Home Phototherapy

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Abstract
Equipment designed for delivering phototherapy in the home has become available in several parts of the United States in the past few years. Home phototherapy for neonatal hyperbilirubinemia has been suggested as an alternative means of providing care for selected infants while saving much of the cost of continued or added hospitalization. Not enough information is available presently, however, on the safety or efficacy of home phototherapy as compared with alternatives to warrant an endorsement of this form of therapy. This statement provides preliminary guidelines for physicians who might choose home phototherapy for their patients. No attempt is made here to address the pros and cons of phototherapy per se or to define types of equipment. A physician who considers the use of home phototherapy should limit its use to infants with the following characteristics: (1) term infants, older than 48 hours, otherwise healthy; (2) serum bilirubin concentration greater than 14 mg/dL but less than 18 mg/dL; (3) no elevation in direct-reacting bilirubin concentration; and (4) diagnostic evaluation (described below) negative. Prior to therapy, a diagnostic evaluation should include: (1) history and physical examination; (2) hemoglobin concentration or hematocrit; (3) WBC count and differential count; (4) blood smear for red cell morphology platelets; (5) reticulocyte count; (6) total and direct-reacting bilirubin concentration; (7) maternal and infant blood typing and Coombs test; and (8) urinalysis including a test for reducing substances. The physician should estimate the rate of rise of the serum bilirubin concentration with laboratory determinations at least four hours apart before home phototherapy is initiated.

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