Home phototherapy in the United Kingdom
- 1Neonatal Intensive Care Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK
- 2Department of Epidemiology, University of Dundee, Ninewells Hospital and Medical School
- 3Maternal and Child Health Sciences, University of Dundee, Ninewells Hospital and Medical School
- Correspondence to:
Dr Fowlie;
peter.w.fowlietuht.scot.nhs.uk
Although successful home treatment of neonatal jaundice using fibre-optic phototherapy units has been reported elsewhere,1,2 we are not aware of any such provision in the United Kingdom. We have introduced a regional home phototherapy programme in Tayside, Scotland and wonder if our initial experience would be of interest to others.
Before introducing the service, hospital and community midwives undertook training covering inclusion criteria (physiological jaundice in well, term infants), the treatment protocol, equipment use (Biliblanket, Ohmeda), and the assessment of parental competence. The protocol conditions were: a daily capillary serum bilirubin (SBR), discussing all results with a paediatrician; basing treatment on SBR and age of the infant3 and an SBR measured after discontinuing phototherapy. Parents underwent a one hour “training” session (equipment use and advice on feeding, skin care, and temperature control) and were given written advice. Tayside Committee on Medical Research Ethics advised that ethical approval for the programme and written consent were not required, as the treatment being offered was not novel.
Between February and August 2002, 28 families were offered home phototherapy in Tayside: six refused (difficulties with feeding, distance from home to hospital, and parental choice). The mean birth weight was 3245 g (range 2240–4220), with a median gestation of 38 weeks (range 35–41). Mean maternal age was 30 years (range 17–41). Twenty (91%) infants were breast fed. Ten were first born. Seven families lived in affluent areas and two in areas of high deprivation.4 Phototherapy started at a median age of 5.5 days (range 1–13). Eight infants received all their phototherapy at home. Mean treatment duration was 47.3 hours (range 17.5–97.0) with a median decrease in SBR of 16.6 μmol/l per day (ranging from a fall of 50 μmol/l to a rise of 53 μmol/l in one case). Community midwives spent about 60 minutes on the first home visit. Subsequent visits were shorter. Poor compliance, without compromise to either infant, was identified in two families and rectified quickly. No other adverse incidents were reported, and there was no equipment failure. All parents preferred home phototherapy to inpatient treatment. Community midwives have been happy to continue the programme.
We believe this is the first report of a home phototherapy programme in the United Kingdom. With appropriate training and enthusiastic community support, it appears to be feasible, safe, and well accepted by families and staff. We would encourage others to consider establishing such programmes.
We are grateful to the rest of the Tayside Home Phototherapy Project Team (J Dalzell, A Jarvis, M Meldrum, V Samson) and the community midwives who contributed to the success of the project. This project was supported by a grant from the Scottish Executive Health Department – Innovative Fund for Children’s Services.
