Page 138 - 16Neonatal Jaundice_compressed

Treatment

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 4 17 6.4% 0.14 [0.01, 2.44]
F - Lewis 1982 0 20 3 20 5.7% 0.14 [0.01, 2.60]
F - Martinez 1993 6 74 11 51 21.1% 0.38 [0.15, 0.95]
F - NICHHD 1985 a 3 70 18 71 29.0% 0.17 [0.05, 0.55]
F - NICHHD 1985 b 14 140 23 136 37.8% 0.59 [0.32, 1.10]
Subtotal (95% CI) 317 295 100.0% 0.37 [0.24, 0.58]
Total events 23 59
Heterogeneity: Chi² = 4.74, df = 4 (P = 0.31); I² = 16%
Test for overall effect: Z = 4.32 (P < 0.0001)
0.01 0.1 1 10 100
Favours Phototherapy Favours No treatment
Figure 7. 2 Number of treatment failures when conventional photothearay is compared with no
treatment in term babies

Although only two studies 129 contributed data, there was a statistically significantly greater
decrease in the mean serum bilirubin levels in the conventional phototherapy group compared
with the no treatment group (MD = −45.55 micromol/litre, 95% CI −46.35 to
−44.75 micromol/litre) (Figure 7.3). There was significant heterogeneity (I² = 100%).

Conventional Phototherapy Comparison Mean Difference Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI
1.19.1 No treatment
F - Bryla 1985 a -94 5 70 -32 4 71 28.5% -62.00 [-63.50, -60.50]
F - Bryla 1985 b -139 4 140 -100 4 136 71.5% -39.00 [-39.94, -38.06]
Subtotal (95% CI) 210 207 100.0% -45.55 [-46.35, -44.75]
Heterogeneity: Chi² = 649.54, df = 1 (P < 0.00001); I² = 100%
Test for overall effect: Z = 111.84 (P < 0.00001)
-100 -50 0 50 100
Favours conventional Favours No treatment
Test for subgroup differences: Not applicable
Figure 7.3 Mean decrease in serum bilirubin when conventional phototherapy is compared with
no treatment in term babies

See below for the overall evidence summary and GDG translation from evidence for
phototherapy in term/normal-birthweight babies.
Conventional phototherapy versus multiple phototherapy

Description of included studies
Four studies 135-138 with 328 participants were included but not all subjects were used in this
comparison as some studies had additional treatment arms examining other types of
phototherapy. Two of the studies were from Thailand, 136;137 one from Saudi Arabia 135 and one
from Singapore. 138 The evidence level of the included studies ranged from EL 1− to EL 1+. One
study 138 specified the method of randomisation used as the lottery method while the remaining
three studies did not report the method used. One study 135 reported using sealed envelopes as
allocation concealment.

The mean gestational age of the study participants ranged from 37.9 ± 2.1 weeks to
38.7 ± 1.3 weeks, the mean birthweight ranged from 2921 ± 696 g to 3130 ± 311 g, the mean
age at entry to the study ranged from 37.9 ± 24.1 hours to 96.9 ± 30.9 hours (not reported in
one study) and the mean baseline serum bilirubin levels ranged from 185 ± 56 micromol/litre to
316 ± 47 micromol/litre. In all, 185 (56.4%) of participants were male.
Review findings

In a meta-analysis of these for studies, there were no cases of exchange transfusion or treatment
failures and only three cases of rebound jaundice, two in the conventional phototherapy group
and one in the multiple phototherapy group, but this difference was not statistically significant.
There was no statistically significant difference between the groups in terms of mean duration of
phototherapy.

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