Some new-born babies suffer from jaundice and there are several Cochrane reviews of possible ways to treat it, including the use of phototherapy. These reviews were added to in March 2022 with a new review of the effects of changing the baby’s position under the phototherapy. Lead author, Anu Thukral from the All India Institute of Medical Sciences tells us about the findings in this podcast.
Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Some new-born babies suffer from jaundice and there are several Cochrane reviews of possible ways to treat it, including the use of phototherapy. These reviews were added to in March 2022 with a new review of the effects of changing the baby's position under the phototherapy. Lead author, Anu Thukral from the All India Institute of Medical Sciences tells us about the findings in this podcast.
Anu: Jaundice, or hyperbilirubinaemia to give it its technical name, in new-borns is caused by increased levels of bilirubin in the blood and phototherapy is the mainstay of treatment if the levels are higher than the acceptable cut-off for the baby's age. Phototherapy uses a light source of a special wavelength that converts bilirubin in the skin to its water-soluble isomers and, usually, babies being treated with phototherapy are kept on their back. However, an alternative approach is to periodically change the baby's position under phototherapy between lying on their back, side and stomach. The hope is that this would improve the efficiency of the phototherapy by hastening the access of phototherapy light to bilirubin deposited in different parts of the skin and subcutaneous tissue. However, our review, based on low certainty evidence, suggests that it may make little or no important difference.
We investigated the effects on the decline in bilirubin level and the duration of treatment in new-born babies, as well as the effects on the need for or number of exchange transfusions, bilirubin‐induced neurological damage, side effects of phototherapy, and the incidence of sudden infant death syndrome.
We found five eligible studies that had enrolled a total of 343 babies. In these studies, the body position under phototherapy was changed every two to three hours. Three of the studies included healthy term babies, whilst the other two also included late or moderately preterm babies. However, separate data were not available for the outcomes in the preterm babies. Overall, the included studies had a high risk of bias due to statistical heterogeneity, unclear risk of selection bias and imprecision.
Our meta-analysis of the results of the studies found that the periodic change in body position may have little or no impact on the duration of phototherapy and, in the single study that reported the rate of fall of serum total bilirubin 24 hours after starting the phototherapy, there was no difference between the two methods. None of the included studies reported the need for or the number of exchange transfusions, incidence of bilirubin‐induced neurological damage or sudden infant death syndrome.
In summary, the available low certainty evidence is insufficient to determine the effects of a periodic change of body position compared with no prescribed change of body position under phototherapy. To resolve this, more studies are needed, especially in very preterm babies and in those with a condition called haemolytic hyperbilirubinaemia.
Mike: If you would like to read the full version of this review and to watch for future updates if new studies become available, just go online to Cochrane library dot com and you can find it by typing 'phototherapy position and jaundice' in the search box.