Home phototherapy for hyperbilirubinemia in term neonates-an unblinded multicentre randomized controlled trial

M Pettersson, M Eriksson, E Albinsson, A Ohlin, M Pettersson, M Eriksson, E Albinsson, A Ohlin

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 NCT03536078 What 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.

Keywords: Home phototherapy; Neonatal jaundice; Total serum bilirubin.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Consort flow diagram
Fig. 2
Fig. 2
Scatterplot showing TSB at time of inclusion/start of phototherapy

References

    1. Rennie J, Burman-Roy S, Murphy MS, Guideline Development G. Neonatal jaundice: summary of NICE guidance. BMJ. 2010;340:c2409. doi: 10.1136/bmj.c2409.
    1. National Institute for Health and Care Excellence (2016) Jaundice in newborn babies under 28 days. .
    1. American Academy of Pediatrics Subcommittee on H Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297–316. doi: 10.1542/peds.114.1.297.
    1. Alkén J, Ahlsson F, Andersson O, Odelberg-Johnson P, Bohlin Blennow K, Norman M (2019) Vårdprogram, Neonatal Hyperbilirubinemi Svenska Neonatalföreningen. .
    1. Sarici SU, Serdar MA, Korkmaz A, Erdem G, Oran O, Tekinalp G, Yurdakok M, Yigit S. Incidence, course, and prediction of hyperbilirubinemia in near-term and term newborns. Pediatrics. 2004;113(4):775–780. doi: 10.1542/peds.113.4.775.
    1. Alken J, Hakansson S, Ekeus C, Gustafson P, Norman M. Rates of extreme neonatal hyperbilirubinemia and kernicterus in children and adherence to national guidelines for screening, diagnosis, and treatment in Sweden. JAMA Netw Open. 2019;2(3):e190858. doi: 10.1001/jamanetworkopen.2019.0858.
    1. Cremer RJ, Perryman PW, Richards DH. Influence of light on the hyperbilirubinaemia of infants. Lancet. 1958;1(7030):1094–1097. doi: 10.1016/s0140-6736(58)91849-x.
    1. Mills JF, Tudehope D. Fibreoptic phototherapy for neonatal jaundice. Cochrane Database Syst Rev. 2001;1:CD002060. doi: 10.1002/14651858.CD002060.
    1. Luciano R, Mancini G, Cota F, Romano A, Purcaro V, Lerro F, Corsello M, Vento G. New high intensity fibreoptic phototherapy devices in healthy newborns: a single pad wrapped around the neonate body in comparison with a double pad device. Ital J Pediatr. 2019;45(1):68. doi: 10.1186/s13052-019-0663-5.
    1. Tan KL. Comparison of the efficacy of fiberoptic and conventional phototherapy for neonatal hyperbilirubinemia. J Pediatr. 1994;125(4):607–612. doi: 10.1016/s0022-3476(94)70019-2.
    1. Eggert LD, Pollary RA, Folland DS, Jung AL. Home phototherapy treatment of neonatal jaundice. Pediatrics. 1985;76(4):579–584.
    1. Jackson CL, Tudehope D, Willis L, Law T, Venz J. Home phototherapy for neonatal jaundice--technology and teamwork meeting consumer and service need. Aust Health Rev. 2000;23(2):162–168. doi: 10.1071/AH000162.
    1. Zainab K, Adlina S. Effectiveness of home versus hospital phototherapy for term infants with uncomplicated hyperbilirubinemia: a pilot study in Pahang, Malaysia. Med J Malaysia. 2004;59(3):395–401.
    1. Slater L, Brewer MF. Home versus hospital phototherapy for term infants with hyperbilirubinemia: a comparative study. Pediatrics. 1984;73(4):515–519.
    1. Grabert BE, Wardwell C, Harburg SK. Home phototherapy. An alternative to prolonged hospitalization of the full-term, well newborn. Clin Pediatr (Phila) 1986;25(6):291–294. doi: 10.1177/000992288602500601.
    1. Chang PW, Waite WM. Evaluation of home phototherapy for neonatal hyperbilirubinemia. J Pediatr. 2020;220:80–85. doi: 10.1016/j.jpeds.2020.01.004.
    1. Personal communication: Home phototherapy at Uppsala University hospital (2020).
    1. Malwade US, Jardine LA. Home- versus hospital-based phototherapy for the treatment of non-haemolytic jaundice in infants at more than 37 weeks’ gestation. Cochrane Database Syst Rev. 2014;6:CD010212. doi: 10.1002/14651858.CD010212.pub2.
    1. Norman M. Bilirubin injuries among newborn infants can be prevented. New tools keep the zero vision alive. Lakartidningen. 2006;103(26-27):2032–2033.
    1. Newman TB, Liljestrand P, Escobar GJ. Infants with bilirubin levels of 30 mg/dL or more in a large managed care organization. Pediatrics. 2003;111(6 Pt 1):1303–1311. doi: 10.1542/peds.111.6.1303.
    1. Hansen TW. Acute management of extreme neonatal jaundice--the potential benefits of intensified phototherapy and interruption of enterohepatic bilirubin circulation. Acta Paediatr. 1997;86(8):843–846. doi: 10.1111/j.1651-2227.1997.tb08608.x.
    1. Tridente A, De Luca D. Efficacy of light-emitting diode versus other light sources for treatment of neonatal hyperbilirubinemia: a systematic review and meta-analysis. Acta Paediatr. 2012;101(5):458–465. doi: 10.1111/j.1651-2227.2011.02561.x.

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