Systematic Review of the Effect of Reflective Materials Around a Phototherapy Unit on Bilirubin Reduction Among Neonates With Physiologic Jaundice in Developing Countries.

OBJECTIVE: To identify the efficacy and safety of the use of various cost-effective reflective materials around phototherapy units to reduce the duration of phototherapy and hasten the reduction of bilirubin among neonates with physiologic jaundice. DATA SOURCES: A systematic review of randomized controlled trials identified from searches in the Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Embase, and the Cochrane Library with the use of keywords, MeSH terms, operators, and the review of reference lists of retrieved articles. STUDY SELECTION: From a total of 186 studies initially screened, five were eventually included in this analysis. DATA EXTRACTION: Two authors independently reviewed each study with a standard template. Review parameters included the quality of each study based on the Physiotherapy Evidence Database scale and the Consolidated Standards of Reporting Trials guidelines. DATA SYNTHESIS: All studies were generalizable and were rated as high quality on the Physiotherapy Evidence Database scale; one study scored 8 points, and the other four scored 6 points each. The reflective materials used in these studies included the following: white 100% cotton cloths (one study), white plastic covers (two studies), underpads (one study), and silver fabric cloth (one study). Pooled analysis of three studies indicated that reflective materials significantly reduced the duration of phototherapy with a large effect size of 0.82 (p = .04). Pooled analysis of another three studies indicated that the mean decrease of the total serum bilirubin 4 hours after the initiation of phototherapy was significantly greater when reflective materials were added (mean difference of 11.39 µmol/L, 95% confidence interval [2.26, 20.52 µmol/L], p = .01). CONCLUSION: The addition of reflective materials to phototherapy units may be therapeutic for neonates with physiologic jaundice.

Effect of turning vs. supine position under phototherapy on neonates with hyperbilirubinemia: a systematic review.

AIMS AND OBJECTIVES: To determine the most effective position jaundiced neonates should assume during phototherapy from appraised randomised controlled trials. BACKGROUND: Many local hospitals still alternate positions of jaundiced neonates receiving phototherapy despite the safe infant sleeping protocol of placing them supine. DESIGN: A systematic review was conducted. METHODS: Databases that included Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Embase and The Cochrane Library were used. Randomized controlled trials published in English language that evaluate the best position for healthy jaundiced neonates aged day 1 to 14 under phototherapy were searched. In addition, any positioning done every 2-3 hours during phototherapy with the outcome measures being bilirubin reduction and duration of phototherapy were also searched and included (n = 5). Physiotherapy Evidence Database scale was adopted for quality assessment. All processes were conducted by both reviewers independently. Discrepancies were resolved by a third reviewer. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guideline were utilised. Out of 20 papers, five were included for qualitative synthesis. Data extraction was based on the template (participants, study designs etcetera) agreed by both authors. RESULTS: All five studies possessed external validity. One paper scored 7, three scored 5 while one scored 3. Four of these studies reported no difference in bilirubin reduction and duration of phototherapy. Only one study reported a significant drop in serum bilirubin and shorter duration of phototherapy in the supine group. CONCLUSION: It has been proved that keeping the jaundiced newborns in the supine position throughout phototherapy is as effective as turning them periodically based on the appraised studies. RELEVANCE TO CLINICAL PRACTICE: It is unnecessary to alternate positions of the jaundiced neonates when conventional phototherapy is delivered to lighten nurses' workload.