Light‐emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates

Praveen Kumar; Deepak Chawla; Ashok Deorari

doi:10.1002/14651858.CD007969.pub2

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Figure 1

Funnel plot of comparison: 1 Phototherapy with LED versus non‐LED light source, outcome: 1.1 Duration of phototherapy.

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Figure 2

Funnel plot of comparison: 1 Phototherapy with LED versus non‐LED light source, outcome: 1.2 Rate of decline of serum total bilirubin.

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Figure 3

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

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Figure 4

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Analysis 1.1

Comparison 1 Phototherapy with LED versus non‐LED light source, Outcome 1 Duration of phototherapy.

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Analysis 1.2

Comparison 1 Phototherapy with LED versus non‐LED light source, Outcome 2 Rate of decline of serum total bilirubin.

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Analysis 1.3

Comparison 1 Phototherapy with LED versus non‐LED light source, Outcome 3 Treatment failure (need of additional phototherapy or exchange transfusion).

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Analysis 1.4

Comparison 1 Phototherapy with LED versus non‐LED light source, Outcome 4 Hypothermia.

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Analysis 1.5

Comparison 1 Phototherapy with LED versus non‐LED light source, Outcome 5 Hyperthermia.

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Analysis 1.6

Comparison 1 Phototherapy with LED versus non‐LED light source, Outcome 6 Skin rash.

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Analysis 2.1

Comparison 2 Phototherapy with LED versus halogen light source, Outcome 1 Duration of phototherapy.

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Analysis 2.2

Comparison 2 Phototherapy with LED versus halogen light source, Outcome 2 Rate of decline of serum total bilirubin.

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Analysis 3.1

Comparison 3 Phototherapy with LED versus compact fluorescent light source, Outcome 1 Duration of phototherapy.

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Analysis 3.2

Comparison 3 Phototherapy with LED versus compact fluorescent light source, Outcome 2 Rate of decline of serum total bilirubin.

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Analysis 4.1

Comparison 4 Phototherapy with LED versus non‐LED light source and irradiance matched, Outcome 1 Duration of phototherapy.

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Analysis 4.2

Comparison 4 Phototherapy with LED versus non‐LED light source and irradiance matched, Outcome 2 Rate of decline of serum total bilirubin.

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Analysis 5.1

Comparison 5 Phototherapy with LED versus non‐LED light source and distance matched, Outcome 1 Duration of phototherapy.

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Analysis 5.2

Comparison 5 Phototherapy with LED versus non‐LED light source and distance matched, Outcome 2 Rate of decline of serum total bilirubin.

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Analysis 6.1

Comparison 6 Phototherapy with LED versus non‐LED light source in term neonates, Outcome 1 Duration of phototherapy.

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Analysis 6.2

Comparison 6 Phototherapy with LED versus non‐LED light source in term neonates, Outcome 2 Rate of decline of serum bilirubin.

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Analysis 7.1

Comparison 7 Phototherapy with LED versus non‐LED light source in preterm neonates, Outcome 1 Duration of phototherapy.

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Analysis 7.2

Comparison 7 Phototherapy with LED versus non‐LED light source in preterm neonates, Outcome 2 Rate of decline of serum bilirubin.

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Summary of findings for the main comparison. Phototherapy with LED versus non‐LED light source for unconjugated hyperbilirubinaemia in neonates

Phototherapy with LED versus non‐LED light source for unconjugated hyperbilirubinaemia in neonates
Patient or population: neonates with unconjugated hyperbilirubinaemia Settings: Intervention: Phototherapy with LED versus non‐LED light source
Outcomes	Illustrative comparative risks (95% CI)		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Control	Phototherapy with LED versus non‐LED light source
Duration of phototherapy hours		The mean duration of phototherapy in the intervention group was 0.43 hours lower (1.91 hours lower to 1.05 hours higher)	Mean Difference (IV, Fixed, 95% CI [Hours]): ‐0.43 [‐1.91 to 1.05]	630 (6 studies)	⊕⊕⊕⊕ high
Rate of decline of serum total bilirubin mg/dL/hour		The mean Rate of decline of serum total bilirubin in the intervention group was 0.01 mg/dL/hour higher (0.02 mg/dL/hour lower to 0.04 mg/dL/hour higher)	Mean Difference (IV, Fixed, 95% CI [mg/dL/hour]): 0.01 [‐0.02 to 0.04]	511 (4 studies)	⊕⊕⊕⊕ high
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

