Fibreoptic phototherapy for neonatal jaundice

Abstract

Phototherapy is used to treat newborn infants with hyperbilirubinaemia. Fibreoptic phototherapy is a new mode of phototherapy which is reported to lower serum bilirubin (SBR) while minimising disruption of normal infant care. To evaluate the efficacy of fibreoptic phototherapy. The standard search strategy of the Cochrane Collaboration was used including searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE and discussion with experts in the field. Randomised or quasi‐randomised controlled trials evaluating the efficacy of fibreoptic phototherapy in the management of newborn infants with hyperbilirubinaemia. Thirty‐one studies were identified of which 24 met inclusion criteria. They evaluated the efficacy of fibreoptic phototherapy in a number of different clinical situations and patient populations. Fibreoptic phototherapy was more effective at lowering SBR than no treatment but less effective than conventional phototherapy (percentage change in SBR after 24 hours of treatment: WMD ‐10.7%, 95%CI ‐18.14, ‐3.26 and WMD 3.59%, 95%CI 1.27, 5.92 respectively). Fibreoptic phototherapy was equally as effective as conventional phototherapy in preterm infants and when two fibreoptic devices were used simultaneously (change in SBR after 24 hours of treatment: WMD 1.7%, 95%CI ‐2.65, 6.05 and change in SBR per day over whole treatment period: WMD 2.82%, 95%CI ‐1.84, 7.48 respectively). A combination of fibreoptic and conventional phototherapy was more effective than conventional phototherapy alone (duration of phototherapy: WMD ‐12.51 hr, 95%CI ‐16.00, ‐9.02, meta‐analysis affected by heterogeneity). No conclusion can be made on the superiority of one fibreoptic device over another as the two studies comparing them (one favouring BiliBlanket, the other finding no difference) did not contain a common outcome measure. Fibreoptic phototherapy has a place in the management of neonatal hyperbilirubinaemia. It is probably a safe alternative to conventional phototherapy in term infants with physiological jaundice. No trials have been identified which support the widely‐held view that fibreoptic devices interfere less with infant care or impact less on parent‐child bonding. 用光纖照光治療新生兒黃疸 照光治療用於有高膽紅素血症的新生兒。光纖照光治療是一種新型的照光治療，可以在幾乎不影響正常嬰兒照顧的情況下來降低血清膽紅素。 評估光纖照光治療的效果。 於Cohrance Collaboration下執行標準搜尋策略，搜尋範圍包括Cochrane Controlled Trials Register、MEDLINE、EMBASE，並和相關專家討論。 以隨機或近似隨機控制試驗來評估光纖照光治療在有高膽紅素血症的新生兒的效果。 共搜尋出31個研究，其中24個研究達到納入標準。它們探討了不同臨床情況和病人族群接受光纖照光治療的效果。 比起不治療，光纖照光治療能夠更有效的降低血清膽紅素值，但效果比傳統照光治療差 (治療24小時後血清膽紅素變化：WMD −10.7%, 95% CI −18.14, −3.26 和WMD 3.59%, 95% CI 1.27, 5.92) 。早產兒同時接受兩台光纖照光治療其效果相當於傳統照光治療 (治療24小時後血清膽紅素變化：WMD 1.7%, 95% CI −2.65, 6.05，血清膽紅素每天變化相較於整個療程：WMD 2.82%, 95% CI −1.84, 7.48) 。合併使用光纖和傳統照光比單獨使用傳統照光效果好 (治療時間：WMD −12.51 小時, 95% CI −16.00, −9.02，整合分析受到資料異質性影響) 。兩個試驗比較了兩種光纖照光設備 (一個認為BiliBlanket較好，另一個認為沒有差別) ，兩者沒有同樣的量尺來評估結果，因此無法做出某一光纖照光治療儀器較好的結論。 光纖照光在治療新生兒高膽紅素血症佔有一席之地。它可能是有生理性黃疸的足月兒除了傳統照光治療外另一個安全的選擇。沒有研究顯示光纖照光對嬰兒照顧或親子互動有較小的影響。 本摘要由馬偕醫院張龍翻譯。 此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。 對新生兒黃疸而言，單獨使用光纖照光治療比起傳統照光效果差，但在早產兒兩者效果相當。新生兒常常會有黃疸，血清中的未結合膽紅素可能會傷害發育中的腦。從1960年代起採用照光治療黃疸，嬰兒需裸身在小床上且將眼睛遮蓋住。光纖照光是一種新型的照光治療，經由光纖光線直接照射於嬰兒皮膚上，對新生兒黃疸而言，如此嬰兒可以包著衣服讓父母親照顧。此篇回顧文章顯示，光纖照光效果比起傳統照光差，除了在早產兒兩者效果相當。