6275 Evaluation of home phototherapy services for treating neonatal jaundice in near-term and term babies in the West Midlands (HoPE Project)

Objectives Jaundice is the main cause (22.3%) of all hospital readmissions in near-term and term babies.¹ Home phototherapy (HPT) offers a safe, effective, and practical option for treatment of jaundice and reduces the need for inpatient phototherapy (IPT).² Furthermore, HPT aligns with British Association of Perinatal Medicine's (BAPM) family- integrated care (FiCare) core principle of empowering parents to be primary caregivers.³ The HoPE project evaluated the uptake of HPT and its impact on neonatal readmission rates in the West Midlands. Methods A two-part mixed-methods service evaluation was conducted. Part 1 involved an online survey of regional HPT services completed by local hospital project leads. Part 2 was a retrospective analysis in which the clinical records of babies ≥ 35 weeks gestation, over 48hours but less than 2 weeks old, weighing > 2 kg who received phototherapy for treatment of physiological jaundice were assessed over a four-month period. Parental views on HPT were collected from two of the tertiary neonatal units. Results All 14 (100%) neonatal units in the region participated in the online survey, and 13 (93%) in the retrospective service evaluation. HPT was introduced in the West Midlands in April 2018, and as of February 2023, a total of 1232 infants have received HPT. Currently, 8 (57%) units offer HPT, 2 (14%) units plan to start, and 1 (7%) unit ceased due to inadequate staffing. In three (21%) of the units, HPT is provided to their service users through a different unit. The eligibility criteria for HPT were similar across the units. The main challenges faced by units that have not yet set up HPT services are staffing and funding. The main challenges faced by units providing HPT services are non-compliance with guidelines, insufficient awareness, staffing, and delays in getting serum bilirubin results. The retrospective service evaluation included 594 babies. Of these, 302 (51%) were treated in centres without HPT and 292 (49%) in centres with HPT. The readmission rate was 39% (117/302) in centres without HPT compared to 27% (80/292) in centres with HPT (see tables 1a, 1b and 2). Conclusion HPT is underutilised as only 21% (62/292) of babies were treated exclusively with HPT and 26% (77/292) of babies received a combination of HPT and IPT. HPT uptake could be improved by increased awareness, improved testing turnaround time, adequate funding, recruitment and retention of staff for the service. Furthermore, we recommend the development of a West Midlands perinatal network HPT guideline. References Battersby C, Michaelides S, Upton M, Rennie JM. Term admissions to neonatal units in England: a role for transitional care? A retrospective cohort study. BMJ Open May 29 2017;7(5):e016050. Pettersson M, Eriksson M, Albinsson E, Ohlin A. Home phototherapy for hyperbilirubinemia in term neonates—an unblinded multicentre randomized controlled trial. Eur J Pediatr 2021;180(5):1603–1610. Family integrated care: a framework for practice. British Association of Perinatal Medicine 2021:10–4.