Abstract
The aim of this study was to assess whether home phototherapy was feasible and safe in a cohort of otherwise healthy term-born neonates who fulfilled the criteria for in-hospital phototherapy. This was a randomized controlled trial in which term newborns with a total serum bilirubin of 18–24 mg/dL (300–400 μmol) were randomized to either home phototherapy or conventional in-hospital phototherapy. The primary outcome measurements were safety and efficacy, length of stay and the number of failed treatments. The secondary outcomes were the number of blood samples and weight gain during treatment. One hundred forty-seven patients were recruited, 69 patients randomized to conventional phototherapy and 78 to home phototherapy. The results showed that no patients needed blood exchange and only 4% of the patients allocated to home phototherapy were admitted to the hospital. The duration of phototherapy, length of stay, amount of blood tests and weight change showed no statically significant differences.Conclusion: Home phototherapy could be a safe alternative to inpatient phototherapy for otherwise healthy newborns with hyperbilirubinemia if daily checkups and 24/7 telephone support can be provided. The parents should be informed to contact the hospital immediately if they fail to perform the treatment at home.Trial registration: Clinicaltrials.gov NCT03536078What is Known:• Phototherapy in the hospital is a safe and effective treatment without major side effects.• Fibre optic equipment has made the choice of home phototherapy possible.What is New:• This is the first randomized controlled trial comparing home phototherapy with hospital phototherapy.• Results indicate that home phototherapy could be considered as a safe and feasible alternative when performed according to instructions given, to hospital treatment for otherwise healthy term newborns.
Highlights
10% of all newborns develop hyperbilirubinemia that requires phototherapy to prevent neurologic complications such as kernicterus [1,2,3,4,5,6].Eur J Pediatr (2021) 180:1603–1610Phototherapy has been established as the first choice for treating hyperbilirubinemia since the late 1950s [7] and is generally performed in a hospital setting
Home phototherapy could be a safe alternative to inpatient phototherapy for otherwise healthy newborns with hyperbilirubinemia if daily checkups and 24/7 telephone support can be provided
Studies have indicated that fibre optic equipment is safe, but less effective, than hospital treatment when treating term newborn infants with uncomplicated hyperbilirubinemia, unless two fibre optic devices are used at the same time [8]
Summary
10% of all newborns develop hyperbilirubinemia that requires phototherapy to prevent neurologic complications such as kernicterus [1,2,3,4,5,6].Eur J Pediatr (2021) 180:1603–1610Phototherapy has been established as the first choice for treating hyperbilirubinemia since the late 1950s [7] and is generally performed in a hospital setting. For the last few decades, fibre optic equipment has made it possible to perform phototherapy at home. Studies have indicated that fibre optic equipment is safe, but less effective, than hospital treatment when treating term newborn infants with uncomplicated hyperbilirubinemia, unless two fibre optic devices are used at the same time [8]. According to guidelines from the American Academy of Pediatrics (AAP), home phototherapy should only be considered when total serum bilirubin (TSB) is 2–3 mg/dL below the treatment threshold [3]. This approach could result in a substantial increase in the number of patients receiving phototherapy. Even though the evidence for this approach is weak, home phototherapy has already been adopted as routine care by some hospitals [11, 14,15,16,17]
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