Page 20 - 16Neonatal Jaundice_compressed

Neonatal jaundice

levels assessed using serum (blood) tests. Outcome: Diagnostic accuracy (sensitivity, specificity,
positive predictive value, negative predictive value), parental anxiety, staff and parental
satisfaction with test and cost effectiveness. Time stamp: Sept 2009

How frequently and for how long can conventional phototherapy be interrupted without
adversely effecting clinical outcomes?
Why this is important
Evidence: The effectiveness and tolerability of intermittent phototherapy has been adequately
demonstrated in term babies at low treatment levels (bilirubin < 250 micromol/litre). New
research is needed to evaluate the effectiveness and tolerability of different frequencies of
interruptions of different durations. Population: Babies in the first 28 days of life in conventional
phototherapy. Exposure: Interruptions of 45 or 60 minutes either on demand, every hour or
every 2 hours. Comparison: Interruptions of up to 30 minutes every 3 hours. Outcome:
Effectiveness in terms of the mean decrease in bilirubin levels and the mean duration of
phototherapy. Extra outcomes should include adverse effects, parental bonding and parental
anxiety, staff and parental satisfaction with treatment and cost effectiveness. Time stamp: Sept
2009

National registries are needed of cases of significant hyperbilirubinaemia, kernicterus and
exchange transfusions.
Why this is important
Evidence: There is good evidence that prospective surveys in the UK and from a national
Kernicterus Register in the US can help is identify root-causes of kernicterus and acute bilirubin
encephalopathy. Population: All children with a peak bilirubin level greater than
450 micromol/litre which is the threshold for an exchange transfusion recommended by NICE.
Exposure: All maternal, prenatal, peri-natal and neonatal factors. Comparison: Not applicable.
Outcome: Shortcomings in clinical and service provision to prevent recurring themes in
kernicterus cases. Time stamp: Sept 2009
1.5.2 Other research recommendations

What is the clinical and cost-effectiveness of:
● LED phototherapy compared to conventional phototherapy in term and preterm babies
with significant hyperbilirubinaemia?
Why this is important
Existing research has shown that while there is no difference between LED phototherapy and
conventional phototherapy, LED phototherapy may be easier to use in clinical setting by
reducing the need for additional fluids. New randomised controlled trials are needed to
examine LED phototherapy. Population: Term and preterm babies with significant
hyperbilirubinaemia in the first 28 days of life. Interventions: LED phototherapy compared with
fiberoptic phototherapy or conventional phototherapy. Outcome: Effectiveness in terms of the
mean decrease in bilirubin levels and the mean duration of phototherapy. Extra outcomes
should include adverse effects, parental bonding and parental anxiety, staff and parental
satisfaction with treatment and cost effectiveness. Time stamp: Sept 2009

● fibreoptic phototherapy using large pads compared to conventional phototherapy in term
babies with significant hyperbilirubinaemia?
Why this is important
Existing research has demonstrated the effectiveness of fiberoptic phototherapy in preterm
babies but not in term babies. This is due to that fact that existing fiberoptic pads are small and
cannot ensure adequate skin coverage in larger babies. New devices using larger pads may be
effective in term babies. New randomised controlled trials are needed to examine fiberoptic
phototherapy which uses larger pads. Population: Term babies with significant
hyperbilirubinaemia in the first 28 days of life. Interventions: Fiberoptic phototherapy with
larger pads compared with conventional phototherapy. Outcome: Effectiveness in terms of
mean decrease in bilirubin levels and mean duration of phototherapy. Extra outcomes should

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