I had a reply back from Natus, the makers of
the neoBLUE. Here's how that went: -----
Original Message -----
From:
Technical Service
To:
dannfox@comcast.net
Sent: Tuesday, March 18, 2008 6:49 PM
Subject: RE: the importance of keeping baby's eyes
covered during phototherapy to treat jaundice.
Dear Ms. Fox
Thank you for your inquiry concerning the phototherapy
treatment and eye protectors. Natus Medical is a medical device
manufacturer and does not have advice nurses, audiologist, or
staff available to speak to the general public. All requests
concerning the phototherapy treatment should be directed to the
health care provider who is performing this treatment. I would
encourage you to speak with your grandchild's attending
physicians. Sorry I am unable to offer you more assistance.
Best Regards,
Bill Douglas
Natus Medical Technical Service
My REPLY:
Unfortunately, I am not able to speak to one of the baby's
physicians since they have no set schedule to do their rounds, and
Grandparent's visiting hours are from 10:00 - 10:30 a.m. and 8:00 -
8:30 p.m. and I've NEVER seen a Dr. during those hours.
Below is some text that is on the Natus website.
WHY ARE MY BABIES EYS COVERED?
Eyeshades must be used during phototherapy to
protect your
baby's
eyes from excessive light exposure. Your nurse will take the
eyeshades off when the neoBLUE light is turned off.
On the Bili-Mask page it says:
A safe, proven means of protecting
babies' eyes during
phototherapy. Easy to put on, stays in place & no light leaks.
All I want to know is what kind of damage can be done to a baby's
eyes when they are are not properly shielded from the phototherapy
lights?
I did not get any answer from the nursing staff because they kept
telling me that it won't cause any harm at all.
Obviously it could cause some harm or it would not be all over
the internet, including the Natus website, to keep the babies
eyes covered.
If these products can be used on the General Public then where
can the General Public find out the necessary information.
Is it ok for these nurses to use these lights on these babies
WITHOUT proper eye protection?
Surely someone at Natus would know the answer, as not only do
they market the product, but the eye masks as well.
Donna Ann Fox
Email:
dannfox@comcast.net
cc:
customer_service@natus.com
Email
received from a Children's Hospital. - March 19, 2008
I have not read current
research related to eye protection for newborns under
phototherapy; however, it is obviously common practice to
provide the eye protection.
As a grandmother, you have a
right and obligation to advocate for your grandchild. If I were
you, I would ask to speak with a nursing manager or director at
the hospital and explain each and every one of your concerns.
There is
no excuse for
not properly fitting and
securing eyewear on infants under phototherapy. Equally
important is maintaining
appropriate body temperature.
This needs to be controlled through the temperature regulator on
the isolette itself. The nursing staff needs to be
checking the infant’s body temperature on a regularly scheduled
basis to ensure that his/her body temperature is being
maintained appropriately.
Email from the March of Dimes: - March 21,
2008
Dear Ms. Fox,
Thank you for your recent request for information from the March of
Dimes.
The March of Dimes has not produced material on this specific topic.
(Of course they haven't as no one can, that is not a study
that can be done, and why protectional measures
have to be taken.)
When March of Dimes literature is unavailable, we
attempt to provide people with information from another source
and/or a referral to an agency or agencies that might be able to
assist them. You may wish to link to one of the following sites.
They sent me a list of sites, below.
Stanford School of Medicine
WHY ARE THE BABY'S EYES COVERED?
In adults, prolonged exposure to blue light
can cause retinal damage. Although retinal damage from
phototherapy has not been reported, eye
covers for newborns are
standard prophylaxis.
WebMD - Fundamentals of Phototherapy for Neonatal
Jaundice
Nursing Care of The
Infant Receiving Phototherapy
Phototherapy is
much more than just
switching on a light. The efficiency
with which phototherapy achieves a
decline in the serum bilirubin level
is largely determined by nursing
care. Appropriate nursing care
also minimizes the
potential side effects and
complications of phototherapy.
