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Meta-Analysis
. 2012 Jan 18;1(1):CD007966.
doi: 10.1002/14651858.CD007966.pub2.

Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants

Charles I Okwundu  1 , Christy A N Okoromah, Prakeshkumar S Shah
Affiliations
Meta-Analysis

Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants

Charles I Okwundu et al. Cochrane Database Syst Rev. .

Abstract

Background: Low birth weight and premature infants are at major risk for exaggerated hyperbilirubinaemia and jaundice that can lead to bilirubin encephalopathy. Phototherapy is the most common treatment for neonatal hyperbilirubinaemia and could be most effective in preventing the sequelae of hyperbilirubinaemia if initiated prophylactically.

Objectives: To evaluate the efficacy and safety of prophylactic phototherapy for preterm (< 37 weeks gestational age) or low birth weight infants (birth weight < 2500 g).

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3) on 31 March 2011, MEDLINE (1950 to 31 March 2011), EMBASE (1980 to 31 March 2011) and CINAHL (1982 to 31 March 2011).

Selection criteria: Randomised controlled trials or quasi-randomised controlled studies evaluating the effects of prophylactic phototherapy for preterm or low birth weight infants.

Data collection and analysis: Two authors independently obtained data from published articles. We performed fixed-effect meta-analysis for the outcomes: rate of exchange transfusion, cerebral palsy or other neurodevelopmental impairment, peak serum bilirubin level and all-cause mortality.

Main results: Nine studies of 3449 participants were included. The rate of exchange transfusion was reduced in one study with liberal transfusion criteria (risk ratio (RR) 0.20; 95% confidence interval (CI) 0.13 to 0.31) but not in the other two more recent studies with stringent criteria (typical RR 0.66; 95% CI 0.19 to 2.28). There was no statistically significant difference in the rate of cerebral palsy (typical RR 0.96; 95% CI 0.50 to 1.85; two studies, 756 participants). However, one large study that reported on neurodevelopmental impairment (a composite outcome including cerebral palsy) found a slightly lower rate of neurodevelopmental impairment with prophylactic phototherapy (RR 0.85; 95% CI 0.74 to 0.99; 1804 participants). The prophylactic phototherapy group had lower peak bilirubin levels (mean difference (MD) -2.73; 95% CI -2.89 to -2.57; six studies, 2319 participants) and had fewer neonates with peak unconjugated serum bilirubin levels > 10 mg/dl (typical RR 0.27; 95% CI 0.22 to 0.33; three studies, 1090 participants) or peak unconjugated serum bilirubin levels > 15 mg/dl (typical RR 0.13; 95% CI 0.07 to 0.23; four studies, 1116 participants). There was no statistically significant difference in the rate of all-cause mortality between the two groups (typical RR 1.08; 95% CI 0.93 to 1.26; four studies, 3044 participants).

Authors' conclusions: Prophylactic phototherapy helps to maintain a lower serum bilirubin concentration and may have an effect on the rate of exchange transfusion and the risk of neurodevelopmental impairment. However, further well-designed studies are needed to determine the efficacy and safety of prophylactic phototherapy on long-term outcomes including neurodevelopmental outcomes.

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Conflict of interest statement

The review authors: Charles Okwundu, Christy A. Okoromah and Prakesh Shah have no financial, personal or academic affiliations which may be construed as a conflict of interest.

Figures

1
1
Study flow diagram.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
4
4
Forest plot of comparison: 1 Prophylactic phototherapy versus control, outcome: 1.1 Exchange transfusion.
5
5
Forest plot of comparison: 1 Prophylactic phototherapy versus control, outcome: 1.3 Cerebral palsy.
6
6
Forest plot of comparison: 1 Prophylactic phototherapy versus control, outcome: 1.4 Peak serum bilirubin.
7
7
Forest plot of comparison: 1 Prophylactic phototherapy versus control, outcome: 1.7 Serum bilirubin > 10 mg/dl.
8
8
Forest plot of comparison: 1 Prophylactic phototherapy versus control, outcome: 1.14 All‐cause mortality.
1.1
1.1. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 1 Exchange transfusion.
1.2
1.2. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 2 Neurodevelopmental impairment.
1.3
1.3. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 3 Cerebral palsy.
1.4
1.4. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 4 Peak serum bilirubin.
1.5
1.5. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 5 Sensorineural hearing loss.
1.6
1.6. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 6 Peak serum bilirubin (by time of intervention).
1.7
1.7. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 7 Serum bilirubin greater than 10 mg/dl.
1.8
1.8. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 8 Serum bilirubin greater than 15 mg/dl.
1.9
1.9. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 9 Duration of phototherapy (hours).
1.10
1.10. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 10 Patent ductus arteriosus.
1.11
1.11. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 11 Retinopathy of prematurity.
1.12
1.12. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 12 Intraventricular haemorrhage.
1.13
1.13. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 13 Duration of hospital stay (days).
1.14
1.14. Analysis
Comparison 1 Prophylactic phototherapy versus control, Outcome 14 All‐cause mortality.
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References

References to studies included in this review

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