Summary of findings for the main comparison. Phototherapy with LED versus non‐LED light source for unconjugated hyperbilirubinaemia in neonates

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Comparison 1. Phototherapy with LED versus non‐LED light source

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of phototherapy Show forest plot	6	630	Mean Difference (IV, Fixed, 95% CI)	‐0.43 [‐1.91, 1.05]

1.1 LED versus halogen light source	4	292	Mean Difference (IV, Fixed, 95% CI)	‐5.00 [‐9.03, ‐0.98]
1.2 LED versus compact fluorescent light source	2	338	Mean Difference (IV, Fixed, 95% CI)	0.29 [‐1.31, 1.88]
2 Rate of decline of serum total bilirubin Show forest plot	4	511	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.02, 0.04]

2.1 LED versus halogen light source	2	173	Mean Difference (IV, Fixed, 95% CI)	0.02 [‐0.03, 0.07]
2.2 LED versus compact fluorescent light source	2	338	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.03, 0.04]
3 Treatment failure (need of additional phototherapy or exchange transfusion) Show forest plot	2	360	Risk Ratio (M‐H, Fixed, 95% CI)	1.83 [0.47, 7.17]

4 Hypothermia Show forest plot	2	360	Risk Ratio (M‐H, Fixed, 95% CI)	6.41 [0.33, 122.97]

5 Hyperthermia Show forest plot	2	360	Risk Ratio (M‐H, Fixed, 95% CI)	0.61 [0.18, 2.11]

6 Skin rash Show forest plot	2	360	Risk Ratio (M‐H, Fixed, 95% CI)	1.83 [0.17, 19.96]

Comparison 1. Phototherapy with LED versus non‐LED light source

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Comparison 2. Phototherapy with LED versus halogen light source

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of phototherapy Show forest plot	4	292	Mean Difference (IV, Fixed, 95% CI)	‐5.00 [‐9.03, ‐0.98]

2 Rate of decline of serum total bilirubin Show forest plot	2	173	Mean Difference (IV, Fixed, 95% CI)	0.02 [‐0.03, 0.07]

Comparison 2. Phototherapy with LED versus halogen light source

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Comparison 3. Phototherapy with LED versus compact fluorescent light source

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of phototherapy Show forest plot	2	338	Mean Difference (IV, Fixed, 95% CI)	0.29 [‐1.31, 1.88]

2 Rate of decline of serum total bilirubin Show forest plot	2	338	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.03, 0.04]

Comparison 3. Phototherapy with LED versus compact fluorescent light source

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Comparison 4. Phototherapy with LED versus non‐LED light source and irradiance matched

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of phototherapy Show forest plot	4	327	Mean Difference (IV, Fixed, 95% CI)	0.43 [‐1.28, 2.14]

2 Rate of decline of serum total bilirubin Show forest plot	3	239	Mean Difference (IV, Fixed, 95% CI)	0.03 [‐0.02, 0.07]

Comparison 4. Phototherapy with LED versus non‐LED light source and irradiance matched

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Comparison 5. Phototherapy with LED versus non‐LED light source and distance matched

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of phototherapy Show forest plot	2	303	Mean Difference (IV, Fixed, 95% CI)	‐2.99 [‐5.95, ‐0.03]

2 Rate of decline of serum total bilirubin Show forest plot	1	272	Mean Difference (IV, Fixed, 95% CI)	0.0 [‐0.03, 0.03]

Comparison 5. Phototherapy with LED versus non‐LED light source and distance matched

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Comparison 6. Phototherapy with LED versus non‐LED light source in term neonates

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of phototherapy Show forest plot	3	382	Mean Difference (IV, Fixed, 95% CI)	‐1.72 [‐4.89, 1.44]

2 Rate of decline of serum bilirubin Show forest plot	3	382	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.02, 0.04]

Comparison 6. Phototherapy with LED versus non‐LED light source in term neonates

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Comparison 7. Phototherapy with LED versus non‐LED light source in preterm neonates

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Duration of phototherapy Show forest plot	3	182	Mean Difference (IV, Fixed, 95% CI)	‐7.22 [‐11.69, ‐2.76]

2 Rate of decline of serum bilirubin Show forest plot	1	61	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.05, 0.07]

Comparison 7. Phototherapy with LED versus non‐LED light source in preterm neonates

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