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Home - versus hospital-based phototherapy for the treatment of non-haemolytic jaundice in infants at more than 37 weeks' gestation

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Authors

Ujjwala S Malwade1, Luke A Jardine2

Background - Methods - Results - References - Data Tables and Graphs


1Department of Paediatrics, Mater Children's Hospital, South Brisbane, Australia [top]
2Department of Neonatology, Mater Mothers' Hospital, Mater Medical Research Institute, The University of Queensland, South Brisbane, Australia [top]

Citation example: Malwade US, Jardine LA. Home- versus hospital-based phototherapy for the treatment of non-haemolytic jaundice in infants at more than 37 weeks' gestation. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD010212. DOI: 10.1002/14651858.CD010212.pub2.

Contact person

Ujjwala S Malwade

Department of Paediatrics
Mater Children's Hospital
Raymond Terrace
South Brisbane
Queensland
4101
Australia

E-mail: drujjwala@yahoo.co.in

Dates

Assessed as Up-to-date: 15 February 2013
Date of Search: 15 February 2013
Next Stage Expected: 15 February 2015
Protocol First Published: Issue 11, 2012
Review First Published: Issue 6, 2014
Last Citation Issue: Issue 6, 2014

Abstract

Background

Phototherapy is commonly used for the treatment of neonatal jaundice, and home-based phototherapy is now being used in certain centres. Home-based phototherapy offers possible advantages by avoiding prolonged hospital admissions, promoting mother-infant bonding and reducing hospitalisation costs. Potential problems include increased duration of phototherapy, increased readmission to hospital and increased risk of bilirubin encephalopathy.

Objectives

To compare exclusively home-based versus exclusively hospital-based phototherapy or a combination of home- and hospital-based phototherapy for the management of non-haemolytic jaundice in term infants up to 28 days of age. We planned to include specific subgroups for duration in hospital, method of phototherapy and criteria for readiness for discharge.

Search methods

We searched the Cochrane Neonatal Review Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) January 2013, Issue 1, part of The Cochrane Library, MEDLINE (from 1966 to 15 February 2013), CINAHL (from 1982 to 15 February 2013) and EMBASE (from 1988 to 15 February 2013). We searched for abstracts from the Pediatric Academic Societies' Annual Meetings 2000 to 2013. We searched for ongoing trials on the following websites: ClinicalTrials.gov and Controlled-Trials.com External Web Site Policy.

Selection criteria

Randomised and quasi-randomised studies comparing term infants who received phototherapy exclusively at home versus phototherapy exclusively in the hospital or a combination of the two for non-haemolytic jaundice.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data.

Results

No studies that met the predefined eligibility criteria were identified.

Authors' conclusions

No high-quality evidence is currently available to support or refute the practice of home-based phototherapy for non-haemolytic jaundice in infants at more than 37 weeks' gestation.

Plain language summary

Home- versus hospital-based treatment for uncomplicated newborn jaundice in term infants

Newborn infants commonly develop a condition called jaundice. Jaundice occurs as the result of accumulation of a yellowish-orange pigment called bilirubin in the skin and eyes. Bilirubin in increased concentrations can be damaging to the brain and can have profound long-term detrimental effects. Phototherapy is a form of treatment used in newborns to reduce levels of bilirubin. "Home-based phototherapy" can be used in the home setting with appropriate supervision. Home phototherapy is used only in cases of uncomplicated newborn jaundice. Home-based phototherapy can offer certain advantages such as reduced hospital costs and improved bonding between an infant and mother. On the other hand, home-based phototherapy could be associated with problems such as increased risk of the damaging effects of bilirubin on the brain and increased risk of readmission to hospital. In this Cochrane review, home-based phototherapy was compared with hospital-based phototherapy for uncomplicated jaundice in full-term newborns. The review authors found no studies that met the eligibility criteria. The authors of this Cochrane review conclude that no high-quality evidence is currently available to support or refute the use of home phototherapy for uncomplicated newborn jaundice.

