Page 143 - 16Neonatal Jaundice_compressed

Neonatal jaundice

Experimental Control Risk Ratio Risk Ratio
Study or Subgroup Events Total Events Total Weight M-H, Fixed, 95% CI M-H, Fixed, 95% CI
LBW - Leite 2004 0 35 0 35 Not estimable
LBW - NICHHD 1985 22 462 110 460 97.3% 0.20 [0.13, 0.31]
P - Curtis-Cohen 1985 0 11 0 11 Not estimable
P - Morris 2008 2 990 3 984 2.7% 0.66 [0.11, 3.96]
P - Wu 1974 0 40 0 40 Not estimable
Total (95% CI) 1538 1530 100.0% 0.21 [0.14, 0.32]
Total events 24 113
Heterogeneity: Chi² = 1.64, df = 1 (P = 0.20); I² = 39% 0.01 0.1 1 10 100
Test for overall effect: Z = 7.19 (P < 0.00001) Favours experimental Favours control
Figure 7.8 Number of exchange transfusions needed when early phototherapy is compared with no
treatment in preterm babies

Four studies 129;145;148;150 examined treatment failure as an outcome. Treatment failure was defined
as serum bilirubin rising above a predefined level or the need for exchange transfusion. There
were statistically significantly fewer treatment failures in babies treated with early phototherapy
(RR 0.23, 95% CI 0.17 to 0.32) (Figure 7.9). Heterogeneity was a factor (I² = 53%).

Experimental Control Risk Ratio Risk Ratio
Study or Subgroup Events Total Events Total Weight M-H, Fixed, 95% CI M-H, Fixed, 95% CI
LBW - Leite 2004 10 35 21 35 12.9% 0.48 [0.26, 0.86]
LBW - NICHHD 1985 22 462 110 460 67.7% 0.20 [0.13, 0.31]
P - Morris 2008 3 990 13 984 8.0% 0.23 [0.07, 0.80]
P - Wu 1974 5 80 14 40 11.5% 0.18 [0.07, 0.46]
Total (95% CI) 1567 1519 100.0% 0.23 [0.17, 0.32]
Total events 40 158
Heterogeneity: Chi² = 6.39, df = 3 (P = 0.09); I² = 53% 0.01 0.1 1 10 100
Test for overall effect: Z = 8.75 (P < 0.00001) Favours experimental Favours control
Figure 7.9 Number of treatment failures when early phototherapy is compared with no treatment in
preterm babies

The mean peak in serum bilirubin was statistically significantly lower among babies who
received early phototherapy (MD = −53.11 micromol/litre, 95% CI −59.44 to
−46.78 micromol/litre) (Figure 7.10) but heterogeneity was high (I² = 84%).

Early PT No treatment Mean Difference Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI
1.1.1 No treatment
LBW - Leite 2004 84 39 35 147 36 35 13.0% -63.00 [-80.58, -45.42]
LBW - Maurer 1973 83 42 37 147 57 15 3.9% -64.00 [-95.86, -32.14]
LBW - NICHHD 1985 110 33 462 170 86 460 56.6% -60.00 [-68.42, -51.58]
LBW - Valdes 1971 58 52 19 140 53 15 3.2% -82.00 [-117.58, -46.42]
P - Curtis-Cohen 1985 112 27 11 123 20 11 10.2% -11.00 [-30.86, 8.86]
P - Wu 1974 125 34 80 161 51 40 13.1% -36.00 [-53.47, -18.53]
Subtotal (95% CI) 644 576 100.0% -53.11 [-59.44, -46.78]
Heterogeneity: Chi² = 27.73, df = 5 (P < 0.0001); I² = 82%
Test for overall effect: Z = 16.44 (P < 0.00001)
-100 -50 0 50 100
Favours Early PT Favours No treatment
Test for subgroup differences: Not applicable
Figure 7.10 Mean peak serum bilirubin when early phototherapy is compared with no treatment in
preterm babies

See below for the overall evidence summary and GDG translation from evidence for
phototherapy in preterm/low-birthweight babies.

Conventional phototherapy versus multiple phototherapy
Description of included studies

Two studies 151;152 of EL 1+ and with 206 participants were included in this comparison. One
study apiece was from Italy 152 and the USA. 151 One study 151 specified the method of

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