Page 146 - 16Neonatal Jaundice_compressed

Treatment

Recommendations
See the end of Section 7.2.1.
Bulb colour for conventional phototherapy

Description of included studies

Six studies 160-165 with a total of 674 participants were included in this comparison. Two of the
studies were from Denmark 160;161 and one apiece were from Greece, 162 Italy, 164 Switzerland 163
and the USA. 165 The included studies ranged from EL 1− to EL 1+. One study 163 used a random
numbers table and one study 160 used sealed envelopes for allocation concealment.

One study dealt with term 163 and three with preterm 160;161;164 babies and as there were no
statistically significant differences in outcome these were analysed together. Where reported, the
mean gestational age ranged from 33.8 ± 2.49 weeks to 39.0 ± 1.03 weeks, the mean age at
entry to study ranged from 70.5 ± 23.1 hours to 101.8 ± 4.32 hours, the mean birthweight
ranged from 1930 g to 3395 ± 547 g, and the mean baseline serum bilirubin levels ranged from
190 micromol/litre to 292 ± 35 micromol/litre. In all, 142 participants (55.5%) were male.

Review findings
Regarding duration of treatment, green phototherapy was statistically significantly shorter than
blue phototherapy (MD = 7.03 hours, 95% CI 6.23 to 7.83 hours), which in turn was statistically
significantly shorter than white phototherapy (MD = −32.00 hours (95% CI −44.72 to
−19.28 hours) (Figure 7.11).

Blue Comparator Mean Difference Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI
5.2.1 Blue versus Green
F - Amato 1991 34 10 15 70 23 15 0.4% -36.00 [-48.69, -23.31]
F - Ayyash 1987 49.88 3.02 100 42.68 2.74 100 99.6% 7.20 [6.40, 8.00]
P - Ayyash 1987 53.29 5.9 31 53.26 5.52 31 0.0% 0.03 [-2.81, 2.87]
Subtotal (95% CI) 146 146 100.0% 7.03 [6.23, 7.83]
Heterogeneity: Chi² = 44.33, df = 1 (P < 0.00001); I² = 98%
Test for overall effect: Z = 17.27 (P < 0.00001)
5.2.3 Blue versus White
F - Sisson 1972 43 17.1 48 75 29.4 24 100.0% -32.00 [-44.72, -19.28]
Subtotal (95% CI) 48 24 100.0% -32.00 [-44.72, -19.28]
Heterogeneity: Not applicable
Test for overall effect: Z = 4.93 (P < 0.00001)

-50 -25 0 25 50
Favours Blue Favours Green
Test for subgroup differences: Chi² = 36.04, df = 1 (P < 0.00001), I² = 97.2%
Figure 7.11 Mean duration of treatment when blue lamps are compared with green lamps and with
white lamps

Compared with blue phototherapy, there was a statistically significantly greater decrease in
serum bilirubin levels among babies treated with green phototherapy
(MD = 3.98 micromol/litre, 95% CI 3.43 to 4.52 micromol/litre), both in term and preterm
babies (Figure 7.12). Turquoise phototherapy also resulted in a statistically significantly greater
decrease in serum bilirubin levels (MD = 14.00 micromol/litre, 95% CI 3.76 to
24.24 micromol/litre).

Evidence summary for bulb colour for conventional phototherapy
Comparison between different types of coloured lights used for phototherapy reveals that green
light phototherapy is statistically significantly better than blue light phototherapy in reducing the
duration of treatment and in reducing the mean serum bilirubin levels. Results from one trial
indicate that turquoise light phototherapy is better than blue light for the same two outcomes.

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