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Treatment







                                      Eye patches  Headbox    Risk Ratio              Risk Ratio
                          Study or Subgroup  Events  Total Events Total Weight  M-H, Fixed, 95% CI  M-H, Fixed, 95% CI
                          4.3.1 Eye patches versus headbox
                          F - Fok 1995  23  102   9  101 100.0%  2.53 [1.23, 5.20]
                          Subtotal (95% CI)  102    101 100.0%  2.53 [1.23, 5.20]
                          Total events  23        9
                          Heterogeneity: Not applicable
                          Test for overall effect: Z = 2.53 (P = 0.01)
                                                                       0.02  0.1        1         10     50
                                                                             Favours Eye patches Favours Headbox
                         Figure 7.15   Purulent eye discharge when the use of eye patches is compared with headboxes



                                      Eye patches  Headbox    Risk Ratio              Risk Ratio
                          Study or Subgroup  Events  Total Events Total Weight  M-H, Fixed, 95% CI  M-H, Fixed, 95% CI
                          4.2.1 Eye patches versus Headbox
                          F - Fok 1995  13  102   2  101 100.0%  6.44 [1.49, 27.80]
                          Subtotal (95% CI)  102    101 100.0%  6.44 [1.49, 27.80]
                          Total events  13        2
                          Heterogeneity: Not applicable
                          Test for overall effect: Z = 2.49 (P = 0.01)
                                                                       0.02  0.1        1         10     50
                                                                             Favours Eye patches Favours Headbox
                         Figure 7.16   Features of conjunctivitis when the use of eye patches is compared with headboxes



                         Evidence summary
                         One  RCT reported fewer cases  of purulent eye discharge and conjunctivitis among babies
                         nursed in a headbox while receiving phototherapy compared with those using eye patches.
                         GDG translation from evidence

                         While headboxes led to fewer eye problems in one study, the GDG feels that, if appropriate eye
                         protection and care are given, either eye patches or headboxes can be used when conventional
                         phototherapy is being used with term babies. During multiple phototherapy, tinted headboxes
                         are not recommended because the head constitutes a significant proportion of the baby’s skin
                         surface, which needs to be exposed to phototherapy for it to be effective.
                         There were no studies of headboxes in preterm babies and the GDG concluded that, unless the
                         preterm baby is being treated with fibreoptic phototherapy, appropriate eye protection and eye
                         care should be given, and tinted headboxes should not be used.

                          Recommendations – 7.2.2 General care of the baby during phototherapy
                          During phototherapy:
                          •   place the baby in a supine position unless other clinical conditions prevent this
                          •   ensure treatment is applied to the maximum area of skin
                          •   monitor the baby’s temperature and ensure the baby is kept in an environment that will
                             minimise energy expenditure (thermoneutral environment)
                          •   monitor hydration by daily weighing of the baby and assessing wet nappies
                          •   support parents and carers and encourage them to interact with the baby

                          Give the baby eye protection and routine eye care during phototherapy.
                          Use tinted headboxes as an alternative to eye protection in babies with a gestational age of
                          37 weeks or more undergoing conventional ‘blue light’ phototherapy.










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