Page 157 - 16Neonatal Jaundice_compressed

Neonatal jaundice

7.2.4 Additional equipment

White curtains

Description of included studies
Three RCTs 190-192 (n = 285) were eligible for this comparison. One study apiece was from
Germany, 191 India 192 and Malaysia. 190 One study 190 was rated EL 1+ as block randomisation was
used and investigators were blind to the allocation, the second 192 was rated EL 1+ as sealed
opaque envelopes were used as allocation concealment while the third study 191 did not report
on either the randomisation method or the allocation concealment and so was rated EL 1−. In
one study 190 the four outer walls of the incubator were draped in white cloth while in the
other 191;192 two a white cloth was hung from both sides of the phototherapy unit.
The mean gestational age of study participants was reported in one study as 37.5 ± 1.3 weeks
and in another the median age was 40 weeks. Mean birthweight was reported in one study as
2856 ± 345 g and not reported in the other two studies. The mean age at entry to study was
69 ± 36 hours and 105 ± 35 hours in two studies and was not reported in the third study. The
mean serum bilirubin ranged from 243 ± 28 micromol/litre to 280 ± 39 micromol/litre. In all,
165 participants (58.3%) were male.

Review findings
As different time-points (4 hours and 24 hours) were used to measure the primary outcome of
change in serum bilirubin concentration, it was not appropriate to combine the results.
However, all studies showed a statistically significantly greater decrease in serum bilirubin at
the different time-points for babies in the curtained groups. At 4 hours the mean difference was
−24.00 micromol/litre (95% CI −33.75 to −14.25 micromol/litre) and at 24 hours the mean
difference was −20.36 micromol/litre (95% CI −31.52 to −9.19 micromol/litre) (Figure 7.18).
PT with curtains Pt Mean Difference Mean Difference
Study or Subgroup Mean SD Total Mean SD Total Weight IV, Fixed, 95% CI IV, Fixed, 95% CI
8.1.1 4 hours
F - Djokomuljanto 2006 -28 25 50 -4 24 47 100.0% -24.00 [-33.75, -14.25]
Subtotal (95% CI) 50 47 100.0% -24.00 [-33.75, -14.25]
Heterogeneity: Not applicable
Test for overall effect: Z = 4.82 (P < 0.00001)
8.1.2 24 hours
F - Eggert 1988 -80 27 36 -56 26 34 80.8% -24.00 [-36.42, -11.58]
F - Sivandan 2009 -39 56 42 -34 63 42 19.2% -5.00 [-30.49, 20.49]
Subtotal (95% CI) 78 76 100.0% -20.36 [-31.52, -9.19]
Heterogeneity: Chi² = 1.72, df = 1 (P = 0.19); I² = 42%
Test for overall effect: Z = 3.57 (P = 0.0004)
-100 -50 0 50 100
Favours Pt with curtains Favours Pt
Test for subgroup differences: Chi² = 0.23, df = 1 (P = 0.63), I² = 0%
Figure 7.18 Mean change in serum bilirubin when white curtains are used compared with not
using white curtains

One study reported that white curtains made no statistically significant difference to the mean
duration of phototherapy. 192 Another study, using Cox proportional hazards regression analysis,
reported that the median duration of phototherapy was statistically significantly shorter
(22 hours) in the phototherapy with curtains group compared with the control. 190

Evidence summary
Three studies reported that using white curtains on the side of the incubator or draped from the
overhead unit led to a greater decrease in serum bilirubin levels at both 4 and 24 hours. One
study reported a significant decrease in the duration of phototherapy when white curtain were
used while a second study reported no difference in duration of phototherapy.

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