Nursing care
Neonatal phototherapy: nursing care to prevent eye injury, overheating and dehydration
Written and reviewed by Amanda Lewis, ADN, RN, BLS · 4 min read · Updated October 2026
Short answer
During phototherapy the nurse shields the newborn's eyes with opaque covers, exposes as much skin as possible with only a nappy left on, and monitors temperature, hydration, stools and skin. Feeding continues, intake and output are recorded, and the lights are turned off while blood is drawn for bilirubin. Complications include overheating, fluid loss, diarrhoea, rash and bronzing.
What phototherapy does and why skin exposure matters
Phototherapy treats unconjugated hyperbilirubinaemia. Blue-green light penetrates the skin and converts bilirubin into water-soluble forms the newborn can excrete in urine and stool. The aim is to lower bilirubin before it reaches levels that risk bilirubin encephalopathy, which presents with lethargy, poor suck and hypotonia, progressing to a high-pitched cry, arching and seizures.
Because the light acts on skin, effectiveness depends on how much skin is exposed. The newborn is nursed unclothed except for a nappy, in an incubator or under a radiant warmer that keeps a neutral thermal environment. In severe cases a unit may remove the nappy to expose more skin. Position lights at the distance the manufacturer specifies.
Eye protection and skin care
Cover the eyes with correctly sized opaque eye shields for the whole time the lights are on, because the light can damage the retina. Check that the shields have not slipped over the nose, which can obstruct breathing, and that they are not too tight. Remove them at intervals during care and feeds to inspect for discharge, infection or irritation.
Keep the skin clean and dry and inspect it at each assessment. Lotions and oils are generally avoided on skin under the lights, per unit policy, because they can increase the risk of burns. A transient rash can appear during treatment. Turning the infant's position, if the unit allows, helps expose different skin surfaces and relieves pressure.
Temperature, hydration and feeding
Overheating and water loss are the main physiological complications. The light and the unclothed position increase insensible water loss, and loose stools from intestinal hypermotility add to it. Monitor temperature and vital signs closely, more often when the infant is in an incubator or radiant warmer, and keep a strict fluid balance chart including nappy counts.
Breastfeeding continues unless another condition prevents it; the nurse watches the infant's suck and attachment and supports the parent's milk supply. Fluid needs may be increased by the provider based on hydration status and electrolytes. If bilirubin is approaching exchange transfusion level, follow unit protocol on whether feeds happen under the lights.
Bilirubin sampling, bronzing and other findings to report
Turn the phototherapy lights off while drawing blood for serum bilirubin, because light breaks down bilirubin in the sample and gives a falsely low result. Plot results on the unit's chart. A level may be repeated after phototherapy stops to check for rebound. Skin colour under the lights is not a reliable guide to the bilirubin level.
Bronze baby syndrome is a grey-brown skin discoloration seen when phototherapy is given to an infant with conjugated hyperbilirubinaemia; report it so the cause of the jaundice is reviewed. Also report lethargy, poor feeding, signs of dehydration such as fewer wet nappies, temperature instability, and eye discharge. Ileus and temporary lactose intolerance are less common complications.
Practice scenario and family teaching
In a hypothetical item, a nurse caring for a newborn under phototherapy must choose an action. Options include dressing the infant in a sleeper to prevent cooling, applying lotion to dry skin, keeping the eye shields on and recording temperature and nappies, or leaving the lights on while a heel stick is done. Keeping shields on with temperature and output monitoring is correct.
Explain to parents why the infant is undressed, why the eyes are covered and why blood tests are repeated. Where the unit allows, brief breaks from the lights let parents cuddle and feed with the eye shields removed. Document start and stop times, the type of lights used, presence of eye protection, intake, output and skin findings.
Sources and further reading
The Royal Children's Hospital Melbourne: Phototherapy for neonatal jaundice nursing guideline. Mechanism, skin exposure with nappy only, opaque eye covers, temperature and fluid monitoring, lights off for SBR sampling, continued breastfeeding, and complications including overheating, water loss, diarrhoea, rash, retinal damage, bronzing, ileus and lactose intolerance.
HealthyChildren.org (American Academy of Pediatrics): Jaundice in Newborns. Link between inadequate breast milk intake and jaundice, frequent breastfeeding, and the importance of measuring bilirubin.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our maternity and newborn practice questions are the closest set to what this page covers.
Common questions
Why are phototherapy lights turned off for a bilirubin blood draw?
Light breaks down bilirubin in the blood sample, which can make the result falsely low. Turning the lights off during collection gives an accurate level for the provider to act on.
Should a baby under phototherapy keep breastfeeding?
Yes, unless another condition prevents it. Feeding supports hydration and stool output, which helps excrete bilirubin. The nurse monitors intake, output and suck, and the provider may adjust total fluids based on hydration and electrolytes.
What is bronze baby syndrome?
It is a grey-brown skin discoloration that can occur when an infant with conjugated hyperbilirubinaemia receives phototherapy. The nurse reports it so the provider can review the cause of the jaundice.
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