Fototerapia intermitente versus fototerapia continua para la ictericia neonatal
Información
- DOI:
- https://doi.org/10.1002/14651858.CD008168.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 02 marzo 2023see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Neonatología
- Copyright:
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- Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
ABO, KGS and FW contributed to the protocol (Onyango 2009).
SB and TS co‐ordinated the review.
SBG, LL and TS assessed studies for eligibility, performed critical appraisal of eligible studies and data extraction.
SBG, LL, SB, KGS and TS formed a consensus on the conclusions.
SBG and TS wrote the review with input from LL, SB and KGS.
MF wrote search strategies, reported on the results of the search and prepared the PRISMA diagram.
Guarantor for the review: TS
Sources of support
Internal sources
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Nil, Australia
Self‐funded
External sources
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Vermont Oxford Network, USA
Cochrane Neonatal Reviews are produced with support from Vermont Oxford Network, a worldwide collaboration of health professionals dedicated to providing evidence‐based care of the highest quality for newborn infants and their families.
Declarations of interest
SBG was involved in one of the RCTs included for final analysis (Gottimukkala 2021). It was a self‐funded RCT. The study was conducted in the Departments of Neonatology & Allied Health Sciences, Chettinad Hospital & Research Institute, Chennai, India. SBG did not make study eligibility decisions about, extract data from, carry out the risk of bias assessments for, or perform GRADE assessments for this study. This study was assessed by TS and independently cross‐checked by LL. SBG was not involved in determining the overall study inclusion criteria.
LL has no interest to declare.
SB has no interest to declare.
KSG is a Senior editor of Cochrane Neonatal. He was not involved in the editorial process for this review.
MF is Managing Editor and Information Specialist with the Cochrane Neonatal Group; she was not involved in the acceptance of this review.
TS has no interest to declare.
Acknowledgements
We gratefully acknowledge the work of Awuonda B. Onyango (ABO) and Fred Ware (FW) who authored the protocol (Onyango 2009).
We would like to thank Cochrane Neonatal: Pua (Makalapua) Motu'apuaka, Colleen Ovelman, Jane Cracknell, and Michelle Fiander, Managing Editors; and Roger Soll,and Bill McGuire, Co‐ordinating Editors, who provided editorial and administrative support.
We thank Michelle Fiander, Information Specialist, for writing and running search strategies and writing search methods.
We thank Anne Lethaby for copy editing.
We would also like to acknowledge our peer reviewers: Dr Anu Thukral, Associate Professor, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India; and Sivam Thanigainathan, Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, India.
As a Cochrane Neonatal Associate Editor, Bill McGuire has peer reviewed and offered feedback for this review.
The methods section of the review is based on a standard template used by Cochrane Neonatal.
Version history
| Published | Title | Stage | Authors | Version |
| 2023 Mar 02 | Intermittent phototherapy versus continuous phototherapy for neonatal jaundice | Review | Sasi Bhushan Gottimukkala, Lisha Lobo, Kanekal S Gautham, Srinivas Bolisetty, Michelle Fiander, Tim Schindler | |
| 2009 Oct 07 | Intermittent phototherapy versus continuous phototherapy for neonatal jaundice | Protocol | Awuonda B Onyango, Gautham Suresh, Fred Were | |
Differences between protocol and review
We made the following changes to the published protocol (Onyango 2009).
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Inclusion of cluster‐randomised trials in Types of studies
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The inclusion criteria states, "We included infants (both term and preterm) up to the age of 30 days with jaundice or hyperbilirubinaemia requiring phototherapy." This included some studies where the initiation of phototherapy might be considered 'prophylactic' because we still considered that they were treating hyperbilirubinaemia.