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Background

Description of the condition

Jaundice is a common condition in neonates, occurring in 60% to 84% of late term and term infants (Keren 2009; Kliegman 2011; Bhutani 2011). Jaundice refers to a yellow discolouration of the skin and sclera that occurs when levels of bilirubin are increased. Bilirubin is produced by the catabolism of haemoglobin. Haeme is broken down in the reticuloendothelial system to biliverdin and carbon monoxide, and biliverdin is reduced to bilirubin by biliverdin reductase (Moerschel 2008). Bilirubin is conjugated by glucuronosyl transferase to bilirubin diglucuronide, which is water soluble and can be excreted easily by the liver and biliary tract (Moerschel 2008). If the rate of bilirubin production exceeds the rate of its elimination, the end result is an increase in total serum bilirubin—a clinical condition called hyperbilirubinaemia.

Distinctive aspects of normal newborn physiology predispose to hyperbilirubinaemia, including increased bilirubin synthesis, decreased binding and transport, impaired conjugation and excretion and enhanced enterohepatic circulation of bilirubin. Breast feeding may also contribute to benign neonatal hyperbilirubinaemia. Normal physiological levels of total serum bilirubin are controversial, as several factors affect these, such as gestational age, birthweight, disease state, degree of hydration, nutritional status and ethnicity. Benign neonatal hyperbilirubinaemia is also known as physiological jaundice. The causes of non-physiological or pathological hyperbilirubinaemia are varied and include disorders of bilirubin production, disorders of bilirubin clearance, metabolic and endocrine disorders, increased enterohepatic circulation and substances affecting the binding of bilirubin to albumin.

Unconjugated bilirubin is lipid soluble and can easily cross the blood-brain barrier. Unconjugated bilirubin is toxic to the central nervous system and in high concentrations can penetrate the brain cells, leading to neuronal dysfunction and death. Factors that determine the toxicity of bilirubin in neurons are complex and are not well understood (AAP 2004). Neurological damage can take the form of acute or chronic bilirubin encephalopathy. Acute bilirubin encephalopathy is an evolving encephalopathy that can progress in three phases. In the initial phase, the infant displays lethargy, hypotonia, reduced movement and a poor suck. The intermediate phase consists of cardinal signs of moderate stupor, irritability and increased tone; retrocollis and opisthotonus may be noted. The advanced stage is characterised by deep stupor, increased tone, inability to feed and a shrill cry; seizures may occur (AAP 2004). Chronic bilirubin encephalopathy (called kernicterus) is the term reserved for infants who have permanent sequelae (AAP 2004). Features of chronic bilirubin encephalopathy include athetoid cerebral palsy, high-frequency sensorineural hearing loss, palsy of vertical gaze and dental enamel hypoplasia (AAP 2004).

Description of the intervention

Phototherapy causes structural changes in the bilirubin molecule and results in the formation of more polar stereoisomers, which are water soluble and can be excreted easily in the urine (Mreihil 2010). Phototherapy can be administered by a variety of different methods (e.g. conventional halogen lamps, fluorescent lamps, fibreoptic systems) (Kumar 2010). Phototherapy has traditionally been used in the hospital setting but can be provided in the home if appropriate equipment and support are available. Home phototherapy can be exclusively home-based or can be preceded or followed by hospital phototherapy. This is a matter of importance because of the rising trend toward early discharges from hospital. Home phototherapy for uncomplicated physiological hyperbilirubinaemia has led to appropriate reductions in serum bilirubin (Tudehope 2000). Home phototherapy can be performed with conventional lamps or with the use of a fibreoptic system. Factors likely to be considered when a patient is recommended for home phototherapy include distance from hospital, motivation and competency of the parents. A Cochrane review looking at types of phototherapy has been completed. It looks at the effectiveness of fibreoptic compared with conventional phototherapy by assessing several different parameters and use of these treatments in different conditions (Mills 2009), Another Cochrane review compared light-emitting diodes versus conventional light sources for providing phototherapy (Kumar 2011).

How the intervention might work

Neonatal jaundice may have to be treated with phototherapy to prevent the damaging effects of unconjugated hyperbilirubinaemia on the developing brain (Mreihil 2010). Guidelines for the treatment of neonatal jaundice vary worldwide (Hansen 2000). The American Academy of Pediatrics (AAP) clinical practice guidelines were put forth in 2004 with the aim of preventing and treating hyperbilirubinaemia in infants with a gestational age of 35 weeks or more (AAP 2004). Several factors may affect the dose and efficacy of phototherapy, such as spectrum of light emitted, spectral irradiance delivered to the surface of the infant, spectral power, the cause of jaundice and total serum bilirubin at the start of phototherapy (AAP 2004). The evidence base for the treatment of hyperbilirubinaemia in term infants, especially with regards to prevention of neurodevelopmental damage, is very limited; overall, four studies reported an absolute risk reduction rate of 10% to 17% for prevention of serum bilirubin levels greater than 20 mg/dL in healthy infants with jaundice when phototherapy was used (Ip 2004).

