Phototherapy at home for the treatment of neonatal jaundice: An innovative, patient centered pilot project during the COVID-19 pandemic

INTRODUCTION Approximately 60% of term babies develop jaundice. This often requires inpatient hospital treatment with phototherapy. Home phototherapy is not well-established within Italy as routine care for the management of neonatal jaundice. The outbreak of coronavirus disease 2019 has become a most challenging health emergency. In that context, hospitals policies and protocols around perinatal care changed, barring faders and extra people from the laboring mom, the delivery room, and the postpartum units, in an effort to keep moms and babies safe. Nevertheless, prolonging hospital stay for phototherapy would increase by the stress of isolation, the anxiety over disease status, and the fear for the new responsibilities in the assumption of the maternal role, making lockdown in hospital challenging for maternal mental health and breastfeeding initiation. This study reports an innovative, patient centered pilot project of phototherapy at home during the COVID-19 pandemic, to promote mother and baby bonding and experience of neonatal jaundice by reducing hospital stay. METHODS Following the introduction of the home phototherapy guideline ('Home Phototherapy': ST-MD-01, 03.15.2018, Policlinico Abano Terme), newborn babies were considered for home phototherapy during COVID-19 outbreak. The inclusion criteria included: feeding established, bilirubin levels at >75<90 percentile of Bhutani nomogram, weight loss <10%, parents motivated, no social concerns, and lived within a pre-defined surrounding area (the Euganean Hills). Parents were trained to use the equipment at home [Mira®, GINEVRI srl. Albano Laziale, Rome: the therapy light, produced by a high-power LED (peak 460 nm), is transmitted, through a flexible fiber optic cable, to a lightening element of small dimensions that has to be placed in contact with patient skin], and the outreach team would visit the baby 24 h after hospital discharge, feeding assessments, perform serum bilirubin levels, plot results and make a management plan in conjunction with the neonatologists. RESULTS 21 babies went home for phototherapy between January and May 2021. Mean gestational age was 39.73 ± 1.13weeks, average weight 3355.90 ± 419 g, average discharged home day 2.3 ± 04, and average days received phototherapy at home 1.27 ± 0.43. No adverse events were noted. Additional babies (n=2) could have been recruited during this period, but did not live within the pre-defined area. Excellent feedback was received from 19/21 (90.4%) the mother-infant dyads involved. CONCLUSION The pilot project of 'Home Phototherap' was introduced safely during COVID-19 pandemic. It was wellappreciated by parents and cost-effective to improve maternal and newborn health. It has given us the basis to roll this project out to different Level 1-3 neonatal units across the country after the COVID-19 outbreak.