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Changed the qualification of the secondary outcome "Infant mortality" from "as a result of complications of hyperbilirubinaemia" to "all cause" in Secondary outcomes
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Added an introductory paragraph in Data collection and analysis
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Addition of paragraph referring to PRISMA flow diagram in Selection of studies
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Specified reporting analyses of primary outcomes only in Sensitivity analysis
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Addition of the following sections: Unit of analysis issues; Dealing with missing data; Assessment of reporting biases; Data synthesis; Subgroup analysis and investigation of heterogeneity; Summary of findings and assessment of the certainty of the evidence
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Minor amendments made to the following sections: Assessment of heterogeneity; Subgroup analysis and investigation of heterogeneity
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We did not search CINAHL as stated in the protocol because Cochrane CENTRAL now includes records from this database.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Humans; Infant; Infant, Newborn;
PICO
PRISMA flow diagram
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 1: Rate of decline of serum bilirubin
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 2: BIND
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 3: Treatment failure
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 4: Mortality
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 5: Exchange transfusion
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 6: Weight gain (g/kg/day)
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 7: Length of hospital stay
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 8: Infant feeding volumes (volume/day)
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 9: Duration of phototherapy (hours)
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 10: Duration of first episode of phototherapy
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 11: Parental satisfaction
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 12: Staff satisfaction
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 13: Incidence of gastrointestinal dysmotility
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 14: Incidence of patent ductus arteriosus
Comparison 1: Intermittent phototherapy versus continuous phototherapy, Outcome 15: Incidence of body rash
Comparison 2: Intermittent phototherapy versus continuous phototherapy: subgrouped by term infants versus preterm infants, Outcome 1: Rate of decline of serum bilirubin (micromol/L/hour)
Comparison 2: Intermittent phototherapy versus continuous phototherapy: subgrouped by term infants versus preterm infants, Outcome 2: BIND
Comparison 3: Intermittent phototherapy versus continuous phototherapy: subgrouped by intermittent phototherapy regimen (phototherapy on < 2 hours versus ≥ 2 hours), Outcome 1: Rate of decline of serum bilirubin (micromol/L/hour)
Comparison 3: Intermittent phototherapy versus continuous phototherapy: subgrouped by intermittent phototherapy regimen (phototherapy on < 2 hours versus ≥ 2 hours), Outcome 2: BIND
Comparison 4: Sensitivity analysis, Outcome 1: Rate of decline of bilirubin (micromol/L/hr)
| Intermittent phototherapy compared to continuous phototherapy for neonatal jaundice | ||||||
| Patient or population: neonatal jaundice | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with continuous phototherapy | Risk with intermittent phototherapy | |||||
| Rate of decline of serum bilirubin (micromol/L/hr) | The mean rate of decline of serum bilirubin (micromol/L/hr) was 1.601 micromol/L/h | MD 0.09 micromol/L/h lower | ‐ | 1225 | ⊕⊕⊝⊝ |
