EVIDENCE CENTRE

EVIDENCE REPORT

Series 2003: Therapy

Phototherapy in the home for

jaundiced neonates.

Simon French

Centre for Clinical Effectiveness

Monash Institute of Health Services Research
Monash Medical Centre
Locked Bag 29
Clayton VIC 3168
Australia
Telephone:
Fax:
Email:
URL:

+61 3 9594 7505

+61 3 9594 7552
cce@med.monash.edu.au (quote author of report)
http://www.med.monash.edu.au/healthservices/cce/

December 2003

SUMMARY STATEMENT
Disclaimer please refer to Appendix 1 for information.
Copyright please refer to Appendix 1 for information.
Publication of materials please use the following format when citing this article:
French, S (2003). Phototherapy in the home for jaundiced neonates. (The Centre for
Clinical Effectiveness), Available: http://www.med.monash.edu.au/healthservices/cce
[Accessed:Access date]

Form Version B.2002.01.05.1

Centre for Clinical Effectiveness Evidence Report

REQUEST
Is conducting phototherapy for jaundiced neonates in the home associated with adverse
effects compared to phototherapy conducted in the hospital?

REQUESTED BY
Minnesha Yasmine, Resource Midwife, Womens and Childrens Program, Monash
Medical Centre.

SUMMARY OF FINDINGS:

No high quality evidence was located that compares home phototherapy to

hospital phototherapy in neonates with jaundice.

The evidence located was methodologically flawed, but concluded that home
phototherapy was a safe and effective alternative to hospital phototherapy.

METHODOLOGY
Search Strategy
The Centre for Clinical Effectiveness defines the best available evidence as that research
we can identify that is least susceptible to bias.
First, we search for systematic reviews, evidence based clinical practice guidelines and
health technology assessments. Then we identify diagnostic studies with independent
blind comparison of an appropriate spectrum of consecutive patients, who have
undergone both the diagnostic test and the reference standard. If we identify sound,
relevant material of this type, the search stops. Otherwise, our search strategy broadens
to include studies that are more prone to bias, less generalisable, or have other
methodologic difficulties. While we cite observational and case series studies, narrative
reviews and consensus statements in our reports, we do not critically appraise them.
These studies can produce accurate results but they are generally too prone to bias to
allow determination of their validity beyond their immediate setting.

Details of Evidence Request

Patients (Subjects): Jaundiced neonates.
Intervention:

Phototherapy conducted in the home.

Comparator:

Phototherapy conducted in the hospital.

Outcomes:

Resolution of jaundice, adverse effects, breastfeeding rates,

bonding.

Search terms
(see Appendix 2 for exact search strategy)
Patient (Subject):

Infant, newborn, neonate, jaundice, hyperbilirubinaemia.

Intervention:

Phototherapy, biliblanket, UV light, home care services.

Centre for Clinical Effectiveness Evidence Report

Resources Searched
We searched the following databases and internet websites for English language articles:
Resource

Issue or Access Date

Australasian Medical Index (Informit)

17 November 2003

CINAHL (OVID)

1982 to November Week 1 2003

Cinch (Informit)

17 November 2003

The Cochrane Library (Online)

17 November 2003

EBM Reviews (OVID):

Cochrane Database of Systematic Reviews

3rd Quarter, 2003

Database of Abstracts of Reviews of Effectiveness

3rd Quarter, 2003

Cochrane Controlled Trials Register

3rd Quarter, 2003

Google (Online)

18 November 2003

MEDLINE (OVID)

1966 to October Week 5 2003

National Guideline Clearinghouse

17 November 2003

MEDLINE

In-Process

PubMED (Online)

17 November 2003
17 November 2003

Refinements, Searching & Reporting Constraints

We applied the following inclusion and exclusion criteria to the articles retrieved:

Inclusion Criteria

Subjects in study must be neonates with jaundice.

Study must compare phototherapy conducted in the home to phototherapy

conducted in the hospital.

Outcomes measured must include resolution of jaundice and adverse events.

Exclusion Criteria

Level IV study, narrative review.

Article not received by 22nd December.

