Page 137 - 16Neonatal Jaundice_compressed

Neonatal jaundice

7.2.1 Type of phototherapy to use

Phototherapy in term/normal-birthweight babies

Nineteen of the included studies contributed to the following comparisons:
● conventional phototherapy versus usual care/no treatment (seven studies from six articles)
● conventional phototherapy versus multiple phototherapy (four studies)
● conventional phototherapy versus fibreoptic phototherapy (six studies)
● conventional phototherapy versus LED phototherapy (two studies).

Conventional phototherapy versus no treatment

Description of included studies
Seven studies 129-134 from six articles with 667 participants were included in this comparison.
One reference 129 included three separate groups each of which was randomly allocated to
treatment or control. Three of the studies were carried out in the USA 129;130;133 and one each in
Italy, 132 Taiwan 134 and the UK. 131 The evidence level of the included studies ranged from EL 1−
to EL 1++. Three studies specified the method of randomisation used as a random numbers
table, 129;131 one study used a computer-generated sequence 133 and one used a coin-toss
method. 130 The remaining two studies did not report the method used. Two studies 129 reported
using sealed envelopes as allocation concealment.

Where reported, the mean and standard deviation for gestational age of the study participants
ranged from 39.0 ± 0.8 weeks to 39.2 ± 0.9 weeks, mean birthweight ranged from 2155 ± 632 g
to 3404 ± 361 g, mean age at entry to study ranged from 48.1 ± 14.7 hours to 97.2 ± 22.4 hours
and mean baseline serum bilirubin levels ranged from 174 ± 40 micromol/litre to
306 ± 12 micromol/litre. In the studies that reported gender, 377 participants (52%) were male.
Review findings

The results from a meta-analysis of these studies showed that significantly fewer exchange
transfusions were carried out in babies treated with conventional phototherapy (RR 0.36,
95% CI 0.22 to 0.59) (Figure 7.1). Heterogeneity was within acceptable limits (I² = 42%). The
number needed to treat with phototherapy to prevent one exchange transfusion was 10.

Phototherapy No treatment Risk Ratio Risk Ratio
Study or Subgroup Events Total Events Total Weight M-H, Fixed, 95% CI M-H, Fixed, 95% CI
1.1.1 No treatment
F - Ju 1991 0 13 0 13 Not estimable
F - Lewis 1982 0 20 0 20 Not estimable
F - Martinez 1993 0 74 0 51 Not estimable
F - Meloni 1974 2 12 6 12 11.3% 0.33 [0.08, 1.33]
F - NICHHD 1985 a 3 70 18 71 33.6% 0.17 [0.05, 0.55]
F - NICHHD 1985 b 14 140 23 136 43.9% 0.59 [0.32, 1.10]
F - Sisson 1971 0 19 5 16 11.2% 0.08 [0.00, 1.30]
Subtotal (95% CI) 348 319 100.0% 0.36 [0.22, 0.59]
Total events 19 52
Heterogeneity: Chi² = 5.16, df = 3 (P = 0.16); I² = 42%
Test for overall effect: Z = 4.08 (P < 0.0001)
0.01 0.1 1 10 100
Favours Phototherapy Favours No treatment
Figure 7.1 Number of exchange transfusions needed when conventional phototherapy is compared
with no treatment in term babies

Five studies 129;131;133;134 examined treatment failure as an outcome. This was defined as either
two successive rises in serum bilirubin after initiation of phototherapy, serum bilirubin rising
above predefined levels or the need for exchange transfusion. The RR was 0.37 (95% CI 0.24 to
0.58) (Figure 7.2). Heterogeneity was within acceptable limits (I² = 16%).

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