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Universal Transcutaneous Bilirubin Screening in a Midwifery-Led Home Care Setting
Lauren E H Westenberg1,2, Marten J Poley3,4, Helene A Bouma5
1Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Transcutaneous bilirubin (TCB) screening for neonatal hyperbilirubinemia is more effective than visual inspection, identifying more infants needing treatment. While TCB screening requires more heel pricks, it is cost-effective and can be optimized through selective application.
Area of Science:
- Neonatal care
- Diagnostic screening
Background:
- Visual inspection is the standard for detecting neonatal hyperbilirubinemia but is unreliable.
- Delayed treatment due to unreliable visual inspection can lead to adverse outcomes.
Purpose of the Study:
- To evaluate the clinical outcomes, cost-effectiveness, and convenience of universal transcutaneous bilirubin (TCB) screening for home-monitored neonates.
- To compare TCB screening with traditional visual inspection for hyperbilirubinemia detection.
Main Methods:
- A prospective decision-analytical model was used, analyzing data from 2314 neonates across 9 Dutch midwifery practices.
- Midwives performed both visual inspection and TCB measurements, with blood tests conducted when indicated.
- Cost-effectiveness was assessed using a decision-tree model.
Main Results:
- Universal TCB screening identified 28% more neonates requiring treatment compared to visual inspection.
- TCB screening led to more heel pricks (244 vs. 142), but selective screening reduced this increase.
- Universal TCB screening was cost-effective, saving €15 per neonate.
Conclusions:
- Universal TCB screening improves detection of neonatal hyperbilirubinemia requiring treatment compared to visual inspection.
- While increasing heel pricks, TCB screening is cost-effective and its impact can be mitigated by selective application.
- TCB screening offers a more reliable approach to managing neonatal jaundice in home-care settings.
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