Centre for Clinical Effectiveness Evidence Report

RESULTS:
From the resources searched, we identified 40 potentially relevant articles. If it was not
clear from the abstract, we obtained the full text of these articles to determine their
relevance. After examination of the 40 articles, 37 studies were excluded for the reasons
outlined in Table 1.
Table 1. Reasons for exclusion of studies identified in the search strategy.
Reason for exclusion

Number

Case series (Level IV)

10

Narrative reviews, letters and commentaries

19

Incorrect comparator

Article not received by 22nd December

Total

37

The 3 articles that met the inclusion criteria were all cohort studies (Table 2). Two were
prospective studies and one was retrospective.
Table 2. Study designs of included articles
Study Design

Number included

Systematic reviews or meta-analyses

Randomised controlled trials

Prospective cohort studies

Retrospective cohort studies

Total

Based on our refinements, searching and reporting constraints we are reasonably

confident these articles represent the most relevant findings published to date.

Findings
Three studies met the inclusion criteria. All of these studies were conducted in the United
States, two in the Salt Lake City region. All three studies were at least 10 years old. All
the studies compared home phototherapy to hospital phototherapy.

Overall Results
For one study (James 1993), the primary outcome was the rate of mothers that ceased
breast feeding during the treatment period. The other two studies (Eggert 1985, Slater
1984) measured decrease in bilirubin levels as their primary outcome.
In the study by James (1993), a much high proportion of mothers stopped breast feeding
in the hospital group than the home group (42% vs 9%, p<0.002). Also, mothers of
hospitalised neonates were less likely to resume breast feeding after treatment was
completed (84% vs 100%, p<0.02).

Centre for Clinical Effectiveness Evidence Report

In the two studies that measured daily decrease in bilirubin, there was no significant
difference between those neonates treated at home and those that were treated in the
hospital.
In two of the studies, no complications were reported in either group, and in one study
(Eggert 1985) six of the mothers (10%) reported only mild complications. In the study
by Slater (1984), one infant treated at home was a considered a treatment failure. The
authors stated that this case demonstrated an issue of concern with home treatment,
questioning whether bilirubin values rise fast enough to produce kernicterus before the
next home visit by the supervising health practitioner occurs.
In all three studies, home treatment took longer. In all studies, home treatment was
cheaper.

Research Methodology
Two of the included studies were prospective comparative studies and the remaining
study was a retrospective comparative study (James 1994). All of the studies were
conducted in the United States. Each study compared hospital phototherapy to
supervised home phototherapy.

Focused Appraisal
All the studies were observational studies and the investigators had influence over which
group patients were allocated to. There are inherent biases in this type of study design
for intervention studies.
None of the studies performed a random allocation of patients to the intervention groups.
This is problematic when testing an intervention. Only one of the studies (Slater 1984)
described how a subject was allocated to home or hospital phototherapy. There may be
other differences between the groups, other than the difference in intervention provided.
For example, in the study by James (1993), mothers may have chosen home
phototherapy specifically because they wanted to continue breast feeding, whereas the
hospital group mothers may not have wanted to continue breast feeding. Randomisation
of neonates to home or hospital phototherapy would reduce this possible bias.
None of the studies blinded the assessor who determined the outcome of the neonates.
Blinding increases the validity of a study by removing the possibility that the assessor is
influenced by the intervention to which the patient is allocated.
The setting for all of the studies was the United States, which may not be generalisable
to the Australian setting. Protocols and practices may vary from hospital to hospital and
country to country.
All the studies employed a small sample size. Only one study (Eggert 1985) was of more
than 100 infants. A small sample size results in decreased generalisability. Also, when
there is no difference between the groups, as for all three of these studies, it may be that
the sample was not large enough to detect any difference (Type II Error).
None of the included studies described clear criteria for the diagnosis of
hyperbilirubinemia. This is a problem as it is not possible to know exactly what their case
definition was. Also, it is not possible to determine a treatment failure without any
criteria to go by.

Centre for Clinical Effectiveness Evidence Report

Conclusion
All three of the included studies concluded that home phototherapy was feasible, safe
and effective alternative to hospital phototherapy. However, weaknesses in study design
as discussed above necessitate that these conclusions be interpreted with caution. There
is currently no high level evidence to answer this evidence request. A randomised
controlled trial is required where one group of neonates is allocated to hospital
phototherapy and another is allocated to home phototherapy in order to definitively
address this topic.

EVIDENCE SUMMARIES
Format
Evidence summaries are presented as spreadsheets attached to this report. Each
spreadsheet contains the article citation, details of the study design, patient description,
scientific validity of the article, results, pertinent remarks from the study authors and
Centre for Clinical Effectiveness reviewer.

