Meta-Analysis of the Effect of Chest Shielding on Preventing Patent Ductus Arteriosus in Premature Infants

Abstract

This study aims to perform a meta-analysis of randomized studies to evaluate if chest shielding during phototherapy is associated with decreased incidence of patent ductus arteriosus (PDA) in premature infants. We used published guidelines for the meta-analysis of clinical trials. The search strategy included electronic searches of CINAHL, CENTRAL Cochrane Library, MEDLINE, PubMed, and abstracts presented at the Pediatric Academic Societies. Inclusion criteria were randomized controlled trials (RCTs), quasi-RCTs or cluster RCTs published in English and involving chest shielding during phototherapy in premature infants with PDA as an outcome. Exclusion criteria involved case reports, case series, and multiple publications from the same author. Heterogeneity testing using Q statistics was performed to evaluate the variance between studies. Two RCTs met study criteria. There was heterogeneity (I: 55.4%) between the two trials. Meta-analysis of RCTs using the random effect model demonstrated that chest shielding during phototherapy was associated with decreased incidence of PDA (odds ratio: 0.47, 95% confidence interval: 0.23-0.96). There was no publication bias on Eggers test. Heterogeneity was seen in gestational age, gender, prophylactic use of postnatal indomethacin, duration of phototherapy, and assessment of PDA. Chest shielding during phototherapy may be associated with decreased incidence of PDA among premature infants.

Challenges of phototherapy for neonatal hyperbilirubinemia (Review)

“…The patent ductus arteriosus can shunt blood from the aorta to the pulmonary artery, significantly increasing the blood volume in the pulmonary circulation and increasing the load on the left heart, thus leading to complications such as congestive heart failure or even death (82,83). It has been reported in the literature that appropriate shielding of the chest during phototherapy may reduce the incidence of patent ductus arteriosus induced by phototherapy (84). However, some researchers disagree with this preventive measure (85).…”

Neonatal Phototherapy Adverse Effects in Infants: A Scoping Review

“…Therefore, although PDA may be increased in these infants, it is not confirmed whether the causation is the phototherapy, the hyperbilirubinemia, the preterm status, or a combination of these. 18 The study by Surmeli-Oney, et al found that phototherapy effects on prostaglandin does not mediate PDA as an outcome in preterm infants. However, no other causation was explored.…”

“…In contrast, a metaanalysis by Mannan J, et al found a decrease in PDA among preterm infants receiving phototherapy with chest shielding. With regards to PDA, 18 Surmeli-Oney, et al concluded from their prospective study that phototherapy does not cause PDA through altered prostaglandins levels. 19…”

“…However, the intent of the Cochrane Review by Bhola, et al and the study by Mannan, et al included in this scoping study, were intended to explore evidence for mitigation of this adverse outcome through use of chest shielding for preterm infants during phototherapy. 17,18 The main weakness within the Cochrane Review was only two trials were included, and both were found to have a risk of bias. 15 In use of chest shielding, there is a loss of surface area exposed to the phototherapy, in theory diminishing its effectiveness.…”