Page 167 - 16Neonatal Jaundice_compressed

Neonatal jaundice

Metalloporphyrins

Five articles were obtained and all were excluded as they examined metalloporphyrins as
prophylaxis for hyperbilirubinaemia.

See the end of Section 7.4 for the overall Evidence summary and GDG translation from
evidence.

Albumin infusions
Three articles were obtained and two were excluded because one study compared two
preparations of human serum albumin and the other study was a non-randomised controlled
trial. The first study 198 has been included in the section on exchange transfusions. There was no
statistically significant difference between DVET and albumin-enriched DVET in terms of mean
reduction of serum bilirubin, the mean duration of adjunctive phototherapy or the level of
rebound jaundice. There were no cases of kernicterus or reported adverse effects in either
group.
See the end of Section 7.4 for the overall Evidence summary and GDG translation from
evidence.
Cholestyramine

Three articles were obtained but no RCTs were identified and one article was a duplicate
publication.

Description of included studies

Two controlled clinical trials 220;221 [EL 2−], from Greece 220 and Singapore, 221 examining
cholestyramine for the treatment of hyperbilirubinaemia were included. Babies were allocated
to treatment groups on an alternate basis in both studies and neither study reported on
allocation concealment. Babies in both studies received 1.5 g/kg per day of cholestyramine
powder mixed in milk.
In the second study, 220 for the preterm sample (n = 20) the mean gestational age was
33.4 ± 0.3 weeks, the mean birthweight was 2077 ± 88 g, the mean age at entry to study was
76 ± 2.9 hours, and the mean serum bilirubin was 198 ± 5 micromol/litre. Nine participants
(45%) were male. Among the term babies in the two studies, the mean gestational ages were
38.9 ± 0.2 and 39.1 ± 0.3 weeks, the mean birthweights were 3154 ± 139 and 3286 ± 39 g, the
mean ages at entry to study were 84 ± 2.9 and 90 ± 1.5 hours, and the mean serum bilirubin
levels were 298 ± 5 micromol/litre in both studies. Gender was reported in one study 220 and
15 participants (37.5%) were male.

Review findings
In the first study 221 (conducted in babies with non-haemolytic hyperbilirubinaemia), control
babies showed a statistically significantly greater reduction in mean serum bilirubin than those
receiving cholestyramine (MD = 18.00 micromol/litre, 95% CI 8.55 to 27.45 micromol/litre).
In the second study 220 (conducted in babies with both haemolytic and non-haemolytic
jaundice), there was a statistically significant reduction in the duration of phototherapy in babies
treated with cholestyramine. For term babies the MD was −42.00 hours (95% CI −50.98 to
−34.62 hours) and for preterm babies the MD was −26.30 hours (95% CI −33.00 to
−19.60 hours).

See the end of Section 7.4 for the overall Evidence summary and GDG translation from
evidence.

Agar
A total of 11 articles were obtained. Two studies, 222;223 from Denmark 223 and the USA 222 , were
included. These were non-randomised controlled trials [EL 2−] that compared phototherapy
alone with agar combined with phototherapy.

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