Home phototherapy: Shedding light on commencement, newborn variations, and outcomes

Abstract

Home phototherapy using fiberoptic lights for the treatment of newborn hyperbilirubinemia has proven to be safe and effective. The purpose of this study was to explore whether differences in the outcomes of duration, reduction of bilirubin levels, hyperbilirubinemia resolution, or readmission could be explained by initial bilirubin levels and variations in newborn clinical characteristics at the commencement of treatment. This retrospective chart review of 187 newborns, who had received home phototherapy, revealed hyperbilirubinemia resolved in 162 of the cases (86.6 percent). Seventeen (9.1 percent) required readmission to the hospital. The strongest predictor of treatment duration using birthweight, feeding type, age at admission, and bilirubin level at commencement of treatment as independent variables was the age of the newborn at admission (R2 =.03) followed by the bilirubin level at commencement of treatment (R2 = 0.10). No variables showed predictive power in relation to the absolute drop in bilirubin. Furthermore, those newborns whose hyperbilirubinemia resolved and those who required readmission showed no significant differences in relation to their clinical characteristics of birthweight, bilirubin level at commencement of treatment, or age at admission. When variables of absolute drop in bilirubin, bilirubin level at the completion of treatment, duration of treatment, gestational age, and age at admission were analyzed based on feeding type (bottle vs. breast), the only significantly different characteristic was the bilirubin level at the completion of treatment (p =.034). Bilirubin levels at the completion of treatment were on the average lower for bottle-fed newborns when compared to breast-fed newborns. Results suggest that the older the newborn at admission, the shorter the treatment duration, and the higher the bilirubin level on admission, the longer the duration of treatment. Findings also suggest pediatricians tolerate higher bilirubin levels at the completion of treatment for breast-fed newborns than for bottle-fed. This study illustrates implications for nursing and medical management of hyperbilirubinemia by providing information regarding the home phototherapy population, treatment outcomes, and highlighting the need for proper follow-up, documentation, and continued research of this potential public health problem.