Page 142 - 16Neonatal Jaundice_compressed

Treatment

less effective than conventional phototherapy in term babies and leads to more treatment
failures. Monitoring the effect of treatment is essential because, despite phototherapy, some
babies may require further medical interventions.
Evidence demonstrates that multiple phototherapy is more effective than conventional
phototherapy. However, conventional phototherapy works in most cases and, in order to
support breastfeeding, the GDG considers that multiple phototherapy should be reserved for the
treatment of jaundice that does not respond to conventional treatment (no reduction in serum
bilirubin 6 hours after initiation of treatment or serum bilirubin that continues to rise) or in cases
that require a rapid reduction in serum bilirubin levels.

Recommendations on phototherapy in term/normal-birthweight babies
See the end of Section 7.2.1.

Phototherapy in preterm/low-birthweight babies
Seventeen of the included studies contributed to the following comparisons:
● early phototherapy versus usual care/no treatment (seven studies)
● conventional phototherapy versus multiple phototherapy (two studies)
● conventional phototherapy versus fibreoptic phototherapy (six studies)
● conventional phototherapy versus LED phototherapy (two studies)
Early phototherapy versus no treatment

Description of included studies

Seven studies 129;145-150 with 1238 participants were included in this comparison. Early
phototherapy is used for lowering maximum bilirubin levels in babies with low birthweight
(< 1500 g) and in preterm babies. Early phototherapy is initiated before serum bilirubin reaches
the normal phototherapy threshold.
Six of the studies 129;145-149 were from the USA and one was from Brazil. 150 Babies were included
either on the basis of gestational age 148 or birthweight. 129;145-147;149;150 The evidence level of the
included studies ranged from EL 1− to EL 1++. One study specified the method of
randomisation used as a random numbers table, 129 one study used a computer-generated
sequence 145 and one reported using randomised cards, 148 while the remaining four studies did
not report the method used. One study 129 used sealed envelopes for allocation concealment.
Where reported, the mean and standard deviation for gestational age of the study participants
ranged from 26.0 ± 2.0 weeks to 34.2 ± 3.8 weeks (not reported in three studies 129;146;150 ), mean
birthweight ranged from 777 ± 134 g to 1860 ± 344 g (not reported in two studies 129;150 ), and
mean age at entry to study was reported in one study 129 as 24.2 ± 8.0 hours. In two studies 129;149
phototherapy was initiated within 24 hours of birth, and the mean baseline serum bilirubin
levels was 97 ± 33 micromol/litre in the one study 129 that reported. In the studies that reported
gender, 1179 participants (51.5%) were male.
Early phototherapy was initiated at varying serum bilirubin levels (e.g. 85.5 micromol/litre) or
within 24 ± 12 hours of birth in low-birthweight babies. One study also used postnatal age, with
phototherapy being initiated at 85 micromol/litre for the first week of life and at
120 micromol/litre in the second week of life. In three studies 145;149;150 babies in the control groups
received phototherapy if their serum bilirubin levels reached an a priori cut-off of serum bilirubin.

Review findings
There were statistically significantly fewer exchange transfusions and treatment failures in babies
treated with early phototherapy (RR 0.21, 95% CI 0.14 to 0.32) in the five studies 129;145;148-150 that
reported on these outcomes (Figure 7.8). Most of the exchange transfusions were carried out in
one study 129 in which exchange transfusions were conducted at relatively low levels of serum
bilirubin based on birthweight and risk profile. 129 The number needed to treat with early
phototherapy to prevent one exchange transfusion was 16.

111