Provide Eye
Protection
Opaque
eye shields
must be used
during
phototherapy
to
protect
the infant's
eyes
from
retinal
damage.
To
adequately
block the
transmission
of light,
carefully
apply eye
coverings by
first
closing the
infant's
eyes and
then
applying
shields
securely.
Avoid eye
patches that
are too
tight,
because they
might apply
undue
pressure to
the infant's
delicate
eyes. Turn
off the
phototherapy
unit and
remove the
eye patches
periodically
to assess
the eyes for
drainage,
edema, and
evidence of
infection;
to provide
visual
stimulation;
and to
encourage
parent-infant
interaction
as
appropriate
based on the
infant's
clinical
status.
Assess and
Adjust
Thermoregulation
Devices
Some
phototherapy
units can
cause a
significant
increase in
the infant's
body
temperature.
When
phototherapy
is directed
over an
incubator,
immediate
and
sustained
fluctuations
can occur in
the thermal
environment.
Thermal
instability
can occur
when using
either the
skin-control
or
air-control
mode of the
incubator.
With
inadequate
monitoring,
vigilance,
and
adjustments
to the
thermal
environment,
the infant
can easily
develop
hypothermia
or
hyperthermia
during
phototherapy.
Investigative
Ophthalmology
and Visual
Science
Phototoxicity to
the newborn primate retina
KH Messner,
MJ Maisels and AE Leure-DuPree
Newborn stump-tail monkeys were
continuously exposed to 400 f-c of
cool, white, fluorescent
light for periods varying from 12 hr
to 7 days. The right eye
of each monkey was occluded by a
patch of black velour material
to serve as a control. The
protected eyes retained normal
ultrastructure; the
exposed eyes showed progressive
damage to the retina from the 12 hr
to the 7-day exposure
periods. Early changes were evident
in the outer nuclear
layer with darkly staining pyknotic
nuclei and electrondense cytoplasmic
processes that could be traced
to their synaptic terminals. Late
changes included marked
distortion, vacuolization, and
fragmentation of the rod and
cone outer segments. The
potential for phototoxicity
to be
additive to the normal
aging of the retina is proposed, and
we conclude that there is a
sound basis for the
current practice of
patching
the eyes of infants
undergoing phototherapy.
Phototherapy and retinal damage
Duration of exposure to the lights can range
from a few hours to 6 or more days of continuous or
intermittent (e.g., 6 hours on, 2 hours off) exposure.
There is concern about
possible deleterious
side-effects of the treatment. One hazard which has
concerned investigators is the
possibility of retinal
damage to infants
exposed to phototherapy continuously for several days. The
basis for concern about
retinal damage lies in
several studies in the animal literature which
have shown structural and functional
changes in the
retinal
photoreceptors following extended periods of exposure to
illumination, even at levels considerably lower than those
used in phototherapy.
In summary, studies of rats and piglets have
indicted that continuous exposure to levels of illumination
similar to those used to treat hyperbilirubinemia (jaundice)
in newborn infants can result in severe photoreceptor
damage. Furthermore, severe damage to the
photoreceptors of animals has been found subsequent to
several weeks of exposure to room lights 24 hours day.
(Which is why many nurseries now have diffused or dimmed
lighting). These results indicate that
care must be
taken to protect both the eyes of infants exposed to
phototherapy and the eyes of infants who are lying adjacent
to a phototherapy unit or who must remain for a number of
days under nursery lights 24 hours a day.
Jaundice, Neonatal
Key
points in the practical execution of phototherapy
are maximizing energy delivery and the available
surface area.
- The infant
should be naked except for diapers (use these
only if deemed absolutely necessary and cut them
to minimum workable size), and the
eyes should
be covered to reduce
risk of
retinal damage.
|
Generally, phototherapy is very safe and may have no
serious long-term effects in neonates; however, the
following adverse effects and complications have
been noted:
-
Retinal damage has
been observed in some animal models
during intense phototherapy. In an NICU
environment, infants exposed to higher
levels of ambient light were found to
have an increased risk of retinopathy.
