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Flow diagram.

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Figure 1

Flow diagram.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 1: Decline in bilirubin at 4 to 8 hours

Figuras y tablas -
Analysis 1.1

Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 1: Decline in bilirubin at 4 to 8 hours

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Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 2: Decline in serum bilirubin (over 24 hours)

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Analysis 1.2

Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 2: Decline in serum bilirubin (over 24 hours)

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Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 3: Decline in bilirubin (first measurement)

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Analysis 1.3

Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 3: Decline in bilirubin (first measurement)

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Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 4: Rate of decline in bilirubin (micromol/L/h)

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Analysis 1.4

Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 4: Rate of decline in bilirubin (micromol/L/h)

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Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 5: Duration of phototherapy (in hours)

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Analysis 1.5

Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 5: Duration of phototherapy (in hours)

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Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 6: Duration of hospital stay (in hours)

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Analysis 1.6

Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 6: Duration of hospital stay (in hours)

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Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 7: Decline in bilirubin at 24 hours (low and high baseline SB)

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Analysis 1.7

Comparison 1: Phototherapy with reflective curtains versus phototherapy alone, Outcome 7: Decline in bilirubin at 24 hours (low and high baseline SB)

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Comparison 2: Reflective curtains versus intensified phototherapy, Outcome 1: Decline in bilirubin (first measurement)

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Analysis 2.1

Comparison 2: Reflective curtains versus intensified phototherapy, Outcome 1: Decline in bilirubin (first measurement)

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Comparison 2: Reflective curtains versus intensified phototherapy, Outcome 2: Duration of phototherapy (in hours)

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Analysis 2.2

Comparison 2: Reflective curtains versus intensified phototherapy, Outcome 2: Duration of phototherapy (in hours)

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Summary of findings 1. Phototherapy with reflective curtains compared to phototherapy alone for newborn infants with unconjugated hyperbilirubinaemia

Phototherapy with reflective curtains compared to phototherapy alone for newborn infants with unconjugated hyperbilirubinaemia

Patient or population: newborn infants with unconjugated hyperbilirubinaemia
Setting: hospital neonatal units
Intervention: phototherapy with reflective curtains
Comparison: phototherapy alone

Outcomes

Anticipated absolute effects* (95% CI)

Relative
effect
(95% CI)

№ of
participants
(studies)

Certainty of the
evidence
(GRADE)

Comments

Decline in bilirubin at 4 to 8

hours (μmol/L)

MD 14.61 lower in the phototherapy with curtains group than in the group with phototherapy alone
(19.8 lower to 9.42 lower)

‐

281
(3 RCTs)

⊕⊕⊕⊝
Moderatea

Decline in serum bilirubin

(over 24 hours)

See comment

‐

893
(9 RCTs)

⊕⊝⊝⊝
Very lowb,c

Although the effect estimate for all studies favoured reflective curtains, no summary effect is available due to substantial heterogeneity

Exchange transfusion

Two studies reported no exchange transfusion; remaining studies did not report this outcome

‐

(2 RCTs)

‐

Acute life‐threatening events

This outcome was not reported in any of the included studies

‐

(11 RCTs)

‐

Parental satisfaction

This outcome was not reported in any of the included studies

‐

(11 RCTs)

‐

Breastfeeding on
discharge

This outcome was not reported in any of the included studies

‐

(11 RCTs)

‐

*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.

aDowngraded one level for moderate inconsistency (heterogeneity).

bLack of blinding of caregivers in all studies and possible selection bias,

cDowngraded two levels for substantial inconsistency (heterogeneity).

Figuras y tablas -
Summary of findings 1. Phototherapy with reflective curtains compared to phototherapy alone for newborn infants with unconjugated hyperbilirubinaemia
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Summary of findings 2. Reflective curtains compared to intensified phototherapy for newborn infants with unconjugated hyperbilirubinaemia

Reflective curtains compared to intensified phototherapy for newborn infants with unconjugated hyperbilirubinaemia

Patient or population: newborn infants with unconjugated hyperbilirubinaemia
Setting: hospital neonatal Wards
Intervention: reflective curtains
Comparison: intensified phototherapy

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Decline in bilirubin (first measurement)

MD 0.17 higher in group with curtains than in group with intensified phototherapy
(8.58 lower to 8.92 higher)

‐

159
(1 RCT)

⊕⊕⊝⊝
Lowa,b,c

Duration of phototherapy (in hours)

MD 4.04 higher in group with curtains than in group with intensified phototherapy
(1.56 lower to 9.64 higher)

‐

159
(1 RCT)

⊕⊕⊝⊝
Lowb,c

Exchange transfusion

Three infants reached exchange transfusion level. No differences between groups

‐

(159)

(1 RCT)

‐

Acute life‐threatening events

No events reported

‐

(159)

(1 RCT)

‐

Patient satisfaction

Not reported

‐

(159)

(1 RCT)

‐

Breastfeeding on discharge

Outcome not reported

‐

(159)

(1 RCT)

‐

*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.

aAlthough blinding of caregivers was lacking, the outcome assessor was blinded.

bDowngraded one level for single study; unable to assess inconsistency with other studies.

cSingle study and wide confidence interval, including potential for a decrease and an increase in the outcome.

Figuras y tablas -
Summary of findings 2. Reflective curtains compared to intensified phototherapy for newborn infants with unconjugated hyperbilirubinaemia
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Comparison 1. Phototherapy with reflective curtains versus phototherapy alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Decline in bilirubin at 4 to 8 hours Show forest plot

3

281

Mean Difference (IV, Fixed, 95% CI)

‐14.61 [‐19.80, ‐9.42]

1.2 Decline in serum bilirubin (over 24 hours) Show forest plot

9

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.2.1 White plastic

4

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.2.2 White linen

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.2.3 Aluminium

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.2.4 White not defined

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.3 Decline in bilirubin (first measurement) Show forest plot

9

796

Mean Difference (IV, Fixed, 95% CI)

‐29.08 [‐31.93, ‐26.22]

1.4 Rate of decline in bilirubin (micromol/L/h) Show forest plot

1

84

Mean Difference (IV, Fixed, 95% CI)

‐3.39 [‐6.88, 0.10]

1.5 Duration of phototherapy (in hours) Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.6 Duration of hospital stay (in hours) Show forest plot

2

279

Mean Difference (IV, Fixed, 95% CI)

‐41.08 [‐45.92, ‐36.25]

1.7 Decline in bilirubin at 24 hours (low and high baseline SB) Show forest plot

9

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.7.1 Mean baseline SB < 300 micromol/L

5

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.7.2 Mean baseline SB ≥ 300 micromol/L

4

Mean Difference (IV, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Phototherapy with reflective curtains versus phototherapy alone
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Comparison 2. Reflective curtains versus intensified phototherapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Decline in bilirubin (first measurement) Show forest plot

1

159

Mean Difference (IV, Fixed, 95% CI)

0.17 [‐8.58, 8.92]

2.2 Duration of phototherapy (in hours) Show forest plot

1

156

Mean Difference (IV, Fixed, 95% CI)

4.04 [‐1.56, 9.64]
Figuras y tablas -
Comparison 2. Reflective curtains versus intensified phototherapy
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