Elsevier

Women and Birth

Volume 35, Supplement 1, September 2022, Pages 31-32
Women and Birth

O81 - Clinical outcomes and cost-effectiveness of large-scale midwifery-led, home phototherapy and neonatal jaundice surveillance

https://doi.org/10.1016/j.wombi.2022.07.087Get rights and content

Aim

We aimed to evaluate a large midwifery-led, paediatrician-overseen home jaundice surveillance and home phototherapy (HPT) program. This is a uniquely holistic model of care, where the surveillance and management of neonatal jaundice is part of the overall midwifery-led care for women who have recently given birth and their infants.

Methods

We conducted a retrospective cohort study over 2019. Included were all infants with birth gestation ≥ 35 weeks, discharged at 4–96 hours and receiving care from midwifery-at-home (a 12-hour daily, 365-days hospital-based outreach service, supported by hospital paediatricians). Phototherapy was delivered via BiliSoft blanket with treatment thresholds determined by standard nomograms. The main outcomes of interest were unplanned readmissions, and cost-effectiveness based on hospital finance department actual costs. Also examined were parental compliance, device issues and safety.

Results

During 2019, 4308 infants received home jaundice surveillance with 86% hospital-discharged before 72 hours, 82% exclusively breastfed and 69% having overseas-born mothers. Four hundred infants received HPT, comprising 101 continuing from inpatient phototherapy (IPT), 56 rebounding after IPT, and 243 home-diagnosed as needing phototherapy and triaged to HPT. Only 1/400 (0.25%) HPT infants required readmission. Additionally, there were 80 home-diagnosed jaundiced infants triaged to immediate readmission for IPT. Maximal serum bilirubin was 454 µmol/L. No exchange transfusion, encephalopathy or HPT-device problems occurred. An early 2019 bilirubin analyser upgrade resulted in higher bilirubin readings and some unintended subthreshold phototherapy. Supported by midwives, most parents managed HPT with ease. HPT cost $640/day compared to $2100/day for infant IPT readmission and $1000/day for a longer birth-admission stay. Up to 2 weeks’ midwifery-at-home care for the whole cohort cost $2 m less than a 2-day longer birth-admission stay.

Conclusion

Large-scale, midwifery-led, paediatrician-overseen jaundice surveillance and HPT can achieve very low unplanned readmission rates and be cost-effective.

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