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Neonatal jaundice

DVET versus no treatment
The first RCT 193 carried out in the USA compared exchange transfusion with no treatment in 100
babies with indirect serum bilirubin > 307.8 micromol/litre. Babies were less than 1 week old.
Demographic details and method of randomisation were not reported although sealed
envelopes were used to conceal allocation to intervention groups. There were three deaths in
each group, none attributable to exchange transfusion. One baby in the control group had
kernicterus confirmed by autopsy. Seven of the exchange transfusion group had an abnormal
neurological examination at 12–24 months compared with six in the control group. [EL 1+]
DVET versus simple transfusion
This RCT 194;195 compared exchange transfusion with simple top-up transfusion in 137 babies
with haemolytic disease of the newborn. All transfusions were carried out within 9 hours of
birth. Sample demographics and method of randomisation were not reported although sealed
envelopes were used to conceal allocation to intervention groups. There were statistically
significantly fewer deaths in the exchange transfusion group (RR 0.26, 95% CI 0.11 to 0.60) and
also statistically significantly fewer cases of kernicterus (RR 0.38, 95% CI 0.17 to 0.87). [EL 1+]
DVET versus single-volume exchange transfusion
This RCT, 196 carried out in Switzerland, compared DVET with single-volume exchange
transfusion (SVET) in the management of ABO haemolytic disease. Twenty babies were
included, of whom 15 (75%) were male. The mean gestational age of the sample was
39.5 ± 1.0 weeks, the mean birthweight was 3305 ± 392 g, the mean age at entry to study was
17.9 ± 6.1 hours, and the mean serum bilirubin was 207 ± 45 micromol/litre. A random
numbers table was used to allocate babies to the groups but allocation concealment was not
reported. Both interventions were initiated according to the modified Polacek curve as
described by Cockington. 200 There was no statistically significant difference between SVET and
DVET in mean reduction of serum bilirubin, mean duration of adjunctive phototherapy and
level of rebound hyperbilirubinaemia. There were no cases of kernicterus or reported adverse
effects in either group. [EL 1−]
Exchange transfusion versus phototherapy
An RCT, 197 carried out in Singapore, compared DVET with phototherapy for the management of
non-haemolytic hyperbilirubinaemia. In all, 52 babies were included, of whom 28 (54%) were
male. The mean gestational age of the sample was 37.0 ± 2.78 weeks, the mean birthweight
was 2501 ± 576 g, the mean age at entry to study was 84 ± 12 hours, and the mean serum
bilirubin was 297 ± 25 micromol/litre. Both interventions were initiated at serum bilirubin
> 256.5 micromol/litre in preterm babies and > 307.8 micromol/litre in term babies. Neither
the method of randomisation nor allocation concealment was reported but there were no
significant differences between the groups on any baseline variable. There was a statistically
significantly greater reduction in mean serum bilirubin 24 hours after initiation of treatment in
the phototherapy group (MD = 51 micromol/litre, 95% CI 39.7 to 62.3 micromol/litre). In the
exchange transfusion group there was an initial fall in serum bilirubin levels at 6 hours but this
was rapidly followed by rebound hyperbilirubinaemia. There were more treatment failures in
the exchange transfusion group, with eight babies requiring repeat exchange transfusion, while
no babies in the phototherapy group required additional treatment. The RR of treatment failure
in the exchange transfusion group was statistically significant, although confidence intervals
were wide, at 17.00 (95% CI 1.03 to 280.07). There were no cases of kernicterus in either
group. [EL 1−]

Alternative methods for DVET
The fifth RCT, 198 carried out in Canada, compared conventional DVET with albumin-enriched
DVET. A total of 42 babies were included, of whom 25 (60%) were male, and 27 (64%) had
Rhesus or ABO incompatibility. The mean gestational age of the sample was 36.0 ± 0.7 weeks,
the mean birthweight was 2455 ± 153 g, and the mean serum bilirubin was
263 ± 82 micromol/litre. Neither the method of randomisation nor allocation concealment was
reported but there were no significant differences between the groups on any baseline variable.
There was no statistically significant difference between DVET and albumin-enriched DVET in
mean reduction of serum bilirubin, mean duration of adjunctive phototherapy and the degree of

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