Community-based monitoring of neonatal jaundice using the point-of-care Bilistick® System 2.0

Abstract

Neonatal jaundice often peaks after discharge, creating the need for reliable post-discharge monitoring. This study evaluated the feasibility and safety of a hospital-to-community pathway using the Bilistick® System 2.0 within routine Community Health Family Services (CHFS). This retrospective observational study was conducted within a Local Health Authority in northeastern Italy. Newborns eligible for out-of-hospital bilirubin testing according to a Diagnostic-Therapeutic Assistance Pathway (DTAP) were referred either to CHFS or to hospital follow-up based on bilirubin risk profile, clinical factors, and organizational considerations. Of 397 eligible newborns meeting inclusion criteria, 244 were included. Of these, 108 (44.3%) were referred to CHFS, 135 (55.3%) to hospital follow-up, and 1 was lost to follow-up. Among newborns referred to CHFS, 97 (89.8%) completed monitoring without hospital referral. Eleven were referred to the hospital, of whom 7 received phototherapy. Among newborns referred directly to the hospital, 6 (4.4%) required phototherapy. No sampling-related adverse events, missed phototherapy, exchange transfusions, or cases of kernicterus were recorded. Community-based bilirubin monitoring using the Bilistick® System 2.0 appears feasible and safe for selected low-risk newborns within a structured hospital-to-community pathway. To our knowledge, this is the first real-world evaluation of a structured hospital-to-community pathway integrating point-of-care bilirubin testing into routine community care within UNICEF’s Baby-Friendly Initiative framework. Among selected newborns referred to community services, 89.8% completed bilirubin monitoring without hospital referral. Community midwives identified infants requiring escalation of care; no missed phototherapy, exchange transfusion, or kernicterus occurred. The model may reduce unnecessary hospital reassessment and disruption to the mother–infant dyad; local administrative estimates indicate a direct cost difference of €32.30 per bilirubin reassessment.