Therefore, covering the eyes of infants
undergoing phototherapy with eye patches
is routine.
Care must be taken lest the patches slip
and leave the eyes uncovered
or occlude one or both nares.
|
|
March 24, 2008
I just received one answer from a Pediatric Website.
"There is very little literature to exactly
determine what is the extent of eye damage that can take place if
the baby is kept without eye protection with phototherapy. Since
phototherapy is known to
damage the eyes, thus no study would be
available where baby is not given eye protection. "
Received April 8, 2008
Another answer from the Pediatric Department of a
major hospital.
Thank you for your email of March 25.
Because of the animal studies that suggest that
phototherapy lights can be damaging to a baby*s retina, we recommend
that the baby*s eyes be covered with an opaque patch. There is no
doubt, however, that achieving this can be a challenge and requires
considerable vigilance on the part of
the nursing staff. Notwithstanding the animal data, it is
true that we have no evidence that any baby*s eyes have been damaged
by phototherapy lights so it is possible that we are being over
protective. Nevertheless, we feel that the safest approach is to
continue to cover the eyes. In our NICU we use the Neotech system
and this works quite well although vigilance is still required to
make sure that the infant*s eyes are
adequately covered.
Some online sources:
The New England Journal of Medicine
Clinical Evidence
Phototherapy was evaluated in a number of randomized trials
conducted from the 1960s through the early 1990s.
Although these trials helped to establish the efficacy of
phototherapy as it was used during this period, none used
the relatively high light doses
used today. Current ethical standards would prevent any
trial comparing phototherapy with placebo.
Because light can be toxic to
the immature retina, the
infant's eyes should
always
be protected with opaque eye patches.
Fundamentals of phototherapy for neonatal jaundice.
Nurse's
Responsibilities In Phototherapy
Nursing care and
procedure for photo therapy:1.
Undress the baby completely.
2. The
baby's eyes are shielded by an
opaque mask to
prevent exposure
to the
light.
3. The eye shield should be
properly sized and
correctly positioned to
cover the eye
completely but prevent any
occlusion of the nares.
4. The baby's eyelids are closed
before the mask is applied, because the
corneas may become excoriated if they
come in contact with the dressing.
5. On each nursing shift the eyes are
checked for evidence of discharge,
excessive pressure on the lids or
corneal irritation.
6. Eye shields are removed during
feedings, which provide the opportunity
to provide visual and sensory
stimulation.
Photo
therapy is
not a
harmless
intervention.
It can
produce
adverse
effects on
the baby and
may disturb
medical and
nursing
personnel
a. Lethargy
b. Loose
green
stool-weigh
often and
compensate
c.
Increased
insensible
water loss-
provide more
frequent
extra
breastfeeding
d. Dark
Urine.
e.
Temperature
elevation.
f. Skin
changes -
greenish
colour, rash
due to
capillary
dilation -
skin rashes
- no need to
discontinue
photo
therapy.
g. Turn
infant on
abdomen for
short period
of time and
will cease
priapism
(persistent
abnormal
erection of
penis)
h.
Retina
damage:
prevented
by
shielding
the eyes.
i. Hypo
or
hyperthermia:
Monitor
temperature
frequently.
(There were
numerous
times when
my
Grandson's
temp. was
101.5,
101.6, etc.
and it
should not
have been
that high)
j.
Increased
metabolic
rate,
dehydration,
and
electrolyte
disturbances
such as
hypocalcemia.
Development of an eye protector for phototherapy on newborns:
A study revealed that,
of the types of lamps utilized in phototherapy,
blue lamps provide more effective
treatment than halogen lamps. However, one of the
complications of the method is
that is causes degeneration of the retina
through exposure to light. Therefore, it is
crucial to
protect the eyes properly. Some
authors say this protection can be provided by bandages, blindfolds
or strips of gauze.
