To Örebro University

Background

There are a few previous studies on home phototherapy but there is a lack of randomised controlled trials. The aim of this study was therefore to assess whether home phototherapy is a safe and effective alternative to hospital treatment and whether it has an impact on bonding and stress. 

Methods

This was a randomised controlled, multicentre, trial in which 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 inclusion criteria were a chronological age of more than 48 hours, a gestational age above 36 +0 weeks and a bilirubin above 20.5 mg/dl (350 µmol/L) after 72 hours of age. After inclusion, the patients were randomised, to either home phototherapy or hospital treatment.

Results

147 patients were recruited from 6 hospitals, 69 patients were randomized to conventional phototherapy and 78 to home phototherapy

Safety/feasability

The duration of phototherapy, length of stay, amount of blood tests and weight change showed no statistically significant differences between hospital and home phototherapy (table 2). However, home treatment failed in three patients and the total readmission rate was 4 %. It is recommended to provide daily check-ups and 24/7 telephone support to the parents.

Bonding and stress

Parents in the intervention group had better bonding both at discharge (p = 0.034) and at 4 months (p = 0.008; effect size r = 0.2) and lower levels of stress at 4 months (p = 0.024) compared with controls.

Cost

The cost was €337 per patient 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.

Descriptive qualitative study

A total of 15 interviews were performed (8 mothers, 7 fathers).The interviews showed that parents felt secure at home. The overall experience of home phototherapy was positive, and five categories were identified describing their experiences: continuing life at home, adjusting to having a newborn, feeling secure, experiencing parenthood, and accessing information.