Neonatology · 2026
Home-Based Transcutaneous Bilirubin Screening and Telemedicine Reduce Neonatal Referrals.
СтатьяНазвание и аннотация: Перевод в очереди
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Nissimov Sagee, Haas Nili, Habib Sonia, Madjar Batia, Zimmerman Deena R, Hazan Ariela, Daniel Sharon, Berkovitch Matitiahu, Kohn Elkana
Аннотация
INTRODUCTION: Neonatal jaundice is a leading cause of early post-discharge referrals. Community follow-up commonly relies on visual assessment and clinic-based evaluation, generating avoidable visits. Scalable home pathways that maintain safety are needed. We evaluated a nurse-led home pathway that integrates transcutaneous bilirubin (TcB) screening with targeted pediatric teleconsultation.
METHODS: A prospective before-after study was conducted within routine nurse-led home visits for eligible infants (firstborn or preterm) ≥35 weeks of gestation. A 3-month pre-intervention phase (usual visual assessment) was compared with a 9-month intervention using TcB-guided thresholds and teleconsultation via a secure digital platform. The primary analysis targeted infants who, under usual care, would be referred ("baseline-eligible"), estimating the absolute difference in referral at the home visit. Secondary outcomes were agreement between clinical cues and TcB, teleconsultation utilization, and phototherapy requirement.
RESULTS: A total of 1,236 infants were enrolled (157 pre-intervention; 1,079 intervention). Among baseline-eligible infants (n = 840), 152 (18.1%) were referred; thus, 688/840 (81.9%) potential referrals were avoided (absolute reduction 81.9%; 95% CI 79.2-84.4; NNR 1.22, 95% CI 1.19-1.26). TcB identified all infants requiring phototherapy (4/1,079; 0.4%) within 14 days. Agreement between clinical cues and TcB-defined need for follow-up was slight (weighted κ = 0.075; 95% CI 0.059-0.091). The reduction in referrals corresponded to an absolute decrease of 0.67 visits per infant.
CONCLUSIONS: A nurse-led, digitally supported home pathway that integrates TcB screening and targeted teleconsultation substantially reduces unnecessary neonatal referrals, with no missed cases requiring phototherapy. This pragmatic precision-triage model is implementable within existing community services and can relieve post-discharge system burden while preserving safety.
METHODS: A prospective before-after study was conducted within routine nurse-led home visits for eligible infants (firstborn or preterm) ≥35 weeks of gestation. A 3-month pre-intervention phase (usual visual assessment) was compared with a 9-month intervention using TcB-guided thresholds and teleconsultation via a secure digital platform. The primary analysis targeted infants who, under usual care, would be referred ("baseline-eligible"), estimating the absolute difference in referral at the home visit. Secondary outcomes were agreement between clinical cues and TcB, teleconsultation utilization, and phototherapy requirement.
RESULTS: A total of 1,236 infants were enrolled (157 pre-intervention; 1,079 intervention). Among baseline-eligible infants (n = 840), 152 (18.1%) were referred; thus, 688/840 (81.9%) potential referrals were avoided (absolute reduction 81.9%; 95% CI 79.2-84.4; NNR 1.22, 95% CI 1.19-1.26). TcB identified all infants requiring phototherapy (4/1,079; 0.4%) within 14 days. Agreement between clinical cues and TcB-defined need for follow-up was slight (weighted κ = 0.075; 95% CI 0.059-0.091). The reduction in referrals corresponded to an absolute decrease of 0.67 visits per infant.
CONCLUSIONS: A nurse-led, digitally supported home pathway that integrates TcB screening and targeted teleconsultation substantially reduces unnecessary neonatal referrals, with no missed cases requiring phototherapy. This pragmatic precision-triage model is implementable within existing community services and can relieve post-discharge system burden while preserving safety.