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| Bilirubin‐induced brain dysfunction (defined as either the pathological finding of deep‐yellow staining of neurons and neuronal necrosis of the basal ganglia and brainstem nuclei or acute or chronic neurological deficit including athetoid cerebral palsy, impaired upward gaze and deafness or isolated conditions, such as auditory neuropathy or dyssynchrony) | Study population | not estimable | 60 | ⊕⊝⊝⊝ |
| |
| 0 per 1000 | 0 per 1000 | |||||
| Treatment failure (need to restart phototherapy or exchange transfusion or both) | Study population | not estimable | 75 | ⊕⊝⊝⊝ |
| |
| 51 per 1000 | 0 per 1000 | |||||
| Mortality (all cause) | Study population | not estimable | 1470 | ⊕⊕⊝⊝ |
| |
| 28 per 1000 | 0 per 1000 | |||||
| *The risk in the intervention group (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). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Moderate heterogeneity 2 Optimal information size not met 3 Reported by single study 4 No events reported in a single study 5 Effect size includes both appreciable benefit and appreciable harm. 6 Optimal information size not met. Effect size includes both appreciable benefit and appreciable harm. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Rate of decline of serum bilirubin Show forest plot | 10 | 1225 | Mean Difference (IV, Fixed, 95% CI) | ‐0.09 [‐0.21, 0.03] |
| 1.2 BIND Show forest plot | 1 | 60 | Odds Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 1.3 Treatment failure Show forest plot | 1 | 75 | Risk Difference (IV, Fixed, 95% CI) | 0.03 [‐0.08, 0.15] |
| 1.4 Mortality Show forest plot | 10 | 1470 | Risk Difference (M‐H, Fixed, 95% CI) | ‐0.01 [‐0.03, 0.01] |
| 1.5 Exchange transfusion Show forest plot | 2 | 364 | Risk Difference (M‐H, Fixed, 95% CI) | 0.00 [‐0.02, 0.02] |
| 1.6 Weight gain (g/kg/day) Show forest plot | 1 | 59 | Mean Difference (IV, Fixed, 95% CI) | ‐3.71 [‐10.25, 2.82] |
| 1.7 Length of hospital stay Show forest plot | 3 | 325 | Mean Difference (IV, Fixed, 95% CI) | ‐0.07 [‐0.22, 0.09] |
| 1.8 Infant feeding volumes (volume/day) Show forest plot | 2 | 136 | Mean Difference (IV, Fixed, 95% CI) | ‐0.82 [‐8.80, 7.16] |
| 1.9 Duration of phototherapy (hours) Show forest plot | 7 | 917 | Mean Difference (IV, Fixed, 95% CI) | ‐15.27 [‐16.42, ‐14.12] |
| 1.10 Duration of first episode of phototherapy Show forest plot | 6 | 629 | Mean Difference (IV, Fixed, 95% CI) | ‐0.89 [‐2.50, 0.72] |
| 1.11 Parental satisfaction Show forest plot | 1 | 174 | Mean Difference (IV, Fixed, 95% CI) | 2.00 [1.56, 2.44] |
| 1.12 Staff satisfaction Show forest plot | 1 | 174 | Mean Difference (IV, Fixed, 95% CI) | ‐2.00 [‐2.35, ‐1.65] |
| 1.13 Incidence of gastrointestinal dysmotility Show forest plot | 1 | 174 | Risk Difference (M‐H, Fixed, 95% CI) | ‐0.01 [‐0.06, 0.04] |
| 1.14 Incidence of patent ductus arteriosus Show forest plot | 1 | 271 | Risk Difference (M‐H, Fixed, 95% CI) | ‐0.02 [‐0.12, 0.08] |
| 1.15 Incidence of body rash Show forest plot | 1 | 174 | Risk Difference (M‐H, Fixed, 95% CI) | ‐0.01 [‐0.07, 0.05] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Rate of decline of serum bilirubin (micromol/L/hour) Show forest plot | 10 | 1225 | Mean Difference (IV, Fixed, 95% CI) | ‐0.09 [‐0.21, 0.03] |
| 2.1.1 Term infants | 7 | 1049 | Mean Difference (IV, Fixed, 95% CI) | ‐0.04 [‐0.17, 0.09] |
| 2.1.2 Preterm infants | 3 | 176 | Mean Difference (IV, Fixed, 95% CI) | ‐0.51 [‐0.86, ‐0.15] |
| 2.2 BIND Show forest plot | 1 | 60 | Odds Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 2.2.1 Term infants | 1 | 60 | Odds Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Rate of decline of serum bilirubin (micromol/L/hour) Show forest plot | 10 | 1294 | Mean Difference (IV, Fixed, 95% CI) | ‐0.10 [‐0.21, 0.02] |
| 3.1.1 Phototherapy on for < 2 hours | 4 | 713 | Mean Difference (IV, Fixed, 95% CI) | ‐0.06 [‐0.20, 0.09] |
| 3.1.2 Phototherapy on for ≥ 2 hours | 7 | 581 | Mean Difference (IV, Fixed, 95% CI) | ‐0.17 [‐0.36, 0.02] |
| 3.2 BIND Show forest plot | 1 | 60 | Odds Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| 3.2.1 Phototherapy on ≥2 hours | 1 | 60 | Odds Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Rate of decline of bilirubin (micromol/L/hr) Show forest plot | 3 | 549 | Mean Difference (IV, Fixed, 95% CI) | 0.02 [‐0.14, 0.19] |
