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Efficacy of home phototherapy versus inpatient phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis.
- Source :
-
Italian Journal of Pediatrics . 3/4/2024, Vol. 50 Issue 1, p1-10. 10p. - Publication Year :
- 2024
-
Abstract
- Background: Home phototherapy (HPT) remains a contentious alternative to inpatient phototherapy (IPT) for neonatal hyperbilirubinemia. To guide evidence-based clinical decision-making, we conducted a meta-analysis of randomized clinical trials (RCTs) and cohort studies and assessed the comparative risks and benefits of HPT and IPT. Methods: PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure Database, Wanfang Database, Chinese Science and Technique Journals Database, ClinicalTrials.gov, and International Clinical Trial Registry Platform trial were searched from inception until June 2, 2023. We included RCTs and cohort studies and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Study quality was assessed with the Cochrane Collaboration Risk of Bias tool and the Newcastle–Ottawa scale. The outcome measures were phototherapy duration, daily bilirubin level reduction, exchange transfusion, hospital readmission, parental stress scale, and complications. We used fixed- or random-effects meta-analysis models, assessed heterogeneity (I2), conducted subgroup analyses, evaluated publication bias, and graded evidence quality. Results: Nine studies (998 patients) were included (four RCTs, five cohort studies). HPT was associated with longer phototherapy duration (SMD = 0.55, 95% CI: 0.06–1.04, P = 0.03). Cohort study subgroup analysis yielded consistent results (SMD = 0.90; 95% CI: 0.69 to 1.11, P < 0.001, I2 = 39%); the RCTs were not significantly different (SMD = -0.04; 95% CI: -0.15 to 0.08, P = 0.54, I2 = 0%). Hospital readmission was higher with HPT (RR = 4.61; 95% CI: 1.43–14.86, P = 0.01). Daily bilirubin reduction (WMD = -0.12, 95% CI: -0.68 to 0.44, P = 0.68) or complications were not significantly different (RR = 2.29; 95% CI: 0.31–16.60, P = 0.41). The evidence quality was very low. HPT was associated with lower parental stress (SMD = -0.44, 95% CI: -0.71 to -0.16, P = 0.002). None of three included studies reported exchange transfusion. Conclusions: The current evidence does not strongly support HPT efficacy for neonatal hyperbilirubinemia, as high-quality data on long-term outcomes are scarce. Future research should prioritize well-designed, large-scale, high-quality RCTs to comprehensively assess HPT risks and benefits. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ONLINE information services
*MEDICAL databases
*META-analysis
*MEDICAL information storage & retrieval systems
*PSYCHOLOGY of parents
*CONFIDENCE intervals
*NEONATAL jaundice
*PHOTOTHERAPY
*HOME care services
*SYSTEMATIC reviews
*TREATMENT duration
*TREATMENT effectiveness
*CRITICAL care medicine
*HOSPITAL care
*DESCRIPTIVE statistics
*RESEARCH funding
*MEDLINE
*STATISTICAL models
*ODDS ratio
*BILIRUBIN
*PSYCHOLOGICAL stress
*EVALUATION
*DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 17208424
- Volume :
- 50
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- Italian Journal of Pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 175828517
- Full Text :
- https://doi.org/10.1186/s13052-024-01613-0