Neonatal jaundice is a frequent condition in neonates, observed in as many as 60% of term and 80% of preterm infants in the first week of life. In most of them, treatment with phototherapy in the neonatal intensive care unit (NICU) is necessary to reduce raised bilirubin levels, which is the direct cause of jaundice. Phototherapy is an effective treatment used for neonatal jaundice, in which eye protectors are used to shield the baby’s sensitive eyes from the strong therapeutic light. But are these eye protectors safe and effective for newborns?
In this blog, we will discuss neonatal jaundice, how phototherapy is done, the role of eye protectors, and the problems with using them.
What is Neonatal Jaundice?
Neonatal jaundice is a condition that makes neonates’ skin and eyes undergo a yellow discolouration. This mostly occurs during the first week of their life due to elevated levels of bilirubin, a pigment formed from the breakdown of red blood cells. This condition is medically known as hyperbilirubinemia.
Bilirubin is eliminated from the foetus through the mother’s liver throughout pregnancy. But after birth, the baby’s liver has to remove bilirubin. Generally, an infant’s liver is not mature enough and may not be able to eliminate bilirubin effectively in the first few days, causing an excess buildup of bilirubin, leading to yellowing of the skin.
Is Neonatal Jaundice dangerous?
Jaundice is very common in babies and is generally not severe and resolves within a matter of weeks. But extremely elevated levels of bilirubin are harmful and might result in an illness called kernicterus, which might produce brain damage. That’s why a timely checkup by a healthcare provider and treatment are important.
When is Phototherapy needed?
Phototherapy is recommended when bilirubin levels are found to be high and continue to rise, crossing the specific thresholds based on the baby’s age in hours, gestational age, and other risk factors like prematurity or haemolytic disease.
How does Phototherapy work?
Phototherapy is a therapy administered to babies with blue spectrum light (typically 460–490 nm) to change bilirubin into a water-soluble form so that the baby can eliminate it freely via urine and stool. During phototherapy, the baby’s skin is exposed to as much light as feasible. Thus, for this process, your baby will be undressed (except for their diaper) and placed under the light in a warm incubator or cot in an NICU unit with eye protectors till their levels get normal. In severe cases, intensified phototherapy may be used.
How many days of Phototherapy does a newborn require?
The duration of treatment typically varies according to bilirubin levels, the age of the baby in hours, and how it responds to treatment. The duration may be between a few hours and 5-7 days. Infants are frequently monitored by taking blood samples and are sent home when their levels reach a normal level.
Is Phototherapy safe in the newborn?
Yes. It is a non-invasive and effective treatment, well-tolerated by most newborns. However, some babies may experience some minor side effects such as dehydration, loose greenish stools, temperature instability, mild skin rash, or tanning, which usually resolve after the therapy is over. Infants are continuously monitored in the NICU to manage these potential side effects.
Why are babies’ eyes covered during Phototherapy?
The bright blue light can damage a newborn’s sensitive eyes and developing retina if directly exposed for longer periods. Therefore, eye protectors are used to block harmful light while ensuring the baby receives full therapeutic exposure to the rest of the body.
What types of Neonatal Eye Protectors are used in Phototherapy?
Neonatal eye protectors come in different forms, tailored to the age, size, and comfort needs of the baby. Here are the main types:
- Velcro-strap soft-fabric eye shields
- Hydrogel adhesive eye pads
- Foam-based eye shields
- Wrap-around cloth covers
- Custom-made or locally sourced eye shields
What are the key requirements of a good eye protector?
As they are used for newborn babies, their suitability for their skin and phototherapy treatment is crucial. Here are some important requirements that an eye protector should have:
- Should completely block phototherapy light
- Be soft, breathable, and hypoallergenic
- Fit securely but comfortably, without restricting breathing or circulation
- Allow easy monitoring and repositioning by healthcare providers
Generally, the eye protectors used in the NICU are made up of soft, breathable, and hypoallergenic fabric. Some use Velcro or elastic bands to keep them in place without causing pressure or skin irritation. As per a research study, black cotton fabric was found to provide the best protection for phototherapy.
What are the challenges in using Neonatal Eye Protectors during Phototherapy?
Eye protectors may shift due to baby movement, especially in active or preterm infants, risking eye exposure to phototherapy light. However, improper use, like poor fitting or infrequent checking, can lead to skin marks or slipping.
The solution is to use properly sized eye shields with adjustable, soft fastenings. NICU staff should check positioning regularly during nursing rounds. Some NICUS are adopting wrap-style or foam-based protectors that mould better to the baby’s face. In addition, innovative new products are emerging, paving the way for improved eye protectors in neonatal care.
Are there any alternatives to Phototherapy?
For severe cases or if phototherapy fails, treatments like exchange transfusion or intravenous immunoglobulin (IVIG) may be considered for neonatal jaundice.
Can Neonatal Jaundice come back after Phototherapy?
A slight rebound in bilirubin levels can happen, especially in premature babies. Doctors monitor this and discharge only after levels stabilise.
References:
- Dey, P., & Baruah, M. M. (2021). Incidence and causes of neonatal jaundice in a population of North East India. ResearchGate. https://www.researchgate.net/publication/350213131
- Cleveland Clinic. (n.d.). Jaundice in newborns. https://my.clevelandclinic.org/health/diseases/22263-jaundice-in-newborns
- Stanford Medicine Newborn Nursery. FAQs about phototherapy. https://med.stanford.edu/newborns/professional-education/jaundice-and-phototherapy/faqs-about-phototherapy.html
- Jaiswal, A., Soni, A., Tripathi, V., Agarwal, S., & Kumar, P. (2021). Knowledge, attitude and practice of mothers towards neonatal jaundice in a tertiary care centre. Journal of Tropical Pediatrics, 67(6), fmab101. https://doi.org/10.1093/tropej/fmab101
- National Health Service (NHS). (n.d.). Jaundice in newborns – Treatment. Retrieved April 22, 2025, from https://www.nhs.uk/conditions/jaundice-newborn/treatment/
- National Institute for Health and Care Excellence (NICE). (2016). Neonatal jaundice in babies under 28 days (Clinical guideline [CG98]). Retrieved from https://www.nice.org.uk/guidance/cg98
- Kumar, M., & Chawla, D. (2023). Neonatal Jaundice. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532930/
Written By:
Swati Manik
An experienced medical writer with an MPharm degree, she is passionate about advancing healthcare. She combines her pharmacy expertise and writing skills to keep the community informed on the latest medical developments, offering valuable insights across a range of health topics.