time

Always start the phototherapy during the daytime. It is best to start it during the wee hours of the morning when most of the babies are calm and relaxed. Not to forget, the unnecessary disturbances like the background noise and when the hospital staff intervention is also nill to minimal

2.Full Feeds

Ensure that the baby has taken full feeds, as recommended by the Pediatrician. Only then transfer the baby to the phototherapy unit.

3. The three step Scientific sequence

Well, this is a very personal one. Makes me feel as if I have been able to decode the mystery. Relate it to the way we have our meals, which is starters, main course, and desserts. 

Start with latching the baby to the breast (Starters), then continue with expressed Breast milk or top feeds (Main Course) and finally provide few teaspoonfuls of sterilized lukewarm sugar water (Dessert).

Pat the baby’s back until it burps and slowly transfers the baby into the phototherapy unit.

Repeat this cycle every 2-3 hours

4. No eye bands.. please!!

We cannot be careless here. Tying an eye band will make situations worse. Note that the babies forehead and upper half of the face are very sensitive.

You must cup your hands and place it on the babies eyes until they sleep comfortably.

Keep a watch if the eyes are completely closed. Else, continue placing your cupped hands over their closed eyes. 

The UV range used here is absolutely harmless to you and the baby. There have been no documented shreds of evidence on retinal harm with the blue light used in phototherapy.

5. Babies are found of Interior designing too…

Roll a cloth or a baby wrapper and place it along both the sides of the baby. It helps to keep them comfortable and cheats their psyche into the feeling of staying at the bedside with the mommy.

No worries, it can still meet the purpose of exposing the maximum surface area of the body to the light.

It worked for me. Why don’t you try it too?

It is said that a doctor is a very bad patient. It is not because of their ignorance or for their ability to spot the lacunae in their/caregivers Clinical management. But, because of their greater expectations from their professional mates.

With this article, I am sharing my observations and recommendations for a happy and smooth phototherapy session for the needy parents.

Although I have exposed your eyes from the blue light of your cellphones, I must assure you that it is every photon worth of it !!

 

1 thought on “Appropriate Counselling in Phototherapy: The missing link in the management of Neonatal Jaundice

  1. Lucid & informative.Practising “Do no harm” is an art.Emotional side of treatment is often misssed these days by most of doctors.Very sad but true.

    Liked by 1 person

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