Efficacy of home phototherapy versus inpatient phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis

Li，Rui1; Li，Tingting1; Yan，Xudong2; Feng，Jing1; Yu，Zhangbin2; Chen，Cheng1

2024-12-01

10.1186/s13052-024-01613-0

Italian Journal of Pediatrics   影响因子和分区

1720-8424

1824-7288

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 (I), 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, I = 39%); the RCTs were not significantly different (SMD = -0.04; 95% CI: -0.15 to 0.08, P = 0.54, I = 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.

Efficacy Home phototherapy Meta-analysis Neonatal hyperbilirubinemia

SCI

英语

其他

2-s2.0-85186612775

Scopus

1.Division of Neonatology,Longgang District Maternity & amp; Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College),Shenzhen,China
2.Department of Pediatrics Division of Neonatology,Shenzhen People’s Hospital (The Second Clinical Medical College,Jinan University,The First Affiliated Hospital,Southern University of Science and Technology),Shenzhen,China

Li，Rui,Li，Tingting,Yan，Xudong,et al. Efficacy of home phototherapy versus inpatient phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis[J]. Italian Journal of Pediatrics,2024,50(1).

Li，Rui,Li，Tingting,Yan，Xudong,Feng，Jing,Yu，Zhangbin,&Chen，Cheng.(2024).Efficacy of home phototherapy versus inpatient phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis.Italian Journal of Pediatrics,50(1).

Li，Rui,et al."Efficacy of home phototherapy versus inpatient phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis".Italian Journal of Pediatrics 50.1(2024).