Centre for Clinical Effectiveness Evidence Report

REFERENCES
ARTICLES CRITICALLY APPRAISED FOR THIS REPORT
James JM, Williams SD & Osborn LM (1993). Discontinuation of breast-feeding infrequent
among jaundiced neonates treated at home. Pediatrics 92(1): 153-5.
Eggert LD, Pollary RA, Folland DS & Jung AL (1985). Home phototherapy treatment of
neonatal jaundice. Pediatrics 76(4): 579-84.
Slater L & Brewer MF (1984). Home versus hospital phototherapy for term infants with
hyperbilirubinemia: a comparative study. Pediatrics 73(4): 515-9.

ARTICLES NOT CRITICALLY APPRAISED

Case studies (Level IV)
Jackson CL, Tudehope D, Willis L, Law T & Venz J (2000). Home phototherapy for
neonatal jaundice--technology and teamwork meeting consumer and service need.
Australian Health Review 23(2):162-8.
Hamelin K & Seshia M (1998). Focus on quality. Home phototherapy for uncomplicated
neonatal jaundice. Canadian Nurse 94(1): 39-40.
Madlon-Kay DJ (1998). Evaluation and management of newborn jaundice by midwest
family physicians. Journal of Family Practice 47(6): 461-4.
Freeman KG (1997). Home phototherapy: shedding light on commencement, newborn
variations, and outcomes. University of Maryland at Baltimore (PhD thesis).
Meropol SB, Luberti AA, De JAR & Weiss JC (1993). Home phototherapy: use and
attitudes among community pediatricians. Pediatrics 91(1): 97-100.
Kirgis CA, Solon JF & McNeal C (1987). Nursing care of newborns with
hyperbilirubinemia. Pediatric Nursing Forum 2(1): 3-8.
Dortch E & Spottiswoode P (1986). New light on phototherapy: home use. Neonatal
Network Journal of Neonatal Nursing 4(4): 30-4.
Grabert BE, Wardwell C & Harburg SK (1986). Home phototherapy. An alternative to
prolonged hospitalization of the full-term, well newborn. Clinical Pediatrics 25(6): 291-4.
Rogerson AG, Grossman ER, Gruber HS, Boynton RC & Cuthbertson JG (1986). 14 years
of experience with home phototherapy. Clinical Pediatrics 25(6): 296-9.
Ellis J (1985). Home phototherapy for newborn jaundice. Birth 12(3): 15-7.

Narrative reviews, letters and commentaries

Richmond G, Brown M & Wagstaff P (2003). Using a home care model to monitor bilirubin
levels in early discharged infants. Topics in Health Information Management 24(1): 3941.
Melton K & Akinbi HT (1999). Neonatal jaundice. Strategies to reduce bilirubin-induced
complications. Postgraduate Medicine 106(6): 167-8.
Woo EK (1998). Biliblanket phototherapy light. Nursing 28(8): 79.
Sater KJ (1995). Color me yellow: caring for the infant with hyperbilirubinemia. Journal
of Intravenous Nursing 18(6): 317-25.
Poland RL (1993). Home phototherapy: not seeing the light. Pediatrics 91(1): 147.
Murphy BN & Welch R (1992). Home phototherapy for the jaundiced full-term newborn.
Journal of Home Health Care Practice 5(1): 26-33.
Centre for Clinical Effectiveness Evidence Report

Dyk J (1990). Home phototherapy: reliable equipment, family education assure quality
treatment. Continuing Care 9(9): 44-6.
Fuller J (1990). Home phototherapy. Caring 9(12): 8-11.
Ludwig MA (1990). Phototherapy in the home setting. Journal of Pediatric Health Care
4(6): 304-8.
Rose BS (1990). Phototherapy: all wrapped up? Pediatric Nursing 16(1): 57-8.
Savinetti-Rose B, Kempfer-Kline RE & Mabry CM (1990). Home phototherapy with the
fiberoptic blanket. The nurse's role in caring for newborns and their caregivers. Journal of
Perinatology 10(4): 435-8.
Greenwald JL (1988). Hyperbilirubinemia in otherwise healthy infants. American Family
Physician 38(6): 151-8.
Shibley B (1988). Now newborns can stay home for phototherapy. RN 51(2): 69-71.
Grabert BE (1986). Home phototherapy recommendations questioned. Pediatrics 78(2):
373-4.
Hartsell MB (1986). Home phototherapy. Journal of Pediatric Nursing 1(4): 282-3.
Sapala S & Belkengren R (1986). Pediatric management problems (neonatal jaundice).
Pediatric Nursing 12(4): 301.
Anonymous (1985). American Academy of Pediatrics. Committee on Fetus and Newborn.
Home phototherapy. Pediatrics 76(1): 136-7.
DeLoache WR (1985). Stop home phototherapy. Pediatrics 75(5): 987-8.
Roeder BJ & Williams DN (1985). Diagnosis-specific home care. The Park Nicollet model.
Postgraduate Medicine 77(2): 79-81.

