Abstract:
Background: Neonatal jaundice remains one of the most common conditions requiring postnatal monitoring and treatment. Home-based phototherapy has increasingly been implemented within community neonatal services in the National Health Service as part of expanding “Hospital at Home” models of care. Effective implementation of these pathways depends on timely bilirubin assessment to support prompt clinical decision-making. Although laboratory serum bilirubin remains the reference standard recommended by the National Institute for Health and Care Excellence, regional neonatal jaundice pathways emphasize rapid point-of-care testing to facilitate early treatment decisions and timely referral for home phototherapy. In our neonatal service, delays in referral were observed due to reliance on laboratory bilirubin results, resulting in missed treatment windows, avoidable hospital admissions, and increased parental anxiety.
Aim: To evaluate implementation of a regional neonatal jaundice pathway recommending point-of-care bilirubin testing for infants eligible for home phototherapy and to introduce targeted interventions to improve timely referral and treatment initiation.
Methods: A retrospective quality improvement evaluation was conducted in a district neonatal service. Eligible neonates were defined as clinically stable infants ≥35 weeks' gestation, birth weight >2 kg, and appropriate postnatal age (>24 hours if ≥37 weeks or >72 hours if <37 weeks). Data were collected using a structured proforma including demographics, timing and modality of bilirubin measurement, bilirubin values, and time intervals from testing to treatment decision and referral.
Interventions included:
- Multidisciplinary teaching sessions for neonatal and postnatal teams.
- Visual clinical pathway reminders in key areas.
- Digital communications to reinforce pathway awareness.
Concurrently, a service evaluation assessed correlation between point-of-care gas bilirubin and laboratory serum bilirubin to support clinician confidence. A second audit cycle (June–July 2025) evaluated the impact of these interventions.
Results: Eighteen neonates met eligibility in the first audit cycle; 56% received point-of-care testing. Gas bilirubin strongly correlated with serum bilirubin (r>0.9), confirming reliability. Post-intervention, point-of-care testing compliance increased to ~80%, enabling faster treatment decisions and timely referrals for home phototherapy. Clinicians reported improved confidence in rapid testing, and service feedback indicated smoother workflow and reduced parental anxiety.
Conclusion: Low-cost, targeted interventions substantially improved adherence to the neonatal jaundice pathway, increasing point-of-care testing from 56% to 80%. This facilitated timely clinical decisions, enhanced access to home phototherapy, and supported family-centered care. The approach represents a scalable model for optimizing neonatal jaundice management, reducing avoidable hospital admissions, and strengthening community-based phototherapy services.
