At a glance
Phototherapy for jaundice is a treatment that uses a specific wavelength of blue-green light to break down excess bilirubin in a newborn's blood. Bilirubin is a yellow pigment that forms naturally when old red blood cells are recycled. In newborns, the liver is sometimes too immature to clear bilirubin fast enough, so it builds up in the skin and eyes, giving them a yellow tint. This yellowing of the skin and eyes is called jaundice (penyakit kuning).
When the baby lies under the phototherapy light, the light energy changes the shape of the bilirubin molecule through a process called photo-isomerization. The altered molecules become water-soluble, meaning they dissolve in water, and the body can then pass them out through urine and stool without needing the liver to process them first. The skin absorbs the light best when as much of it as possible is exposed, which is why babies are usually undressed during treatment and their eyes are protected with small shields.
Medical Condition
Phototherapy is used when a newborn's bilirubin level rises high enough to require treatment but not so high that a blood exchange transfusion is needed right away. Doctors use the baby's age in hours, weight, gestational age (how many weeks the pregnancy lasted), and measured bilirubin level together to decide whether to start phototherapy.
- Physiological jaundice: the common, expected rise in bilirubin that peaks in the first week of life in otherwise healthy newborns.
- Jaundice in premature babies, whose livers are even less mature and who reach treatment thresholds at lower bilirubin levels.
- ABO or Rh incompatibility: when the mother's and baby's blood types conflict, causing faster breakdown of the baby's red blood cells.
- G6PD deficiency (glucose-6-phosphate dehydrogenase deficiency, an inherited enzyme problem that makes red blood cells fragile).
- Breastfeeding jaundice, where insufficient milk intake in the first days causes mild dehydration and higher bilirubin.
- Breast milk jaundice, a separate condition in which a substance in breast milk slows bilirubin clearance and can persist for several weeks.
- Polycythemia (too many red blood cells), which produces more bilirubin as the extra cells break down.
- Cephalohematoma (a collection of blood under the scalp from birth trauma), which releases bilirubin as it resolves.
Phototherapy alone is not suitable for every cause of jaundice. Babies with very high bilirubin levels that risk brain damage, those with certain types of liver disease such as cholestasis (bile flow obstruction), or those with a rapidly rising level that does not respond to light may need other treatments such as exchange transfusion or specific medication. A paediatrician will assess each baby individually.
Risks & Complications
Phototherapy is one of the safest treatments used in newborn care, and serious complications are rare. The risks that do exist are mostly mild and go away when treatment ends.
- Increased fluid loss through the skin, which can lead to mild dehydration if the baby is not fed frequently enough during treatment.
- Loose, frequent stools (often greenish) caused by the altered bilirubin passing through the gut.
- Skin rash, a temporary blotchy or red rash that appears on some babies during exposure to the light.
- Temperature instability: the light can warm the baby's skin, so staff monitor body temperature closely.
- Eye irritation if the protective eye shields slip or are not fitted properly, which is why nurses check them regularly.
- Bronze baby syndrome: a rare, harmless darkening of the skin, urine, and serum that can occur in babies who also have liver disease. It resolves after treatment stops.
- Separation anxiety for parents: prolonged time in the incubator under lights can limit skin-to-skin contact, which is emotionally difficult even though it is not a medical complication of the light itself.
Preparation & Procedure
Because phototherapy is almost always started in hospital shortly after birth, there is usually no preparation the parent can do in advance. The treating team acts on the bilirubin result and begins treatment promptly. However, understanding what will happen before, during, and around treatment helps parents feel less anxious.
Before lights are switched on, the team will run or review a set of tests to confirm the diagnosis and guide treatment decisions. These typically include a blood test to measure the total bilirubin level, a blood type check for both mother and baby, a direct Coombs test (a test to detect antibodies on the baby's red blood cells that could be causing faster cell breakdown), a full blood count to check for signs of haemolysis (rapid destruction of red blood cells), and sometimes a G6PD enzyme test if the baby's ethnic background puts them at higher risk.
Once the decision to start treatment is made, the steps generally follow this sequence:
- The baby is undressed, leaving only a small nappy or diaper in place, to maximise the skin area exposed to light.
- Small, opaque eye shields are fitted snugly over both eyes to protect the retinas (the light-sensitive layer at the back of the eye) from direct light exposure.
- The baby is placed in a cot or incubator directly under the phototherapy lamp, at the distance specified by the device manufacturer.
- In some cases, a fibre-optic blanket (a pad that emits light directly against the skin) is placed under the baby at the same time to provide light from two sides at once.
- The team sets a timer and checks the baby's position, eye shields, temperature, and feeding regularly throughout treatment.
- Bilirubin levels are re-checked through blood tests at intervals your doctor determines, usually every few hours at first, to track whether levels are falling.
- Treatment continues until the bilirubin drops to a safe level and stays there after the lights are turned off for a short monitoring period.