Incorrect comparator
George P & Lynch M (1994). Ohmeda Biliblanket vs Wallaby Phototherapy System for the
reduction of bilirubin levels in the home-care setting. Clinical Pediatrics 33(3): 178-80.
Schuman AJ & Karush G (1992). Fiberoptic vs conventional home phototherapy for
neonatal hyperbilirubinemia. Clinical Pediatrics 31(6): 345-52.
Woodall D & Karas JG (1992). A new light on jaundice. A pilot study. Clinical Pediatrics
31(6): 353-6.
Van Enk A & de Leeuw R (1987). Phototherapy: the hospital as risk factor. British Medical
Journal Clinical Research Ed 294(6574): 747-9.

Article not received by 22nd December

Armany K & Egan E (1998). Bili babies bond at home. Nursing Spectrum (New England
Edition) 2(19): 13.
Reece E & Iverson LJ (1989). Phototherapy for treatment of neonatal hyperbilirubinemia.
Journal of Home Health Care Practice 1(2): 46-54.
Heiser CA (1987). Home phototherapy. Pediatric Nursing 13(6): 425-7.
Parlett CH & Spitzer A (1986). Home phototherapy: keeping baby home. Caring 5(11):
56-60

Centre for Clinical Effectiveness Evidence Report

EVIDENCE SUMMARIES
Evidence Summary
Therapy/Intervention
Phototherapy in the home for
jaundiced neonates

Study 1
James JM, Williams SD & Osborn LM (1993). Discontinuation of
breast-feeding infrequent among jaundiced neonates treated at
home. Pediatrics 92(1): 153-5.

Study 2
Eggert LD, Pollary RA, Folland DS & Jung AL (1985). Home
phototherapy treatment of neonatal jaundice. Pediatrics 76(4):
579-84.

STUDY DESIGN & NHMRC LEVELS

OF EVIDENCE

Retrospective cohort study.

Level III-2

Prospective cohort study.

Level III-2

DESCRIPTION:
Patients (subjects), Intervention,
Comparisons, Outcomes,
Inclusion & Exclusion Criteria

Setting: Salt Lake City, United States, 1987-88.

Patients (subjects): Otherwise healthy, jaundiced, term newborns
with no underlying haemolysis or birth trauma.
Intervention: Home phototherapy (n=48).
Comparisons: Hospital phototherapy (n=48).
Outcomes: Primary outcome was rate of breast feeding. Medical
record and telephone survey to determine type of infant feeding, ie
breast, formula or both, and also whether breast feeding was
suspended during therapy.
Exclusion Criteria: None stated.

VALIDITY:
Methodology, rigour, selection

Treatment allocation method: Not described.

Allocation concealment: No.
Similar groups: Groups were similar for age at therapy initiation,
birth weight and gestational age.
Blinding of assessors to treatment group: No.
For home therapy patients, 9% of mothers stopped breast feeding,
compared to 42% of the hospital treated patients (p<0.002). Also,
mothers of hospitalised neonates were less likely to resume breast
feeding after treatment was complete (p<0.02).
There were no complications or readmissions in the home group.
Treatment at home took longer (3 days compared to 4 days), but
was cheaper (hospital treatment five times more expensive).

Setting: Hospitals in Salt Lake Valley, United States, 1981-82.

