Page 149 - 16Neonatal Jaundice_compressed

Neonatal jaundice

Fixed supine Changing position Mean Difference Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI
3.2.1 Supine versus changing position
F - Chen 2002 53.3 17.9 24 52.8 20.2 27 42.6% 0.50 [-9.96, 10.96]
F - Shinwell 2002 28 9 16 40 15 14 57.4% -12.00 [-21.01, -2.99]
Subtotal (95% CI) 40 41 100.0% -6.67 [-13.50, 0.15]
Heterogeneity: Chi² = 3.15, df = 1 (P = 0.08); I² = 68%
Test for overall effect: Z = 1.92 (P = 0.06)
-50 -25 0 25 50
Favours Fixed supine Favours Changing position
Test for subgroup differences: Not applicable
Figure 7.13 Mean duration of treatment when fixed supine position is compared with changing the
baby’s position

Conventional Comparison Mean Difference Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI
3.1.1 Supine versus changing positions
F - Chen 2002 -128 55 24 -127 45 27 10.0% -1.00 [-28.79, 26.79]
F - Mohammadzadeh 2004 -68 27 25 -62 22 25 41.6% -6.00 [-19.65, 7.65]
F - Shinwell 2002 -115 23 16 -108 11 14 48.4% -7.00 [-19.66, 5.66]
Subtotal (95% CI) 65 66 100.0% -5.98 [-14.79, 2.82]
Heterogeneity: Chi² = 0.15, df = 2 (P = 0.93); I² = 0%
Test for overall effect: Z = 1.33 (P = 0.18)
-100 -50 0 50 100
Favours Conventional Favours Comparison
Test for subgroup differences: Not applicable
Figure 7.14 Mean change in serum bilirubin when fixed supine position is compared with
changing the baby’s position

Evidence summary
There was a trend (not statistically significant) in favour of a fixed supine position for mean
duration of treatment and mean decrease in serum bilirubin in reviewed studies.
GDG translation from evidence

The GDG accepts that, in term babies, the position of the baby during phototherapy has no
significant influence on duration of phototherapy or mean change in serum bilirubin. No studies
in preterm babies were identified. To ensure consistent advice regarding the risk of sudden
infant death syndrome, babies should be placed in a supine position.

Recommendations
See the end of Section 7.2.2.

Eye coverings
Description of included studies

Two studies, reported in three publications, 169-171 with 241 participants were eligible for this
comparison but only one 170 (comparing eye patches with a tinted headbox) contributed
outcome data. One study 169;170 was from Hong Kong and the other was from Italy. 171 The
evidence level of one study 169;170 was EL 1+ as a computer-generated sequence was used to
allocate babies into the two groups. The second study 171 was rated EL 1− as neither the method
of randomisation or allocation concealment was reported.
The mean gestational age from this study 169;170 was 38.6 ± 2.6 weeks, the mean age at entry to study
was 89.5 ± 27.6 hours, the mean birthweight was 3087 ± 611 g, and the mean baseline serum
bilirubin level was 258 ± 27 micromol/litre. In this study, 106 participants (52.2%) were male.

Review findings
There were statistically significantly more cases of purulent eye discharge among the eye
patches group compared with the headbox group (RR 2.53, 95% CI 1.23 to 5.20) (Figure 7.15).
Similarly, there were more features of conjunctivitis among the eyepatch group (RR 6.44,
95% CI 1.49 to 27.80). (Figure 7.16)

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