How to select the correct patients for home phototherapy of neonatal hyperbilirubinaemia-a retrospective population-based implementation study.

UNLABELLED: To examine how many patients received home phototherapy and describe the major reasons for admission to hospital for phototherapy. The study was performed as a retrospective population-based observational study. All newborns at Örebro University Hospital born in October 2019-March 2023 ≥ gestational week 36 + 0 and having performed phototherapy were included. The primary outcome was the proportion of newborns receiving hospital vs home phototherapy. Secondary outcomes were the reasons for not performing home phototherapy. Further secondary outcomes were the number of readmissions (failed home treatments) and the number of infants with bilirubin > 425 µmol/L. In total, 492 patients were included. Of these, 256 (52%) received home phototherapy (180 exclusively, and 76 for part of the treatment); 236 (48%) received phototherapy exclusively in hospital. Among the 302 (236 + 66) patients in whom home phototherapy was not primarily performed, the most common reasons were haemolytic disease (35%) and the need for the use of multiple phototherapy devices (26%). In total, 14% received hospital phototherapy for various other reasons, such as concerns regarding breastfeeding or poor weight gain of the baby.

CONCLUSION

In this retrospective study, we found that approximately 50% of full-term infants with neonatal hyperbilirubinaemia were suitable for home phototherapy. The most common reasons for not receiving home phototherapy in our population were haemolytic disease and severe hyperbilirubinaemia. These results indicate what may be expected when planning to start a home phototherapy programme.

WHAT IS KNOWN: • Phototherapy at home is considered a safe alternative to hospital treatment for well-selected patients, but the proportion of suitable patients has not been studied.

WHAT IS NEW: • This study shows that approximately 50% of all full-term newborns with hyperbilirubinaemia can safely be treated at home. • The most common contraindications to home phototherapy are haemolytic disease and need for intensive phototherapy.