Effectiveness Of Fiberoptic Phototherapy Compared To Conventional Phototherapy In Treating Hyperbilirubinemia Amongst Term Neonates: A Randomized Controlled Trial

Abstract

Background: Neonatal jaundice is one of the most common problems in newborns. Effective treatment of jaundice requires therapeutic intervention with phototherapy. Over recent years, several studies reported fiberoptic phototherapy to be less effective than conventional phototherapy in term neonates. Our study aimed to compare the effectiveness of fiberoptic phototherapy with a larger illuminated area and higher irradiance to conventional phototherapy methods. Methods: This was a randomized controlled trial conducted at Kilimanjaro Christian Medical Centre (KCMC). A total of 41 term neonates, less than 7 days of age with unconjugated hyperbilirubinemia were randomized. Thirteen (13) newborns were allocated to receive fiberoptic phototherapy, 13 to blue light conventional phototherapy and 15 to white light conventional phototherapy. Effectiveness was assessed by comparing the duration of phototherapy, bilirubin reduction rate and side effects of treatment. The data was analyzed with the independent t-test.Results: The mean overall bilirubin reduction rate was comparable in the fiberoptic phototherapy group (0.74%/h) and the blue light conventional phototherapy group (0.84%/h), with no statistically significant difference (p-value 0.124). However, white light conventional phototherapy had a significantly lower mean overall bilirubin reduction rate (0.29%/h) as compared to fiberoptic phototherapy (p-value <0.001). The mean treatment duration of phototherapy was 69 h, 68 h and 90 h in the fiberoptic, blue light conventional and white light conventional phototherapy groups respectively. Side effects such as loose stool and skin rash were noted in some participants who received conventional phototherapy. No side effects of treatment were noted in the fiberoptic phototherapy group.Conclusion: The effectiveness of fiberoptic PT and blue light conventional PT were comparable in terms of bilirubin reduction rate and treatment duration, whereas fiberoptic phototherapy was more effective than white light conventional PT, with a significantly lower bilirubin reduction rate and treatment duration. Fiberoptic phototherapy may mitigate side effects caused by conventional phototherapy.Trial registration: The Pan African Clinical Trial Registry, PACTR202004723570110. Registered 22nd April 2020- Retrospectively registered, http://www.pactr.org/

Light-Emitting Diode (LED) Phototherapy versus Non-LED Phototherapy Devices for Hyperbilirubinemia in Neonates: A Systematic Review and Meta-analysis

“…We evaluated 41 fulltext articles to check for eligibility, and, ultimately, 21 were included in this review. 3,15,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] The flowchart for evidence search and study selection is shown in ►Fig. 1.…”

“…15,[23][24][25] Fifteen articles compared LED devices with fluorescent lights. 3,[26][27][28][29][31][32][33][34][35][36][37][38]40,41 Two studies compared LED devices with halogen and fluorescent lights. 30,39 Five studies enrolled only full-term neonates 15,23,38,40,41 and 13 studies included infants over 35 or 36 weeks of gestation.…”

“…3,[26][27][28][29][31][32][33][34][35][36][37][38]40,41 Two studies compared LED devices with halogen and fluorescent lights. 30,39 Five studies enrolled only full-term neonates 15,23,38,40,41 and 13 studies included infants over 35 or 36 weeks of gestation. 3,[26][27][28][29][31][32][33][34][35][36][37]39 Two studies enrolled only preterm neonates, 24,25 while the study by Viau Colindres et al 30 included infants over 32 weeks.…”

“…There was an unclear risk of bias in random sequence generation in seven studies, 24,25,27,28,30,31,38 and an unclear risk of allocation concealment in the other seven studies. 15,23,24,27,29,38,41 The risk of bias by blinding the participants, personnel, and the outcome assessment were high. Only two studies 35,36 reported blinding of participants and personnel, and three studies 33,35,36 reported blinding of the outcome assessment.…”

“…The cause of jaundice that influences the endogenous rate of production, and severity of hyperbilirubinemia might determine the efficacy of phototherapy. Neonates with hemolytic jaundice were included in five studies 3 34 38 39 41 and only one of them 38 studied neonates with this type of hyperbilirubinemia exclusively. Other five studies do not adequately defined whether they included these infants.…”