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Discharge of newborns with risk factors of severe hyperbilirubinemia: description of a hospital at home-based care monitoring and phototherapy

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Abstract

Neonatal jaundice is common and associated with delay in hospital discharge and risk of neurological sequelae if not treated. The objectives of the study were to report on our experience of the monitoring and treatment of neonatal jaundice in a home care setting and its feasibility and safety for neonates with high risk of severe hyperbilirubinemia. The 2-year study has been led in the greater Paris University Hospital At Home (Assistance Publique—Hôpitaux de Paris). The device of the intervention was the Bilicocoon® Bag, a light-emitting diode sleeping bag worn by the neonate when the total serum bilirubin value exceeds intensive phototherapy threshold, according to the guidelines from the American Academy of Pediatrics. One hundred and thirty-nine neonates had participated in the intervention and 39 (28%) were treated by phototherapy at home, as continuation of inpatient phototherapy or started at home. Seventy-five percent of the sample had more than two risk factors for development of severe hyperbilirubinemia. Twenty five percent of the cohort who received phototherapy at home had lower gestational age (p < 0.014) and had younger age at discharge from maternity (p < 0.09). Median length of stay in hospital at home was 5 days. Two patients needed readmission in conventional hospital (1%) for less than 24 h. In multivariate model, the length of stay decreased with the higher gestational age (p < 0.001) and increased significantly with the older age at discharge, the birth weight < 10th percentile, and a treatment by phototherapy at home.

   Conclusion: Hospital at home, which is a whole strategy using an effective and convenient phototherapy device combined with a specialized medical follow-up, could be an alternative to conventional hospitalization for neonates at high risk of severe jaundice. The maternity discharge is facilitated, the mother-infant bonding can be promoted, and the risk of conventional rehospitalization is minimal, while guaranteeing the safety of this specific care.

What is Known:

• Managing neonatal jaundice is provided in conventional hospital with phototherapy.

• Neonatal jaundice increases the risk of prolonged hospitalization or readmission.

What is New:

• Phototherapy is feasible in hospital at home for neonates with high risk of severe hyperbilirubinemia.

• The care pathway of neonates from conventional hospital to hospital at home is described.

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Availability of data and materials

Data are available. Some variables have been removed to ensure confidentiality.

Code availability

Analyses were performed with R. The script cannot be provided because it contains some data management parts with identifying variables. However, functions used in the script can be found in the repository: https://github.com/AlexandreGGS/R-statistics-functions (reference: https://pubmed.ncbi.nlm.nih.gov/30306900/).

Abbreviations

AAP:

The American Academy of Pediatrics

APHP:

Assistance Publique—Hôpitaux de Paris

BIND:

Bilirubin-induced neurological dysfunctions

CNRHP:

French National Reference Center in Perinatal Hemobiology

G6PD:

Glucose-6 phosphate dehydrogenase

LED:

Light-emitting diode

PT:

Phototherapy

SFN:

French Society of Neonatology

SD:

Standard deviation

TcB:

Transcutaneous bilirubin measurements

TSB:

Total serum bilirubin level

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Acknowledgements

The authors thank Pr Pascal Boileau and Pr Jean Marie Jouannic for their great contribution to the proofreading of the manuscript. Authors also thank Aymeric Watine and Nesrine Belkadi Cheniki for their help in the redaction of the article.

Author information

Authors and Affiliations

  1. Assistance Publique Hôpitaux de Paris (AP-HP), Hospitalisation À Domicile (HAD), 14 rue Vésale, 75005, Paris, France

    Sarah Spyridakis Coquery, Alexandre Georges, David Avran, Edith Gatbois, Claire Mehler-Jacob & Matthieu de Stampa

  2. Assistance Publique Hôpitaux de Paris (AP-HP), Centre National de Référence en Hémobiologie Périnatale (CNRHP), 26 avenue du Dr Arnold-Netter, 75571, Paris, France

    Anne Cortey

  3. Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Louis Mourier, 178 rue des Renouillers, 92700, Colombes, France

    Corinne Floch

  4. Unité Mixte de Recherche (UMR), UVSQ, 1018 INSERM, Paris, France

    Matthieu de Stampa

Authors
  1. Sarah Spyridakis Coquery
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  2. Alexandre Georges
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Contributions

S.S.C contributed to the conception of the study design, prepared material, collected data, drafted the manuscript, and approved the final version. AG performed analysis and drafted the manuscript. He approved the final version of the manuscript. A.C. contributed to the study conception and design and she approved the final version of the manuscript. C.F. contributed to the study conception and design and she approved the final version of the manuscript. D.A. contributed to the study conception and design, collected data, and approved the final version of the manuscript. E.G. contributed to the study conception and design, collected data, and approved the final version of the manuscript. C.M.J. contributed to the study conception and design, drafted the manuscript, and approved the final version of the manuscript. M.D.S. contributed to the study conception and design, participated in the data analysis, drafted the manuscript, and approved the final version of the manuscript.

Corresponding author

Correspondence to Matthieu de Stampa.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Assistance Publique Hopitaux de Paris (APHP) ethical review board, Paris (n° 20210625102716).

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Written informed consent was obtained from the parents.

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Written informed consent was obtained from the parents.

Conflict of interest

The authors declare no competing interests.

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Communicated by Daniele De Luca

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Coquery, S.S., Georges, A., Cortey, A. et al. Discharge of newborns with risk factors of severe hyperbilirubinemia: description of a hospital at home-based care monitoring and phototherapy. Eur J Pediatr 181, 3075–3084 (2022). https://doi.org/10.1007/s00431-022-04461-4

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