Effectiveness and Safety of Prophylactic Phototherapy to Prevent Jaundice in Premature Newborns: Systematic Review and Meta-Analysis

Objective: To determine the effectiveness and safety of prophylactic phototherapy compared to conventional phototherapy in premature newborns for the prevention of neonatal jaundice.

Methods: A systematic review including clinical trials that compare prophylactic phototherapy in premature newborns. We searched databases such as Embase, MEDLINE, LILACS, Central and other databases of published and unpublished literature to thoroughly seek information. The statistical analysis was performed in Review Manager v.5.3. The outcomes were analyzed according to the type of variable: risk difference (RD) and mean difference (MD). A random effects model was used due to the heterogeneity found in the studies. The results were reported in forest plots. The risk of bias was evaluated within and among the results, and a sensitivity analysis was made.

Results: A total of 1127 articles were found, and six studies (2332 patients) were included in the meta-analysis. Five of the studies evaluated the need for exchange transfusion as the primary outcome RD -0.01 95%CI (-0.05 to 0.03). For the outcome hyperbilirubinemic encephalopathy, only one study was found with an RD -0.04 95%CI (-0.09 to -0.00). The duration of the phototherapy was described in five studies with an MD of 38.47 95%CI (1.28 to 55.67). Lastly, the levels of bilirubin were found in four studies with an MD -1.23 95%CI (-2.25 to -0.21). Mortality was evaluated only in two studies, with an RD 0.01 95%CI (-0.03 to 0.04).

Conclusion: When comparing prophylactic phototherapy to conventional phototherapy, the former decreases the last level of bilirubin. However, it increases the duration of phototherapy in hours.