129 - Prophylactic Home Phototherapy to Prevent Neonatal Hyperbilirubinemia Readmissions

Poster Number: 129
Publication Number: 129.415

Susie Shin, University of Illinois College of Medicine, Peoria, IL, United States; Ginger Barton RN MSN, OSF Healthcare Children's Hospital of Illinois, Peoria, IL, United States; Sade Francois, University of Illinois College of Medicine, North Little Rock, AR, United States; Shelly Shallat, OSF Healthcare Children's Hospital of Illinois, Peoria, IL, United States; Amira Alfil, OSF Healthcare Children's Hospital of Illinois, Peoria, IL, United States

Background: Neonatal jaundice is the most common cause of readmission of term and near-term newborns to the hospital. Substantial variation exists among hospitals in the management of infants with hyperbilirubinemia. Conventional phototherapy (PT) has been the standard therapy for years for babies whose total serum bilirubin (TSB) is elevated above the set PT threshold. An alternative is home PT. According to the current American Academy of Pediatrics guidelines, home PT should be considered only when the TSB level is 2-3 mg/dL below the treatment threshold.

Objective: This study aims to reduce readmission rate of neonatal hyperbilirubinemia by 20% in neonates with GA ≥ 36 weeks with TSB 2 mg/dl below PT threshold by using Home Biliblanket over 24 months and to compare the nursery length of stay between the pre intervention and Home Biliblanket groups.

Design/Methods: 1. Developed criteria to evaluate newborn at risk for indirect hyperbilirubinemia prior to initial discharge (Figure 1)
2. Determine the baseline readmission rate: retrospectively searched hospital database of a comparison pre intervention group who met the same inclusion criteria within a 2 year period
3. Developed standardized process to initiate home PT
4. Created a process to have DME readily available when home PT is ordered
5. Increased provider awareness of availability, process, and beneficial outcomes of home PT
6. Developed standardized education for parents for prevention and treatment of hyperbilirubinemia
7. Estimated the readmission rate of Biliblanket group monthly over 24 months period

Results: In our pre intervention group, 90 patients met the inclusion criteria in which 74 patients (82%) received conventional PT in the hospital and 16 patients (17.7%) were discharged with PCP follow up. Of those 16 patients, three (19%) got readmitted. In the Home Biliblanket group, 35 patients met the inclusion criteria with 0% readmission. P-value of Fischer’s exact test was 0.027. The mean length of stay in the pre intervention group was 76 hours. The mean length of stay in Biliblanket group was 53 hours (P-value of Welch 2 sample t-test < 0.001). Average length of stay on the general floor is 1.19 days and costs $3801. Average length of time Wallaby blanket used is 3.23 days and costs $402. Home Biliblanket is 9x cheaper, over $3000 saved per neonate.Conclusion(s): Home phototherapy is a safe and cost-effective way to prevent readmissions and reduce nursery length of stay. Home phototherapy should be considered when TSB is ≤ 2mg/dL below the treatment threshold at discharge from birth hospitalization in neonates without neurotoxic risk factors.
Figure 1Inclusion and Exclusion Criteria
Figure 2Readmission Rates