Phototherapy in transport for neonates with unconjugated hyperbilirubinaemia.
OBJECTIVE
In Victoria, neonates with severe unconjugated hyperbilirubinaemia at risk of requiring exchange transfusion are retrieved by the Paediatric Infant Perinatal Emergency Retrieval Service and transferred to a Neonatal Intensive Care Unit where an exchange transfusion can be performed if necessary. Transfer may result in prolonged periods without phototherapy in neonates at risk of developing bilirubin encephalopathy. We aimed to describe our experience of the introduction of phototherapy using a portable phototherapy unit during transport.


METHODS
Neonates with a primary diagnosis of severe unconjugated hyperbilirubinaemia were identified from the Paediatric Infant Perinatal Emergency Retrieval clinical database over an 11-year period. Demographic and clinical data including gestation, age at transport, serum bilirubin levels pre- and post-transport, use of phototherapy during transport (PTDT), likely diagnosis, and use of exchange transfusion were included.


RESULTS
A total of 147 neonates were included with 104 neonates receiving PTDT and 43 who did not. Neonates who received PTDT were less likely to require exchange transfusion, 19.2% versus 34.9%, odds ratio 0.44 (95% CI 0.2-0.98), P = 0.05. However, after correction for factors appearing to be related to use of exchange transfusion, the odds ratio increased to 0.58 (95% CI 0.21-1.63), P = 0.3. There was a greater reduction in the pre- to post-transport total serum bilirubin levels (μmol/L) for the group receiving PTDT (mean 46.3, SD 64.6) versus no PTDT (mean 26.1, SD 62.5), but this did not reach significance, P = 0.08.


CONCLUSIONS
Phototherapy during neonatal transport is feasible and safe and may result in a decreased requirement for subsequent exchange transfusion.
Paediatric Infant Perinatal Emergency Retrieval Service, Royal Children's Hospital, Melbourne, Victoria, Australia.
Michelle
M
Waterham
Paediatric Infant Perinatal Emergency Retrieval Service, Royal Children's Hospital, Melbourne, Victoria, Australia.
Risha
R
Bhatia
Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.
Susan
S
Donath
Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.
Charlotte
C
Molesworth
Monash Newborn, Monash Medical Centre, Melbourne, Victoria, Australia.
Kenneth
K
Tan
Paediatric Infant Perinatal Emergency Retrieval Service, Royal Children's Hospital, Melbourne, Victoria, Australia.
Michael
M
Stewart
D016208:Databases, Factual; D005260:Female; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D010789:Phototherapy / Q000295:instrumentation*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014187:Transportation of Patients; D014739:Victoria
hyperbilirubinaemia; jaundice; phototherapy; retrieval; transport