Home- versus hospital-based treatment for uncomplicated newborn jaundice in term infants

Newborn infants commonly develop a condition called jaundice. Jaundice occurs as the result of accumulation of a yellowish-orange pigment called bilirubin in the skin and eyes. Bilirubin in increased concentrations can be damaging to the brain and can have profound long-term detrimental effects. Phototherapy is a form of treatment used in newborns to reduce levels of bilirubin. "Home-based phototherapy" can be used in the home setting with appropriate supervision. Home phototherapy is used only in cases of uncomplicated newborn jaundice. Home-based phototherapy can offer certain advantages such as reduced hospital costs and improved bonding between an infant and mother. On the other hand, home-based phototherapy could be associated with problems such as increased risk of the damaging effects of bilirubin on the brain and increased risk of readmission to hospital. In this Cochrane review, home-based phototherapy was compared with hospital-based phototherapy for uncomplicated jaundice in full-term newborns. The review authors found no studies that met the eligibility criteria. The authors of this Cochrane review conclude that no high-quality evidence is currently available to support or refute the use of home phototherapy for uncomplicated newborn jaundice.

Authors' conclusions: 

No high-quality evidence is currently available to support or refute the practice of home-based phototherapy for non-haemolytic jaundice in infants at more than 37 weeks' gestation.

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Background: 

Phototherapy is commonly used for the treatment of neonatal jaundice, and home-based phototherapy is now being used in certain centres. Home-based phototherapy offers possible advantages by avoiding prolonged hospital admissions, promoting mother-infant bonding and reducing hospitalisation costs. Potential problems include increased duration of phototherapy, increased readmission to hospital and increased risk of bilirubin encephalopathy.

Objectives: 

To compare exclusively home-based versus exclusively hospital-based phototherapy or a combination of home- and hospital-based phototherapy for the management of non-haemolytic jaundice in term infants up to 28 days of age. We planned to include specific subgroups for duration in hospital, method of phototherapy and criteria for readiness for discharge.

Search strategy: 

We searched the Cochrane Neonatal Review Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) January 2013, Issue 1, part of The Cochrane Library, MEDLINE (from 1966 to 15 February 2013), CINAHL (from 1982 to 15 February 2013) and EMBASE (from 1988 to 15 February 2013). We searched for abstracts from the Pediatric Academic Societies' Annual Meetings 2000 to 2013. We searched for ongoing trials on the following websites: ClinicalTrials.gov (http://clinicaltrials.gov/) and Current Controlled Trials (http://controlled-trials.com/).

Selection criteria: 

Randomised and quasi-randomised studies comparing term infants who received phototherapy exclusively at home versus phototherapy exclusively in the hospital or a combination of the two for non-haemolytic jaundice.

Data collection and analysis: 

Two review authors independently assessed trial quality and extracted data.

Main results: 

No studies that met the predefined eligibility criteria were identified.

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