Page 168 - 16Neonatal Jaundice_compressed

Treatment

Description of included studies
Babies in both studies were allocated to treatment according to their hospital numbers, and thus
allocation concealment was not possible.

Agar was given in 250 mg oral doses either every 8 hours during phototherapy or at each 3-
hourly feed. The samples in both studies were comparable, with mean birthweight of
2767 ± 69 g and 2729 ± 538 g, mean age at entry to study of 80.6 ± 28.7 hours and
87 ± 26 hours, and mean serum bilirubin of 234 ± 46.8 micromol/litre and
274 ± 51 micromol/litre. One study 223 reported the mean gestational age of 36.8 ± 2.5 weeks.
Of the combined sample, 57 participants (56.4%) were male.

Review findings
When both studies were pooled in a meta-analysis, there was no statistically significant
difference between treatment and control groups in mean reduction in serum bilirubin
(MD = −2.00 micromol/litre, 95% CI −24.13 to 20.13 micromol/litre). Also there there was no
statistically significant difference in the mean duration of phototherapy (MD = −6.57 hours,
95% CI −16.06 to 2.92 hours). Heterogeneity was low at I² = 21%.

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

Barbiturates
Eighteen articles were obtained, including one controlled clinical trial from New Zealand 224
concerning phenobarbitone treatment of hyperbilirubinaemia. Seventeen papers were excluded
for the following reasons: phototherapy not evaluated concurrently (two studies),
phenobarbitone evaluated for prophylaxis, not treatment, of jaundice (12), maternal treatment
with phenobarbitone evaluated (two) and no jaundice-related outcomes included (one).

Description of included studies
In one controlled clinical trial [EL 2−] the mean gestational age of the sample was
34.8 ± 2.7 weeks, the mean birthweight was 2155 ± 632 g, the mean age at entry to study was
48.1 ± 14.7 hours, and the mean serum bilirubin was 174 ± 40 micromol/litre. Forty-nine (49%)
of the sample were male. Babies who met the criteria for phototherapy were allocated to routine
care, routine care and phototherapy, or routine care, phototherapy and phenobarbitone.
Allocation to treatment was on a rotational basis and allocation concealment was not reported.
Babies with birthweight > 3000 g received 8 mg of phenobarbitone three times daily while
those babies with birthweight < 3000 g received 2 mg/kg of phenobarbitone three time daily.
Review findings
No baby who received phototherapy alone required an exchange transfusion but one who
received phenobarbitone combined with phototherapy had an exchange transfusion. This was
attributed to extensive bruising aggravating hyperbilirubinaemia. Babies who received
phenobarbitone received phototherapy for longer than control babies (72 ± 31 hours versus
67 ± 33 hours).

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

D-penicillamine
Three articles were obtained and all were excluded. Two were historical control studies and one
was a controlled clinical trial examining D-penicillamine as prophylaxis for hyperbilirubinaemia
in preterm babies.
See the end of Section 7.4 for the overall Evidence summary and GDG translation from
evidence.

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