Jubilee Jirah Reyes

BSN 2-YB-11

Laboratory Course Task 6

“UPDATES REGARDING THE USE OF INCUBATORS OR PHOTOTHERAPY IN

HIGH RISK NEWBORN”

Of 15 studies identified, we included 12 (1288 babies) in the review ‐ 11 comparing

phototherapy with reflective materials and phototherapy alone, and one comparing a single
phototherapy light bank with reflective materials with double phototherapy. All reflective
materials consisted of curtains on three or four sides of the cot and were made of white plastic
(five studies), white linen (two studies), or aluminium (three studies); materials were not
specified in two studies. Only 11 studies (10 comparing reflective materials versus none and one
comparing reflective curtains and a single bank of lights with a double (above and below)
phototherapy unit) provided sufficient data to be included in the meta‐analysis. Two excluded
studies used the reflective materials in a way that did not meet our inclusion criteria, and we
excluded one study because it compared four different phototherapy interventions not including
reflective materials. The risk of bias of included studies was generally low, but all studies had
high risk of performance bias due to lack of blinding of the intervention.

Three studies (281 participants) reported a decline in serum bilirubin (SB) (μmol/L) at four to
eight hours (mean difference (MD) ‐14.61, 95% confidence interval (CI) ‐19.80 to ‐9.42; I² =
57%; moderate‐certainty evidence). Nine studies (893 participants) reported a decline in SB over
24 hours and showed a faster decline in SB in the intervention group, but heterogeneity (I² =
97%) was too substantial to permit a meaningful estimate of the actual effect size (very low‐
certainty evidence). Subgroup analysis by type of reflective material used did not explain the
heterogeneity. Exchange transfusion was reported by two studies; both reported none in either
group. Four studies (466 participants) reported the mean duration of phototherapy, and in each of
these studies, it was reduced in the intervention group but there was substantial heterogeneity (I²
= 88%), precluding meaningful meta‐analysis of data. The only two studies that reported the
mean duration of hospital stay in hours showed a meaningful reduction (MD ‐41.08, 95% CI ‐
45.92 to ‐36.25; I² = 0; moderate‐certainty evidence).

No studies reported costs of the intervention, parental or medical staff satisfaction, breastfeeding
outcomes, or neurodevelopmental follow‐up.

The only study that compared use of curtains with double phototherapy reported similar results
for both groups.
Studies that monitored adverse events did not report increased adverse events related to the use
of curtains, including acute life‐threatening events, but other rarer side effects could not be
excluded.

Moderate‐certainty evidence shows that the use of reflective curtains during phototherapy may
result in greater decline in SB. Very low‐certainty evidence suggests that the duration of
phototherapy is reduced, and moderate‐certainty evidence shows that the duration of hospital
stay is also reduced. Available evidence does not show any increase in adverse events, but
further studies are needed.

My take away :

According to a recent Cochrane Review, light sources from light emitting diodes are just as
effective as traditional light sources (Kumar 2011). These lights are energy efficient, produce
less heat, and have a very long life period (Kumar 2011). Light-emitting diodes, on the other
hand, are currently pricey, and further research on their safety is required. As a result, traditional
phototherapy will likely continue to be used for
some time. Reflective materials used in
traditional phototherapy are inexpensive; if they
can be found to boost the intensity and, more
importantly, the efficiency of phototherapy while
reducing treatment time with little or no
additional expense, this might be beneficial in
resource-constrained environments. However, an
increasing body of research demonstrates that
phototherapy has enough negative effects to
warrant avoiding unneeded phototherapy in any
scenario. Infants that received phototherapy have
higher levels of oxidative stress markers
(ElFarrash 2019). Phototherapy has been linked
to childhood cancer (Auger 2019; Newman
2016), and its use has been linked to
breastfeeding failure (Waite 2016), both of which
are reasons for reducing phototherapy duration.
The goal of this review is to assemble and
evaluate available information from randomised
and quasirandomised trials comparing the effects
of phototherapy with and without reflective
curtains.