Home-Based Transcutaneous Bilirubin Screening and Telemedicine Reduce Neonatal Referrals

Introduction: Neonatal jaundice is a leading cause of early post-discharge referrals. Community follow-up commonly relies on visual assessment and clinic-based evaluation, generating avoidable visits. Scalable home pathways that maintain safety are needed. We evaluated a nurse-led, home pathway that integrates transcutaneous bilirubin (TcB) screening with targeted pediatric teleconsultation. Methods: Prospective before–after study within routine nurse-led home visits for eligible infants (firstborn and preterm) ≥35 weeks’ gestation. A 3-month pre-intervention phase (usual visual assessment) was compared with a 9-month intervention using TcB-guided thresholds and teleconsultation via a secure digital platform. The primary analysis targeted infants who, under usual care, would be referred (“baseline-eligible”), estimating the absolute difference in referral at the home visit. Secondary outcomes were agreement between clinical cues and TcB, teleconsultation utilization, and phototherapy requirement. Results: 1,236 infants were enrolled (157 pre-intervention; 1,079 intervention). Among baseline-eligible infants (n=840), 152 (18.1%) were referred; thus 688/840 (81.9%) potential referrals were avoided (absolute reduction 81.9%; 95% CI 79.2–84.4; NNR 1.22, 95% CI 1.19–1.26). TcB identified all infants requiring phototherapy (4/1,079; 0.4%) within 14 days. Agreement between clinical cues and TcB-defined need for follow-up was slight (weighted κ=0.075; 95% CI 0.059–0.091). The reduction in referrals corresponded to an absolute decrease of 0.67 visits per infant. Conclusions: A nurse-led, digitally supported home pathway that integrates TcB screening and targeted teleconsultation substantially reduces unnecessary neonatal referrals, with no missed cases requiring phototherapy. This pragmatic precision-triage model is implementable within existing community services and can relieve post-discharge system burden while preserving safety.