Page 151 - 16Neonatal Jaundice_compressed

Neonatal jaundice

7.2.3 Feeding and hydration during phototherapy

Interupting phototherapy for feeding – intermittent versus continuous phototherapy

Description of included studies
Two studies 172;173 (n = 110) contributed to this analysis, each comparing continuous
phototherapy with various intermittent regimens. One study 172 was from Hong Kong and one 173
from the USA. The evidence level of both studies was EL 1−. Neither study reported the
method of randomisation or allocation concealment.
Data from the various intermittent regimens were combined. Respectively the mean gestational
ages were 34.7 ± 2.0 weeks 173 and 39.9 ± 1.5 weeks, 172 the mean age at entry to study was
56.8 ± 10.8 hours in one study 173 and not reported in the second, the mean birthweight was
1836 ± 299 g 173 and 3229 ± 394 g, 172 and the mean baseline serum bilirubin levels were
150 ± 19 micromol/litre 173 and 198 ± 25 micromol/litre. 172 Gender was not reported. One study
each dealt with term 172 and preterm 173 babies.
Review findings

There was a difference (not statistically significant) between the two groups in favour of
continuous phototherapy (MD = −6.97 hours, 95% CI −26.31 to 12.38 hours) (Figure 7.17).

Continuous Intermittent Mean Difference Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI
2.1.1 Continuous versus Intermittent
F - Lau 1984 89.9 54.2 13 94.3 48.8 21 28.7% -4.40 [-40.51, 31.71]
P - Vogl 1978 64 50 26 72 45 50 71.3% -8.00 [-30.91, 14.91]
Subtotal (95% CI) 39 71 100.0% -6.97 [-26.31, 12.38]
Heterogeneity: Chi² = 0.03, df = 1 (P = 0.87); I² = 0%
Test for overall effect: Z = 0.71 (P = 0.48)

-20 -10 0 10 20
Favours Continuous Favours Intermittent
Test for subgroup differences: Not applicable
Figure 7.17 Mean duration of treatment when continuous phototherapy is compared with
intermittent phototherapy

Evidence summary

Two RCTs, one in term babies and one in preterm babies, examined continuous phototherapy
versus intermittent phototherapy, with phototherapy being initiated at low serum bilirubin
levels. No statistically significant difference was found for any of the reported outcomes. No
studies have examined intermittent phototherapy at moderate or high levels of serum bilirubin
so we were unable to examine any evidence on the effectiveness of intermittent phototherapy at
moderate or high serum bilirubin levels.

GDG translation from evidence
The GDG notes that there was no difference between continuous and intermittent phototherapy
on either the duration of phototherapy or the mean change in serum bilirubin when initiated at
low serum bilirubin levels.

Interrupting phototherapy at low bilirubin levels does not hinder the baby’s treatment. The
GDG supports brief interruptions of phototherapy treatment to facilitate breastfeeding and
cuddles. These interruptions can be used by healthcare professionals to support parents and
carers and encourage them to interact with the baby. This may help to reduce the anxiety and
stress for both parents and babies caused by phototherapy.
The GDG notes that there is no evidence to support the safe use of intermittent phototherapy at
moderate or high levels of serum bilirubin.

The GDG concluded that multiple phototherapy should be continuous and that other types of
phototherapy can be interrupted (see also Sections 7.1.1 and 7.1.2.)

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