Turning position versus supine under phototherapy in term and preterm neonates with hyperbilirubinaemia

Patient or population: term and preterm neonates with hyperbilirubinaemia
Setting: level 2 to 3 neonatal intensive care units
Intervention: turning position under phototherapy
Comparison: supine position under phototherapy

Duration of phototherapy (hours)

Mean duration of phototherapy was on average 1.71 hours longer in the turning group (95% CI −3.17 to 6.59).

231
(4 RCTs)

⊕⊕⊝⊝
Low^a

Periodic change in body position may lead to little or no difference in the duration of phototherapy.

Rate of fall of serum total bilirubin at 24 hours of starting phototherapy (mg/dL/h)^b

MD in the rate of fall of serum total bilirubin was an average of 0.02 mg/dL/h higher in the turning group
(95% CI −0.02 to 0.06).

100
(1 RCT)

⊕⊕⊝⊝ Low^c

Periodic change in body position may lead to little or no effect on the rate of fall of serum total bilirubin at 24 hours of starting phototherapy.

Need for exchange transfusion

Bilirubin‐induced neurological damage (BIND)

Sudden infant death syndrome (SIDS)

*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).

CI: confidence interval; MD: mean difference; RCT: randomised controlled trial

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.