Page 147 - 16Neonatal Jaundice_compressed

Neonatal jaundice

Conventional Comparison Mean Difference Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI
5.1.1 Blue versus Green
F - Amato 1991 -157 22 15 -154 31 15 0.1% -3.00 [-22.24, 16.24]
F - Ayyash 1987 -39 2 100 -43 2 100 97.2% 4.00 [3.45, 4.55]
P - Ayyash 1987 -34 6 31 -38 8 31 2.4% 4.00 [0.48, 7.52]
P - Vecchi 1986 -50 23 42 -48 26 42 0.3% -2.00 [-12.50, 8.50]
Subtotal (95% CI) 188 188 100.0% 3.98 [3.43, 4.52]
Heterogeneity: Chi² = 1.76, df = 3 (P = 0.62); I² = 0%
Test for overall effect: Z = 14.26 (P < 0.00001)
5.1.2 Blue versus Turquoise
P - Ebbesen 2007 -78 31 69 -92 31 72 100.0% 14.00 [3.76, 24.24]
Subtotal (95% CI) 69 72 100.0% 14.00 [3.76, 24.24]
Heterogeneity: Not applicable
Test for overall effect: Z = 2.68 (P = 0.007)

-100 -50 0 50 100
Favours Conventional Favours Comparison
Test for subgroup differences: Chi² = 3.67, df = 1 (P = 0.06), I² = 72.8%
Figure 7.12 Mean decrease in serum bilirubin when blue lamps are compared with green lamps
and with white lamps

GDG translation from evidence for bulb colour for conventional phototherapy

The GDG recognises that the colour of the phototherapy lamps is important and that green light
is the most effective in reducing serum bilirubin. It is not, however, well tolerated by clinical
staff. Phototherapy units that combine white with blue light are ‘easier on the eyes’ and are
better tolerated by clinical staff. These may also be more acceptable to parents.

Recommendations – 7.2.1 Type of phototherapy to use
Do not use sunlight as phototherapy for hyperbilirubinaemia.
Single phototherapy treatment for term babies
Use conventional ‘blue light’ phototherapy as treatment for significant hyperbilirubinaemia in
babies with a gestational age of 37 weeks or more unless:
• the serum bilirubin level is rising rapidly (more than 8.5 micromol/litre per hour)
• the serum bilirubin is at a level that is within 50 micromol/litre below the threshold for
which exchange transfusion is indicated after 72 hours (see the threshold table
(Section 1.3) and treatment threshold graphs (Section 1.6)).
Do not use fibreoptic phototherapy as first-line treatment for hyperbilirubinaemia for babies
with a gestational age of 37 weeks or more.
Ensure all equipment is maintained and used according to the manufacturers’ guidelines.
Single phototherapy treatment for preterm babies
Use either fibreoptic phototherapy or conventional ‘blue light’ phototherapy as treatment for
significant hyperbilirubinaemia in babies less than 37 weeks unless:
• the serum bilirubin level is rising rapidly (more than 8.5 micromol/litre per hour)
• the serum bilirubin is at a level that is within 50 micromol/litre below the threshold for
which exchange transfusion is indicated after 72 hours (see treatment threshold table
(Section 1.3) and treatment threshold graphs (Section 1.6)).
Continuous multiple phototherapy treatment for term and preterm babies
Initiate continuous multiple phototherapy to treat all babies if any of the following apply:
• the serum bilirubin level is rising rapidly (more than 8.5 micromol/litre per hour)
• the serum bilirubin is at a level within 50 micromol/litre below the threshold for which
exchange transfusion is indicated after 72 hours (see threshold table (Section 1.3) and
treatment threshold graphs (Section 1.6)).
• the bilirubin level fails to respond to single phototherapy (that is, the level of serum
bilirubin continues to rise, or does not fall, within 6 hours of starting single phototherapy)

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