Light transmission of Phototherapy Eye Shields
Recently there has been concern that bright ambient
light may be an important factor in the pathogenesis of retinopathy
of prematurity,' yet small preterm jaundiced infants may be exposed
to
high levels of light during
phototherapy. As a
direct consequence of studies in
animals that showed the damaging effects of phototherapy light
on
the neonatal retina, human neonates
receiving phototherapy now
have their eyes covered
routinely with eye shields.
Phototherapy:
Light intensities inside
phototherapy units greatly exceed NICU ambient levels. We estimate
them to be at least 10,000 lux, and even higher in some of the newer
units with tungsten sources. Because much of the energy is at
short wavelengths, we should be
particularly cautious about measuring only illuminances - there may
be sufficient intensity in the short wavelengths for
photo-chemical damage to the
retina. This is particularly true in
the units that use only blue fluorescent lights.
Infants receiving phototherapy
typically have their eyes covered with
protective shields. When properly fitted, the commercially
available occluders are quite effective in blocking light,
especially when coupled with closed eyelids.
However, mere use of occluders
does not necessarily protect the retina. Staff sometimes use
makeshift occluders made from, for example, stacks of gauze pads,
which may not attenuate sufficiently, and even the best occluders
may not stay in place well. In a minute-by-minute study of infants
in an NICU, it was observed that for those receiving phototherapy,
the occluders slipped and no longer fully covered the eyes more than
50 percent of the time. This observation is easy to confirm
anecdotally in conversation with NICU staff. Often the slippage
exposed only one
eye, another factor that predicts the possibility of
monocular damage.
There are some animal data on exposure to
phototherapy units. Piglets and infant macaque monkeys raised in
human phototherapy units without occluders but with the
ability to close
their eyes suffered considerable
histological damage to their
retinas. In the latter study, newborn
macaques were exposed to illuminance of about 4300 lux for periods
from 12 hours to four days. Even after 12 hours, there was some
immediate damage to photoreceptors. Ten months later, all exposed
eyes showed some recovery, but many eyes were histologically
abnormal, particularly if exposed for three or four days. Thus,
there is reason to be concerned for infants
receiving phototherapy. What is less obvious is that there
might be even greater risk for infants in NICUs who are the
neighbors of infants receiving phototherapy. It is not generally the
practice to shield the eyes of infants next to those being
photo-treated, yet there can be a significant increase in total
light exposure for such patients, as our data on control infants
demonstrates.
Abstract:
Phototherapy is the use of visible light for the treatment
of hyperbilirubinemia in the newborn. This relatively common
therapy lowers the serum bilirubin level by transforming
bilirubin into water-soluble isomers that can be eliminated
without conjugation in the liver. The dose of phototherapy
largely determines how quickly it works; the dose, in turn,
is determined by the wavelength of the light, the intensity
of the light (irradiance), the distance between the light
and the infant, and the body surface area exposed to the
light. Commercially available phototherapy systems include
those that deliver light via fluorescent bulbs, halogen
quartz lamps, light-emitting diodes, and fiberoptic
mattresses. Proper
nursing care enhances the effectiveness of
phototherapy and minimizes
complications. Caregiver
responsibilities include ensuring effective irradiance
delivery, maximizing skin exposure,
providing eye protection and eye care,
carefully monitoring thermoregulation,
maintaining adequate hydration, promoting elimination, and
supporting parent-infant interaction.
(C) 2006 National Association of Neonatal Nurses
Needless to say, there are hundreds of websites
stating that the eyes must be protected and the infants
temperature
monitored carefully. I'm not going to list each and every
one.
Sep 12, 2008:
It looks like after 6 months and a 2nd eye exam we are
unfortunately, finally getting some answers. Apparently my
grandson cannot focus either up close
or
far away. SEE
UPDATE
It makes one wonder
just how many children's
severe eye problems SHOULD
BE linked to improper eye
care
and protection during
phototherapy, yet is only linked
to prematurity?
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