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Treatment

Research recommendations

What is the clinical and cost-effectiveness of:
● LED phototherapy compared to conventional phototherapy in term and preterm babies
with significant hyperbilirubinaemia?
Why this is important
Existing research has shown that while there is no difference between LED phototherapy and
conventional phototherapy, LED phototherapy may be easier to use in clinical setting by
reducing the need for additional fluids. New randomised controlled trials are needed to
examine LED phototherapy. Population: Term and preterm babies with significant
hyperbilirubinaemia in the first 28 days of life. Interventions: LED phototherapy compared
with fiberoptic phototherapy or conventional phototherapy. Outcome: Effectiveness in terms
of the mean decrease in bilirubin levels and the mean duration of phototherapy. Extra
outcomes should include adverse effects, parental bonding and parental anxiety, staff and
parental satisfaction with treatment and cost effectiveness. Time stamp: Sept 2009
● fibreoptic phototherapy using large pads compared to conventional phototherapy in
term babies with significant hyperbilirubinaemia?
Why this is important
Existing research has demonstrated the effectiveness of fiberoptic phototherapy in preterm
babies but not in term babies. This is due to that fact that existing fiberoptic pads are small and
cannot ensure adequate skin coverage in larger babies. New devices using larger pads may be
effective in term babies. New randomised controlled trials are needed to examine fiberoptic
phototherapy which uses larger pads. Population: Term babies with significant
hyperbilirubinaemia in the first 28 days of life. Interventions: Fiberoptic phototherapy with
larger pads compared with conventional phototherapy. Outcome: Effectiveness in terms of
mean decrease in bilirubin levels and mean duration of phototherapy. Extra outcomes should
include adverse effects, family adjustment, breastfeeding effects, parental bonding and anxiety,
staff and parental satisfaction with treatment and cost effectiveness. Time stamp: Sept 2009

7.2.2 General care of the baby during phototherapy

Fixed position versus changing positions

Description of included studies
Three studies 166-168 with 133 participants were included in this comparison but not all studies
contributed data to each analysis. One study apiece was from Iran, 168 [EL 1−] Israel 166 [EL 1+]
and Taiwan. 167 [EL 1+] No study reported the method of randomisation although two
studies 166;167 used sealed envelopes for allocation concealment.
All three studies included only term babies. Where reported, the mean gestational age ranged
from 38.1 ± 1.0 weeks to 38.2 ± 1.14 weeks, the mean age at study entry ranged from
104.2 ± 48.5 hours to 143.4 ± 48.5 hours, the mean birthweight ranged from 3137 ± 384 g to
3500 ± 478 g, and the mean baseline serum bilirubin levels ranged from
320 ± 17 micromol/litre to 321 ± 39 micromol/litre. For the two studies 166;167 that reported
gender, 27 of 81 participants (33.3%) were male.
Review findings

There was a trend (not statistically significant) in favour of a fixed supine position as regards the
mean duration of treatment (MD = −6.67 hours, 95% CI −13.50 to 0.15 hours) (Figure 7.13).

A similar trend was also reported for mean change in serum bilirubin
(MD = −5.98 micromol/litre, 95% CI −14.79 to 2.82 micromol/litre) (Figure 7.14).

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