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Neonatal jaundice
Review findings
There were no reported cases of exchange transfusion, treatment failures or rebound jaundice in
either study.
In a meta-analysis, both studies reported the mean decrease in serum bilirubin, which did not
differ statistically significantly between the groups (MD = −4.29 micromol/litre, 95% CI −18.95
to 10.36 micromol/litre), with no heterogeneity (I² = 0%). Likewise, there was no statistically
significant difference in terms of mean duration of phototherapy (MD = 0.64 hours, 95% CI
−4.97 to 6.26 hours), with no heterogeneity (I² = 0%).
Overall evidence summary for phototherapy in term/normal-birthweight babies
No studies examining sunlight or environmental light for the treatment of hyperbilirubinaemia
were identified.
The pooled results of meta-analysis show that in hyperbilirubinaemia, conventional
phototherapy is more effective than no treatment. Although there were variations in the initial
serum bilirubin level at which treatment was initiated, conventional phototherapy was found
statistically significantly to decrease the risk of exchange transfusion and treatment failure.
Treatment failure was defined as either two successive rises in serum bilirubin after initiation of
phototherapy, serum bilirubin rising above predefined serum bilirubin levels or the need for
exchange transfusion. There was also a statistically significantly greater decrease in the mean
serum bilirubin levels with conventional phototherapy compared with no treatment.
A statistically significant decrease in treatment failure was reported in babies who received
conventional phototherapy compared with those receiving fibreoptic phototherapy. Similar
results were seen for mean decreases in serum bilirubin, with results favouring conventional
phototherapy. Conventional phototherapy was statistically significantly more effective than
fibreoptic phototherapy in term babies.
Compared with fibreoptic phototherapy, treatment failure was statistically significantly less
common in babies receiving conventional phototherapy. Similarly, conventional phototherapy
was associated with a statistically significantly greater mean reduction in serum bilirubin than
fibreoptic phototherapy. Specifically, conventional was statistically significantly more effective
than fibreoptic phototherapy in term babies.
There was a trend towards a greater decrease in serum bilirubin levels among the group treated
with conventional phototherapy when compared with LED phototherapy but this was not
statistically significant, and there was no difference between the two types of phototherapy in
terms of the mean duration of phototherapy.
Overall GDG translation from evidence for phototherapy in term/normal-
birthweight babies
A formal cost-effectiveness analysis of the different modalities of phototherapy was not
undertaken because the GDG did not believe these represented realistic treatment alternatives.
No evidence regarding sunlight was reviewed so the GDG cannot recommend sunlight as a
treatment option for hyperbilirubinaemia. Fibreoptic phototherapy, which has greater treatment
failure, was not deemed a suitable treatment for term babies. While the evidence suggests that
multiple phototherapy is more effective than conventional phototherapy, advances in
technology have rendered this characterisation less useful because modern phototherapy units
are more powerful than those tested in the trials examined. Multiple phototherapy involves
exposing a greater area of skin to more powerful irradiance and it is currently believed that this
needs to be continuous. However, as a result of this, multiple phototherapy is also accompanied
by more fluid balance problems. The GDG felt that further research was needed on LED
phototherapy before they could be in a position to recommend it, although their clinical
experience so far is that it is effective.
Conventional modes of phototherapy, when used and maintained according to the
manufacturer’s instructions, have a low adverse side effects profile and are effective as first-line
medical treatment for hyperbilirubinaemia in term babies. Other modes of phototherapy are as
effective as conventional phototherapy, with the exception of fibreoptic phototherapy, which is
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