Patients (subjects): Healthy, term newborns with
hyperbilirubinaemia.
Intervention: Home phototherapy (n=62).
Comparisons: Hospital phototherapy (n=55).
Outcomes: Bilirubin levels, duration of phototherapy,
complications.
Inclusion & Exclusion Criteria: Infants were included if they
were >24h postnatal age and weighed >2.2K. Physicians
selected infants whose clinical diagnoses and bilirubin levels
allowed an adequate margin of error for a trial of phototherapy
and that parents were capable of managing home phototherapy
Treatment allocation method: Not described.
Allocation concealment: No.
Similar groups: Hospital group were younger (3.0 vs 4.2 days)
and had lower bilirubin levels at start of therapy.
Blinding of assessors to treatment group: No.
The mean daily decrease in bilirubin levels between each group
was similar (1.4 vs 1.5, p value not significant).
The home group had a longer duration of phototherapy (2.8 vs
1.6 days, p<0.001).
Six (10%) of mothers reported complications with home
phototherapy. All complications were considered mild (mild
vomiting and mild diarrhoea). No notable complications occurred
for the hospital group.
Home phototherapy was cheaper ($200 vs $40 per day).
We found home phototherapy to be a feasible, safe and
effective alternative to in-hospital phototherapy for otherwise
healthy, jaundiced infants with motivated and capable parents.

RESULTS:
Generally favourable or
unfavourable, specific outcomes
of interest, estimate of
experimental effect and precision
if appropriate

AUTHOR(S) CONCLUSIONS:
Limitations, implications for
practice and research

Our study indicates that home treatment may neutralize some of

these negative factors (of hospital phototherapy). Further,
termination of breast feeding during therapy is probably
unnecessary except in those cases in which a very rapid decrease in
serum bilirubin levels is deemed critical. Further investigation is
needed to help define the optimal approach to treatment for
exaggerated neonatal jaundice and the implications of our current
treatment strategies.

Centre for Clinical Effectiveness Evidence Report

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OUR COMMENTS:
Opportunity for bias, weakness
and strength

Opportunity for bias:

No randomisation

Reason why newborns were allocated to the different

treatment groups not explained may be that mothers
chose home phototherapy because they wanted to perform
breast feeding, therefore bias in primary outcome
measure.
Weakness/es:

Retrospective

Small sample

Hyperbilirubinaemia not defined

Centre for Clinical Effectiveness Evidence Report

Opportunity for bias:

No randomisation

Reason why newborns were allocated to the different

treatment groups not explained.
Weakness/es:

Small sample

Treatment method decided by clinician

No blinding of assessors

Hyperbilirubinaemia not defined

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Evidence Summary
Therapy/Intervention
Phototherapy in the home for
jaundiced neonates

Study 3
Slater L & Brewer MF (1984). Home versus hospital phototherapy for term infants with hyperbilirubinemia: a comparative study.
Pediatrics 73(4): 515-9.

STUDY DESIGN & NHMRC LEVELS

OF EVIDENCE

Prospective cohort study.

Level III-2

DESCRIPTION:
Patients (subjects), Intervention,
Comparisons, Outcomes,
Inclusion & Exclusion Criteria

Setting: California, United States, 1979-81.

Patients (subjects): Healthy term infants with sufficient bilirubinaemia to warrant treatment yet not require transfusion.
Intervention: Home phototherapy (n=25).
Comparisons: Hospital phototherapy (n=33).
Outcomes:
Inclusion & Exclusion Criteria: Term, Apgar >7, normal physical examination, actively feeding, stooling and voiding by 24 hours,
>48hrs and <7 days of age, defined bilirubin levels (detailed in article), adequate home and parental environment.
Treatment allocation method: Home treatment if met inclusion criteria and parent consented. Hospital group if physician or parent
not interested or if there were barriers that precluded supervision at home, eg distance from hospital, lack of a telephone.
Allocation concealment: No.
Similar groups: Similar in terms of maternal age, gestation, labour complications, gravidity and parity, oxytocin use during labour,
breast vs bottle feeding, birth weight, Apgar score, initial bilirubin levels.
Blinding of assessors to treatment group: No.
Two infants in the home group required rehospitalisation. One was due to the diagnosis of a congenital heart defect, the other was a
treatment failure. A third infant was readmitted after the mother developed a postpartum infection requiring hospitalisation.
There was no significant difference in the mean decrease in bilirubin levels between the groups.
The home group had a longer duration of treatment (2.8 vs 2.1 days).
No complications were reported in either group.
Cost saving were approximately $225 per day in the home group.

VALIDITY:
Methodology, rigour, selection

RESULTS:
Generally favourable or
unfavourable, specific outcomes
of interest, estimate of
experimental effect and precision
if appropriate
AUTHOR(S) CONCLUSIONS:
Limitations, implications for
practice and research

..effectiveness of home and hospital phototherapy is the same.

OUR COMMENTS:
Opportunity for bias, weakness
and strength

Opportunity for bias:

No randomisation

Allocation to the two groups was different, which may have led to a bias in outcome.
Weakness/es:

No blinding of assessors.