Aftercare
After phototherapy ends, the baby usually stays in hospital for a monitoring period so staff can confirm that bilirubin levels do not rebound. How long this takes depends on how high the levels were, the underlying cause, and the baby's overall condition.
- A follow-up blood bilirubin test is done within hours of stopping the lights to check for a rebound rise. If levels climb again, phototherapy may be restarted.
- Feeding is encouraged frequently throughout and after treatment. Breast milk or formula helps flush bilirubin through the gut, so frequent, effective feeding is central to recovery.
- Once discharged, the baby's doctor will usually arrange a repeat bilirubin check within one to two days at an outpatient clinic or through a home-visit nurse, depending on the hospital's protocol.
- Parents are asked to watch for signs that jaundice is worsening at home: deepening yellow colour spreading to the abdomen, legs, or palms; the baby becoming very sleepy and difficult to wake for feeds; a high-pitched cry; or poor feeding.
- Skin-to-skin contact and breastfeeding on demand are actively encouraged once phototherapy is finished, as both support the baby's recovery and the parent-child bond.
- If the jaundice was caused by an underlying condition such as G6PD deficiency or blood type incompatibility, the paediatrician will counsel parents on long-term implications and any follow-up testing needed for the baby as they grow.
- A routine newborn follow-up visit, usually within the first two weeks of life, gives the doctor the chance to recheck weight gain, feeding, and overall progress.
Cost & What Determines It
The cost of phototherapy varies considerably from one hospital and one country to another, driven by how long treatment lasts, what triggered the jaundice in the first place, and what level of care the baby needs alongside the lights.
- Duration of treatment: a baby who needs lights for one day costs far less than one who needs several days of intensive phototherapy.
- Severity and underlying cause: jaundice linked to blood type incompatibility or G6PD deficiency often requires more frequent blood tests, closer monitoring, and sometimes additional treatments, all of which add to the total.
- Type of phototherapy unit: conventional overhead fluorescent or LED lamps, double-surface phototherapy units that shine light from above and below simultaneously, and fibre-optic blankets vary in their running costs.
- Neonatal unit level: a standard postnatal ward costs less per day than a special-care baby unit or neonatal intensive care unit (NICU), and babies with complications may need a higher level of care.
- Country and hospital class: public hospitals, private hospitals, and internationally accredited facilities price their services differently, and costs differ significantly between countries.
- Laboratory tests: repeated bilirubin blood tests, blood type and Coombs testing, full blood count, and G6PD screening are usually billed per test.
- Consultations: neonatologist (a paediatrician who specialises in newborns) or paediatric specialist visits may be charged separately from the room and nursing fees.
- Length of hospital stay for the mother: if the baby stays longer than the mother's planned postnatal admission, the mother's continued stay or separate accommodation for the family may add to costs.
Hospital packages, where they exist, typically bundle the daily room rate, nursing care, use of the phototherapy equipment, and basic monitoring into one fee. Blood tests, specialist consultations, medications such as intravenous fluids or antibiotics if an infection is also present, and any extended NICU stay are usually billed separately from the package price.
BPJS Kesehatan covers phototherapy when it is carried out at an accredited Indonesian facility within the referral system, but it does not cover treatment received abroad. Most Indonesian private health insurance policies also exclude overseas care. Families who choose to have their baby treated at a hospital in another country will typically pay out of pocket or through an international private insurance plan that specifically covers newborn care abroad. Before travelling or committing to a hospital, asking for a written cost estimate that lists every item separately is the clearest way to avoid unexpected charges.
Frequently Asked Questions
How many sessions of phototherapy does my baby need for jaundice?
Most babies need one continuous session lasting between 24 and 48 hours, though some need a little longer depending on how high their bilirubin level is. Bilirubin is the yellow pigment that builds up in the blood and causes the skin to look yellow. Your baby's doctor checks the bilirubin level regularly during treatment and decides when it is safe to stop the light.
What does phototherapy feel like for a newborn, and is it safe?
Phototherapy is generally well tolerated by newborns, who lie under a special blue light while their eyes are protected by a small mask. The light breaks down bilirubin through the skin without needles or incisions. Some babies develop a mild, temporary rash or loose stools during treatment, both of which usually settle once the light is switched off.
How soon does phototherapy start working for newborn jaundice?
Bilirubin levels usually begin to fall within a few hours of starting the light, though your baby's doctor will confirm this with blood tests rather than going by appearance alone. Skin colour can take a day or two to look noticeably less yellow even after the level has already dropped. The treatment continues until the reading is safely below the threshold the doctor sets for your baby's age and weight.
How much does phototherapy for jaundice cost?
The cost depends on how long your baby needs to stay under the light, the level of nursing care required, and the type of facility, whether a standard ward or a neonatal unit with closer monitoring. Babies who need additional tests or a second round of phototherapy will also see a higher total. Requesting a written cost estimate from the hospital before admission is the most reliable way to get a figure that reflects your baby's specific situation.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
