Home phototherapy for neonatal hyperbilirubinemia: a mixed methods systematic review and meta-analysis

To promote home phototherapy adoption, clearer insights are needed on current evidence and the population most likely to benefit.

Six online databases were searched until 20 January 2025. Studies were included that reported on (cost-)effectiveness, safety, and/or implementation barriers and facilitators of home phototherapy. Two reviewers independently extracted data and assessed bias using the Mixed Methods Appraisal Tool. Data were pooled via random-effects meta-analysis. Barriers and facilitators were analyzed using the Theoretical Domains Framework. GRADE was used to assess evidence quality.

Thirty-one studies were included, representing 5059 neonates, 869 healthcare professionals, and 478 parents. Risk of bias was moderate. Hospital (re)admission following home phototherapy was 3.5% (95% CI, 2.2-5.3%). No difference was found in treatment duration (mean difference = +4.9 h, 95% CI -8.0 to +17.9) and daily decline in bilirubin (mean difference = +5.7 μmol/L, 95% CI -2.6 to +13.9). No studies evaluated cost-effectiveness. Key facilitators included eligibility screening and parental education, while key barriers included bilirubin measurement, healthcare professionals' concerns about homecare consequences, and parental insecurity. Quality of evidence was rated low for all outcomes.

Evidence suggests home phototherapy can be an alternative to in-hospital treatment for hyperbilirubinemia in near-term neonates. Clinical recommendations are limited due to low-certainty evidence.

Home phototherapy can be a safe and effective alternative to in-hospital treatment for low-risk neonates with hyperbilirubinemia. Strength of this recommendation is low. Our study is the first to systematically synthesize parent/caregiver and healthcare professional perspectives on home phototherapy using the Theoretical Domains Framework. Key facilitators included eligibility screening and parental education, while key barriers included concerns about home care consequences by healthcare professionals and parental insecurity. Addressing these barriers through improved support and accurate monitoring is recommended.