The efficacy of home phototherapy for physiological and non-physiological neonatal jaundice: A systematic review

Abstract This study aimed to establish the cost-effectiveness of home phototherapy versus hospital phototherapy treating hyperbilirubinemia in neonates more than 36 weeks. Based on clinical results from a randomised controlled trial showing that home phototherapy for hyperbilirubinemia in term neonates is as effective as hospital phototherapy, we performed a cost-minimisation analysis to identify the most cost-effective alternative. We included costs for health care resource use as well as costs for transportation in connection with re-visits. The cost per patient was €337 for home phototherapy compared with €1156 for the hospital alternative indicating average cost savings of €819 (95% confidence interval €613–1025) or 71% per patient. Transportation and outpatient costs were higher in the home treatment group and hospital care costs were higher in the hospital group. Sensitivity analysis shows that results are robust also when allowing for uncertainty. Home phototherapy for neonates more than 36 weeks costs less than in-hospital phototherapy while being equally effective, meaning that home phototherapy is a cost-effective alternative to hospital treatment for infants with neonatal hyperbilirubinemia. Trial registration NCT03536078 . Date of registration: 24/05/2018. 

/pdf/the-cost-effectiveness-of-home-phototherapy-for-19mh75v2.pdf

The cost-effectiveness of home phototherapy for hyperbilirubinemia in neonates: results from a randomized controlled trial

To the editor Infection control is a priority in neonatal care during the pande­ mic, leading to isolation precautions, newer monitoring, and discharge protocols. Such a need paved the way for telehealth development in neonatal medicine to facilitate a lower risk of coronavirus disease 2019 (COVID­19) transmission while simulta­ neously easing the stress on new parents. The novel advances suggested in this letter are based on a review of the recent literature that provides a qualitative analysis (Table 1). Teleconsultations are the most efficient way to relay information between healthcare providers and parents without the risk of cross­infection. Online consultations have the potential to become a mainstay in the future, even after the pandemic. This method significantly reduces the risk of misinformation, saves travel time, is feasible, and most importantly helps ease the burden on already saturated hospital resources. While this is ideal, for maximum efficacy, clear and concise parental education of the methodology and ailment in general by healthcare workers is crucial.1) It should be emphasized to parents that, if they were to notice any of the signs mentioned in Table 2, they should take the neonate to the hospital immediately. Parental education via virtual training provides information about the risk factors of jaundice, growth and nutrition, benefits of breastfeeding, monitoring of bilirubin levels, and assessment of their newborn while utilizing COVID­19 prevention strategies.2) Mobile phone applications are useful for assessing bilirubin levels in neonates, which would otherwise be done via biochemical screening or tests. One method is to correlate the neonate’s skin color with a color calibration card, which is then uploaded onto the application for review by the care team through teleconsultation. However, discrepancies and false positives are likely to occur due to limited lighting availability and poor photo quality, which creates unnecessary anxiety among parents.3,4) A novel mobile application that can be used primarily works by measuring the neonates’ scleral chromaticity, showing 100% sensitivity and 61% and 54% specificity in infants with transcutaneous serum bilirubin levels above 2.82 mg/dL and 2.310 mg/dL, respectively.5) Drive­through screening for hyperbilirubinemia in neonates was performed in a hospital in Malaysia. Parents and the neonate are required to stay in the car throughout the assessment while driving through an assigned path. After registration and triage, the healthcare worker places the bilirubin detection device on the baby's sternum. The results are reviewed and a follow­up plan is charted. Compared to conventional testing, the drive­through option has a reduced testing duration and is noninvasive. Addi­ tionally, this approach promotes the infection control required during the pandemic while managing to provide appropriate care.6) Another ramification of routine treatment that is a worthy replacement is home phototherapy, which has many benefits such as convenience, mother­child bonding, and remote access.7) A recent trial from Sweden monitored the use of fiber optic LED devices with an irradiance of 35 μW/cm2/nm provided to parents

https://www.e-cep.org/upload/pdf/cep-2021-01235.pdf

Telemedicine as progressive treatment approach for neonatal jaundice due to the coronavirus disease 2019 pandemic

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of the WHO’s new Labour Care Guide and commentaries on reviews focused on prevention of mastitis in women during the postpartum period and a comparison of outcomes for fresh versus frozen embryos for in vitro fertilization.

Current Resources for Evidence-Based Practice, January 2021

Objective. Phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. We reviewed the current literature to determine whether home-based phototherapy is more effective than hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. Method. PubMed, Scopus, Embase, Cochrane library, CBM, CNKI, and Wanfang Data were searched to collect the comparative study of home-based phototherapy versus hospital-based phototherapy for the treatment of neonatal hyperbilirubinemia. All studies were found to be of low risk based on Cochrane Collaborative Risk of Bias Tool. Data were statistically extracted and evaluated by RevMan 5.3 software. Result. A total of 259 neonates were included in the meta-analysis. Compared with hospital-based phototherapy, home-based phototherapy appeared more effective for the treatment of neonatal hyperbilirubinemia in reducing the rate of total serum bilirubin (standard mean difference = 0.32, 95% confidence interval = -0.22 to 0.86, P = .04); however, there was no signiﬁcant difference in duration of phototherapy (standard mean difference = 0.59, 95% confidence interval = 0.28 to 0.90, P = .06) in the 2 groups. Conclusion. Home-based phototherapy was more effective than hospital-based phototherapy in treatment for neonatal hyperbilirubinemia; home-based phototherapy is an effective, feasible, safe, and alternative to hospital-based phototherapy for neonatal hyperbilirubinemia.

https://journals.sagepub.com/doi/pdf/10.1177/0009922820916894

Home-Based Phototherapy Versus Hospital-Based Phototherapy for Treatment of Neonatal Hyperbilirubinemia: A Systematic Review and Meta-Analysis

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Home-Based Phototherapy Versus Hospital-Based Phototherapy for Treatment of Neonatal Hyperbilirubinemia: A Systematic Review and Meta-Analysis