Home phototherapy service

Inclusion Criteria

• Baby is clinically stable
• Babies ≥35 weeks gestation
• Babies who are 35-36 weeks gestation SHOULD BE DISCUSSED WITH ATTENDING CONSULTANT
• > 24 hours old (if >37 weeks gestation)
• > 72hours old (if <37 weeks gestation)
• Baby is > 2kg
• Serum bilirubin level above recommended treatment level but 50mmol/L below exchange transfusion level (see table below)
• Serum bilirubin rate of rise is <8.5mmol/hr
• Parents are competent in using home phototherapy unit
• No safeguarding concerns
• No other clinical concerns or co morbidities i.e.. no known family history or risk factors which might indicate a rapid rise of bilirubin e.g. blood group incompatibility or significant bruising

Exclusion criteria

• < 35 weeks gestation
• Jaundice < 24h of age
• Family history of jaundice requiring exchange transfusion
• Family history of haemolytic disease
• Serum bilirubin level within 50mmol of exchange transfusion level
• Known ABO or rhesus incompatibility
• Serum bilirubin level continuing to rise despite phototherapy
• Signs suggesting infection or that the baby is unwell:
  • Inability to maintain normothermia (36.5-37.5 degrees)
  • Lethargic or poor feeding
  • Irritable, pale or floppy
  • Mottled skin / poor perfusion
  • Signs of respiratory distress including increased work of breathing / shallow breathing, tachypnoea or cyanosis

• Any other concerns that baby should not be managed at home:
  • Social concerns
  • Compliance with home phototherapy

• Ensure parents are competent in using equipment safely
• Ensure equipment and eye protection is being used optimally
• Perform SBR via heel prick
• Daily assessment of feeding, urine and stools to ensure adequacy
• Daily physical examination
• Check body temperature
• Weigh on alternate days
• Parent communication, addressing concerns
• Daily liaison with senior medical team/ ANNP regarding ongoing management
• Document assessment, SBR and plan on maternity TRAK

FBC, Group + Direct Coombs’s test and total SBR will be done on first blood test after starting home phototherapy treatment.

Documentation

• Babies referred from RIE will be booked into TRAKS "Neonatal Paediatrics: NNU Virtual Clinic"
• Babies from SJH will be booked into TRAKS "Neonatal Paediatrics: Neonatal Screening Clinic SJH"

All documentation will be written in babies TRAK maternity progress notes. 

Criteria for (re-) admission to hospital

• A rising SBR while on treatment
• Signs of illness (documented above)
• Inability to maintain normothermia
• Poor compliance with instructions

Treatment threshold for phototherapy

Safety assessment will be made by Senior Medical team/ ANNP and NCOT.

All babies undergoing home phototherapy should be referred to the Senior Medical/ ANNP team. NCOT nurse on call will be identified at the start of each shift.

Junior doctor/ ANNP are responsible for chasing blood results and ensuring no gap in service provided.

If NCOT are unable to do a home visit, arrangements will be made by the medical team for further monitoring of jaundice which may involve bringing baby back to Emergency Department for bloods.

Babies receiving home phototherapy will be included in the HDU/SCBU handover until rebound bilirubin is deemed to be satisfactory.

A database of all babies undergoing home phototherapy will be maintained by NCOT.

The home phototherapy unit will be collected by NCOT after use and returned to the NNU/ SCBU where it will be cleaned according to unit protocol.

• Stop phototherapy when SBR has fallen to ≥ 50 micromol/L below phototherapy line.
• A rebound SBR should be checked 12-18 hours after stopping home phototherapy.
• If the rebound SBR is ≥ 50 micromol/L below the phototherapy line, and the infant is making good progress with feeding, they can be discharged back to the community midwife.

The parent information leaflet will be given to all parents undertaking home phototherapy. This details how to use the home phototherapy equipment. Parents will be assessed on their competency in using the equipment and eye shield appropriately.

Parents will be provided with information on:

NCOT contact details

Monitoring baby’s body temperature and management

Adequacy of feeding – intake and output

Signs of increasing jaundice and other illness

Possible side effects of phototherapy – i.e. loose and frequent stools or skin rash

Parents will be given details of who to contact should they have concerns about their baby or equipment at home.