Clinical outcomes and cost‐effectiveness of large‐scale midwifery‐led, paediatrician‐overseen home phototherapy and neonatal jaundice surveillance: A retrospective cohort study

AIM: To evaluate a large midwifery‐led, paediatrician‐overseen home jaundice surveillance and home phototherapy (HPT) programme. METHODS: We conducted a retrospective cohort study over 2019. Included were all infants with birth gestation ≥35 weeks, discharged at 4–96 h and receiving care from midwifery‐at‐home (a 12‐h 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 h, 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 of 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.