Small sample.
Strength/s:

Definition of hyperbilirubinaemia provided, although no accepted standard was available at time of study.

Centre for Clinical Effectiveness Evidence Report

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EXPLANATION OF TERMINOLOGY USED IN SPREADSHEET

Level of evidence: A hierarchy of study evidence that indicates the degree to which bias has
been eliminated in the study design.
Intervention: A therapeutic procedure such as treatment with a pharmaceutical agent,
surgery, a dietary supplement, a dietary change or psychotherapy.
Randomisation: A process of allocating participants to treatment or control group within a
controlled trial by using a random mechanism, such as coin toss, random number table or
computer-generated random numbers. Study subjects have an equal chance of being allocated
to an intervention or control group; thus, the two groups are comparable. Randomisation
ensures that the results are not biased by the selection of particular types of patients to
receive a specific therapy.
Blinding: Blinding or masking is a process used in epidemiological studies and clinical trials in
which the observers and the subjects have no knowledge as to which treatment groups
subjects are assigned. It is undertaken in order to minimise bias occurring in patient response
and outcome measurement.
All patients accounted for: Once patients are randomly allocated to a specific group and
withdraw before study conclusion, they have to be accounted for in order to ensure that
patients withdrawing from the study are not significantly different from those continuing in the
study. The final analysis should be conducted on an intention-to-treat basis, which includes the
results of withdrawn patients in the analysis.
Patients treated equally: To be able to attribute any difference in the observed outcome to
the intervention, study patients need to be treated equally in every way except for the
intervention being evaluated.
Similar groups: Baseline characteristics of patients that are also likely to affect results should
be evenly distributed between the intervention and control groups. Following proper
randomisation, patients attributes would be expected to be equally distributed between
groups.
Validity:
- Of measurement: an expression of the degree to which a measurement measures what it
purports to measure; it includes construct and content validity.
- Of study: the degree to which the inferences drawn from the study are warranted when
account is taken of the study methods, the representativeness of the study sample, and the
nature of the population from which it is drawn (internal and external validity, applicability,
generalisability).
Potential for bias: Bias is a systematic deviation of a measurement from the true value
leading to either an over (or under) estimation of the treatment effect. Bias can originate from
many different sources (including allocation of patients, measurement, interpretation,
publication and review of data).

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APPENDIX 1
Copyright
This publication is the copyright of Southern Health. Other than for the purposes and
subject to the conditions prescribed under the Copyright Act 1968 as amended, no part of this
publication may, in any form or by any means (electric, mechanical, microcopying,
photocopying, recording or otherwise), be reproduced, stored in a retrieval system or
transmitted without prior written permission. Inquiries should be addressed to Centre for
Clinical Effectiveness.

Disclaimer
The information in this report is a summary of that available and is primarily designed to give
readers a starting point to consider currently available research evidence. Whilst appreciable
care has been taken in the preparation of the materials included in this publication, the authors
and Southern Health do not warrant the accuracy of this document and deny any
representation, implied or expressed, concerning the efficacy, appropriateness or suitability of
any treatment or product. In view of the possibility of human error or advances of medical
knowledge the authors and Southern Health cannot and do not warrant that the information
contained in these pages is in every aspect accurate or complete. Accordingly, they are not
and will not be held responsible or liable for any errors of omissions that may be found in this
publication. You are therefore encouraged to consult other sources in order to confirm the
information contained in this publication and, in the event that medical treatment is required,
to take professional expert advice from a legally qualified and appropriately experienced
medical practitioner.

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APPENDIX 2
Search strategy (only MEDLINE search is shown)
Search terms for MEDLINE
1

Infant, Newborn/

(neonate or newborn).mp.

infant.tw.

Or/1-3

jaundice$.mp. or JAUNDICE/ or JAUNDICE, NEONATAL/

Hyperbilirubinemia/ or Bilirubin/ or bilirubinaemia.mp.

5 or 6

Home Care Services, Hospital-Based/ Or Home Care Agencies/ Or

Accidents, Home/ Or Home.mp. Or Home Nursing/ Or Home Care
Services/

(phototherapy adj4 home).tw.

10

biliblanket or uv light.tw.

11

((ultraviolet or uv) adj light).tw.

12

Or/8-10

13

4 and 7 and 11

14

limit 11 to (human and english language)

Similar search terms, appropriately translated, were used in other databases.

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