Page 139 - 16Neonatal Jaundice_compressed

Neonatal jaundice

Three studies 135-137 compared changes in serum bilirubin with each intervention. The mean
decrease in serum bilirubin was statistically significantly greater in the multiple phototherapy
group (MD = 27.75 micromol/litre, 95% CI 14.50 to 41.00 micromol/litre) (Figure 7.4).
Heterogeneity was significant (I² = 74%).

Conventional Multiple Mean Difference Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI
1.1.2 Multiple phototherapy
F - Al-Alaiyan 1996 -14 28 15 -19 35 15 34.1% 5.00 [-17.68, 27.68]
F - Boonyarittipong 2008 -111 39 30 -144 36 30 48.7% 33.00 [14.01, 51.99]
F - Nuntnarumit 2002 -98 46 27 -156 67 24 17.2% 58.00 [26.07, 89.93]
Subtotal (95% CI) 72 69 100.0% 27.75 [14.50, 41.00]
Heterogeneity: Chi² = 7.61, df = 2 (P = 0.02); I² = 74%
Test for overall effect: Z = 4.11 (P < 0.0001)
-100 -50 0 50 100
Favours Conventional Favours Multiple
Test for subgroup differences: Not applicable
Figure 7. 4 Mean decrease in serum bilirubin when conventional phototherapy is compared with
multiple phoptotherapy 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 fibreoptic phototherapy

Description of included studies
Six studies 135;138-142 with 426 participants were included in this comparison. Two of the studies
were from the USA 140;141 and there was one apiece from Italy, 142 Saudi Arabia, 135 Singapore 138
and Turkey. 139 The included studies ranged from EL 1− to EL 1+. Three studies specified the
method of randomisation used as the lottery method, 138 computer-generated 141 or sequential 139
and the remaining three studies did not report the method used. Two studies 135;142 reported
using sealed envelopes as allocation concealment while in one study 139 the nurses who
allocated the babies to the groups were blind to the serum bilirubin levels.

Where reported, the mean gestational age ranged from 37.9 ± 2.1 weeks to 39.6 ± 1.6 weeks,
mean birthweight ranged from 2921 ± 696 g to 3380 ± 359 g, mean age at entry to study ranged
from 37.9 ± 24.1 hours to 105.4 ± 42.8 hours (not reported in two studies) and mean baseline
serum bilirubin levels ranged from 185 ± 56 micromol/litre to 308 ± 47 micromol/litre. In the
studies that reported gender, 190 participants (55.4%) were male.
Review findings
No exchange transfusions were needed with either intervention. Two studies 138;139 reported on
treatment failures, defined in one study 139 as having two successive rises in serum bilirubin after
initiation of phototherapy, but not defined in the second. 138 Babies who received fibreoptic
phototherapy were more likely to be considered as treatment failures (RR 0.12, 95% CI 0.02 to
0.92) (Figure 7.5). There was no heterogeneity (I² = 0%).

Conventional Fibreoptic Risk Ratio Risk Ratio
Study or Subgroup Events Total Events Total Weight M-H, Fixed, 95% CI M-H, Fixed, 95% CI
1.1.3 Fiberoptic
F - Sarici 2001 0 50 4 50 46.6% 0.11 [0.01, 2.01]
F - Tan 1997 0 44 7 85 53.4% 0.13 [0.01, 2.18]
Subtotal (95% CI) 94 135 100.0% 0.12 [0.02, 0.92]
Total events 0 11
Heterogeneity: Chi² = 0.00, df = 1 (P = 0.95); I² = 0%
Test for overall effect: Z = 2.05 (P = 0.04)

0.01 0.1 1 10 100
Favours Conventional Favours Fibreoptic
Figure 7.5 Number of treatment failures when conventional phototherapy is compared with
fibreoptic phototherapy in term babies

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