Page 140 - 16Neonatal Jaundice_compressed

Treatment

Three studies 135;138;139 reported on rebound jaundice, which was defined as serum bilirubin
returning to pre-phototherapy levels. Babies who received fibreoptic phototherapy had fewer
cases of rebound jaundice but this was not statistically significant.
All six studies reported the mean change in serum bilirubin. Babies in the conventional
phototherapy group had a greater decrease in serum bilirubin than babies in the fibreoptic
group (MD = −12.01 micromol/litre, 95% CI −14.03 to −9.99 micromol/litre) (Figure 7.6).
Heterogeneity was within acceptable limits (I² = 36%).

Conventional Fibreoptic Mean Difference Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI
1.1.3 Fiberoptic
F - Al-Alaiyan 1996 -14 28 15 23 39 16 0.7% -37.00 [-60.79, -13.21]
F - Gale 1990 -10 56 22 -18 54 20 0.4% 8.00 [-25.28, 41.28]
F - Holtrop 1992 -45 18 14 -28 20 12 1.9% -17.00 [-31.73, -2.27]
F - Pezzati 2002 -55 16 21 -51 23 20 2.7% -4.00 [-16.18, 8.18]
F - Sarici 2001 -125 39 50 -111 42 50 1.6% -14.00 [-29.89, 1.89]
F - Tan 1997 -109 5 44 -97 7 85 92.7% -12.00 [-14.10, -9.90]
Subtotal (95% CI) 166 203 100.0% -12.01 [-14.03, -9.99]
Heterogeneity: Chi² = 7.79, df = 5 (P = 0.17); I² = 36%
Test for overall effect: Z = 11.66 (P < 0.00001)
-100 -50 0 50 100
Favours Conventional Favours Fibreoptic
Test for subgroup differences: Not applicable
Figure 7.6 Mean decrease in serum bilirubin when conventional phototherapy is compared with
fibreoptic phototherapy in term babies

Three studies 135;138;139 reported the mean duration of phototherapy. Babies receiving
conventional phototherapy spent statistically significantly less time undergoing phototherapy
than babies receiving fibreoptic phototherapy (MD = −12.30 hours, 95% CI −16.97 to
−7.63 hours) but heterogeneity was a factor (I² = 72%) (Figure 7.7).

Conventional Fibreoptic 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 Fiberoptic
F - Al-Alaiyan 1996 52.8 24.8 15 47.5 24.8 16 7.1% 5.30 [-12.17, 22.77]
F - Sarici 2001 49.4 14.4 50 61 13.1 50 74.9% -11.60 [-17.00, -6.20]
F - Tan 1997 62.6 24.8 44 84.8 38.7 85 18.0% -22.20 [-33.22, -11.18]
Subtotal (95% CI) 109 151 100.0% -12.30 [-16.97, -7.63]
Heterogeneity: Chi² = 7.07, df = 2 (P = 0.03); I² = 72%
Test for overall effect: Z = 5.16 (P < 0.00001)

-100 -50 0 50 100
Favours Conventional Favours Fibreoptic
Test for subgroup differences: Not applicable
Figure 7.7 Mean duration of phototherapy when conventional phototherapy is compared with
fibreoptic phototherapy 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 LED phototherapy

Description of included studies
Two studies from Israel 143;144 with 183 participants were included in this comparison. The
evidence level of both studies was EL 1+. Both used computer-generated sequences as the
method of randomisation but neither reported on allocation concealment.

The mean gestational age in one study 144 was 39.5 ± 1.5 weeks but was not reported in the
second 143 although gestational age > 37 weeks was an inclusion criterion. The mean age in one
study 144 was 53.9 ± 37.8 hours and was not reported in the second. 143 Gender and mean
birthweight were not reported in either study. The mean baseline serum bilirubin level was
251 ± 74 micromol/litre in one study and 251 ± 77 micromol/litre in the second.

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