Identifying best practices for global standardization of home phototherapy for neonatal hyperbilirubinemia: An...

To identify insights from home phototherapy protocols for neonatal hyperbilirubinemia in Australia, the Netherlands, and Sweden, and to inform future efforts toward standardizing a curriculum and implementation framework.

We performed a cross-country comparative study of national and local guidelines and protocols on home phototherapy. Documents were collected through publicly available resources and professional networks. Data were extracted on four domains: patient selection and eligibility criteria, parental education, logistics and care delivery models, and safety aspects.

Twenty protocols were included: six from Australia, six from the Netherland, and eight from Sweden. While variation in eligibility criteria for home phototherapy was observed across protocols. Eligible neonates were generally required to be ≥36 weeks' gestation, ≥48 h postnatal age, clinically well, with total serum bilirubin (TSB) well below exchange transfusion thresholds, and without evidence of hemolysis. Care delivery models varied, across midwifery-led, nurse-led, and hospital-led approaches. Escalation criteria were present in five (25%) protocols and inconsistently defined. All protocols emphasized structured parental education delivered by qualified nurses and recommended daily TSB monitoring.

Home phototherapy protocols demonstrate consistent emphasis on TSB monitoring and parental education, with more variation in eligibility, care delivery models and escalation criteria. A Delphi consensus study is recommended to address observed variability and to inform the development of a globally applicable framework for different healthcare systems.