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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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