Shining a Light on the Icteric Neonate; the Use of Transcutaneous Bilirubinometers to Reduce Hospital Admissions

Background: A £22 billion efficiency requirement for the NHS makes cost-efficiency savings an important aspect of clinical practice in the UK. Short-term, less than (<) 1 day, hospital admission rates are increasing and, in the neonatal population, the commonest cause pertains to jaundice. Preventing unnecessary attendances with the use transcutaneous bilirubinometer (TcB) in the community can ease the burden. National Institue of Clinical Excellence guidelines stipulate that TcB can be used in babies greater than (>) 35 weeks gestation at birth and >24 hours of life; serum bilirubin measurements are warranted if TcB reading is >250micromoles/litre.

Objective: To identify whether the use of TcB readings can prevent hospital admission.

Method: Data was collected on patients admitted to Children’s Assessment Unit (CAU) with jaundice, between December 2016 and February 2017. Those who were older than 28 days and who did not have a TcB reading on arrival to the A&E were excluded. Primary outcome was the proportion of babies with a TcB of <250micromoles/l. Secondary outcome measures were length of hospital stay for these patients and an assessment in the difference in weight loss between those requiring phototherapy and those who did not.

Results: In this cohort (n=37) the average age at admission was 4.7 days; 72% (n=27) had TcB <250micromoles/l. None of these patients required phototherapy during their admission, and the average length of stay was 5.5 hours. The average weight loss in patients requiring phototherapy (n=7) and those who did not was 11%, and 5% respectively.

Conclusion: The volume of patients attending CAU with jaundice is disproportionate to those who go on to require phototherapy and could have been prevented by the use of TcB readings in the community. The use of percentage weight loss as a marker of the severity of jaundice could further aid the community team in making a decision for or against hospital attendance.