Neonatal jaundice: phototherapy

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Neonatal jaundice is a common condition in newborn babies, affecting about 50% of term and 80% of preterm babies. Phototherapy is often used to reduce levels of unconjugated bilirubin that may result in acute or chronic encephalopathy. However, exchange transfusion is still the gold standard of treatment for severe hyperbilirubinaemia.

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Focus of the review

The efficacy of phototherapy in the treatment of unconjugated hyperbilirubinaemia may be influenced by the wavelength of the light used, the intensity of the light source, the total dose of light received (time under phototherapy and amount of skin exposed), and/or the threshold at which phototherapy is commenced. In this review we try to determine the most safe and effective method for the delivery of phototherapy to decrease unconjugated bilirubin levels in the neonate.

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Comments on evidence

Due to a large range of treatment options, the evidence is difficult to interpret. However, it is generally accepted that intensive phototherapy applied to infants with already high serum bilirubin levels or rapidly rising serum bilirubin levels has greatly reduced the need for exchange transfusions in infants with or without haemolysis. If there is a choice of blue-green or blue wavelengths, blue-green appears to be slightly more effective than blue. Using a lower threshold for the commencement of phototherapy in extremely low birth weight (ELBW) infants may improve neurodevelopmental outcome. Overall, there is a lack of RCT evidence on effectiveness of low versus high threshold for the commencement of phototherapy in babies other than those who are ELBW infants.

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Search and appraisal summary

The update literature search for this review was carried out from the date of the last search, February 2010, to January 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the review, please see the Methods section. After deduplication and removal of conference abstracts, 75 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 56 studies and the further review of 19 full publications. Of the 19 full articles evaluated, one systematic review and three RCTs were added at this update. One RCT was added to the Comment section.

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Additional information

If treatment is required for neonatal jaundice, phototherapy is generally accepted as first-line clinical management. Exchange transfusion should be reserved for those infants with very high serum bilirubin levels or rapidly rising serum bilirubin levels that are not responding to phototherapy.

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Substantive changes at this update

(Daylight) fluorescent versus blue fluorescent lamps Condition restructured. No new evidence. Categorised as 'unknown effectiveness'.

Blue fluorescent versus green fluorescent lamps Condition restructured. No new evidence. Categorised as 'unknown effectiveness'.

Blue-green fluorescent versus blue fluorescent lamps Condition restructured. No new evidence. Categorised as 'likely to be beneficial'.

Blue LED versus conventional quartz-halogen Condition restructured. One systematic review[13] and two RCTs[14][15] added. Categorised as 'likely to be beneficial'.

Blue-green LED versus conventional quartz-halogen Condition restructured. One systematic review added.[13] Categorised as 'unknown effectiveness'.

Close phototherapy versus distant light-source phototherapy Condition restructured. One RCT added.[20] Categorised as 'likely to be beneficial'.

Double phototherapy versus single phototherapy Condition restructured. One RCT added to the Comment section.[25] Categorised as 'likely to be beneficial'.

Triple phototherapy versus double phototherapy Condition restructured. No new evidence. Categorised as 'unknown effectiveness'.

Intermittent phototherapy versus continuous phototherapy Condition restructured. No new evidence. Categorised as 'unknown effectiveness'.

Increased skin exposure versus standard skin exposure phototherapy Condition restructured. No new evidence. Categorised as 'unknown effectiveness'.

Prophylactic phototherapy versus threshold phototherapy Condition restructured. No new evidence. Categorised as 'unknown effectiveness'.

Low threshold versus high threshold phototherapy Condition restructured. One subsequent report of a previously included RCT added.[34] Categorised as 'likely to be beneficial'.

Abstract

INTRODUCTION: About 50% of term and 80% of preterm babies develop jaundice, which usually appears 2 to 4 days after birth, and resolves spontaneously after 1 to 2 weeks. Jaundice is caused by bilirubin deposition in the skin. Most jaundice in newborn infants is a result of increased red cell breakdown and decreased bilirubin excretion. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of different wavelengths of light in hospital phototherapy as treatment for unconjugated hyperbilirubinaemia in term and preterm infants? What are the effects of different intensities of light in hospital phototherapy as treatment for unconjugated hyperbilirubinaemia in term and preterm infants? What are the effects of different total doses of light in hospital phototherapy as treatment for unconjugated hyperbilirubinaemia in term and preterm infants? What are the effects of starting hospital phototherapy at different thresholds in term and preterm infants? We searched Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: Fourteen studies were included. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of different wavelengths, intensities, total doses, and threshold for commencement of the following intervention: hospital phototherapy.

Cite as

Woodgate P, Jardine LA. Neonatal jaundice: phototherapy. Systematic review 319. BMJ Clinical Evidence. . 2015 May. Accessed [date].

Latest citations

Oral zinc for the prevention of hyperbilirubinaemia in neonates. ( 02 September 2015 )

Early discharge of infants and risk of readmission for jaundice. ( 25 June 2015 )