Home phototherapy may prevent prolonged hospitalisation. It can promote mother-infant bonding and lead to increased parental satisfaction (Grabert 1986). Parents may experience a sense of independence and control regarding the care of their baby when using home phototherapy. Its use may result in a reduction in the costs of treatment. Home phototherapy may provide an opportunity to review the mother or the baby for other problems (aside from jaundice) in the early neonatal period, which may not have been obvious in the hospital setting. Three observational studies have looked at home versus hospital phototherapy in term infants. One of these studies revealed that the average reduction in serum bilirubin concentration was similar in the two groups after the first day of treatment. However, the duration of phototherapy was longer for the group treated at home (Slater 1984). The second study revealed that both mean daily reduction in serum bilirubin concentration and mean duration of treatment were significantly less for the home group as compared with the hospital group (Zainab 2003). The third study revealed that the two groups were comparable with regards to reduction in bilirubin levels and duration of phototherapy, and that home phototherapy was a feasible, safe and effective alternative to in-hospital phototherapy for otherwise healthy, jaundiced infants with motivated and capable parents. This study also demonstrated a significant reduction in costs with home phototherapy (Eggert 1985).

Why it is important to do this review

Potential problems with home phototherapy include increased risk of bilirubin encephalopathy, increased duration of phototherapy and increased risk of readmission to hospital. Home phototherapy can be cheaper to perform than hospital-based phototherapy, as it releases valuable bed space; however home phototherapy also has the potential for increased costs because of the required equipment and support personnel and the risk of readmission. Home phototherapy may facilitate establishment of the parent-infant bond. We reviewed the literature to determine the risks and benefits of home versus hospital phototherapy for the treatment of non-haemolytic jaundice in term infants.

Objectives

To compare exclusively home-based versus exclusively hospital-based phototherapy or a combination of home- and hospital-based phototherapy for the management of non-haemolytic jaundice in term infants up to 28 days of age. We planned to include specific subgroups for duration in hospital, method of phototherapy and criteria for readiness for discharge.

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Methods

Criteria for considering studies for this review

Types of studies

Randomised controlled trials (RCTs) or quasi-RCTs in which individual newborns or clusters of infants were randomly assigned to receive phototherapy at home or in the hospital.

Types of participants

Newborn infants (gestation of 37 weeks or more at birth) up to 28 days of age with jaundice or an elevated serum bilirubin (as defined in individual studies) who required phototherapy for non-haemolytic jaundice. Non-haemolytic jaundice was defined by the absence of jaundice in the first 24 hours of life or the absence of progressive or prolonged jaundice, a negative Coombs' test and the absence of anaemia or an increased reticulocyte count. Infants otherwise were to be healthy and feeding well.

Types of interventions

Exclusively home-based phototherapy versus exclusively hospital-based phototherapy or combinations of hospital and home phototherapy (e.g. phototherapy commenced in the hospital and participant discharged home on phototherapy, or phototherapy commenced at home and participant transferred to hospital for continuation) for non-haemolytic jaundice in term infants. We planned to consider any type of phototherapy device. We planned to consider for inclusion any trial in which phototherapy was undertaken in the home setting (even if initiated in hospital).

Types of outcome measures

Primary outcomes
  • Rate of change of serum bilirubin (micromoles/L/h) from initiation of phototherapy to cessation of phototherapy.
  • Duration of phototherapy from initiation to end (hours).
  • Duration of time exposed to phototherapy (hours). Some infants will have short periods off phototherapy for feeding, etc.
  • Incidence of acute bilirubin encephalopathy, which ranges from the initial phase of lethargy, hypotonia, reduced movement and a poor suck to the advanced phase of deep stupor, hypertonia, inability to feed and a shrill cry or seizures.
  • Incidence (percentage) of chronic bilirubin encephalopathy or kernicterus, defined by a tetrad of choreoathetoid cerebral palsy, high-frequency sensorineural hearing loss, palsy of vertical gaze and dental enamel hypoplasia.
  • Rate of treatment failure (percentage) (defined as the need for exchange transfusion).
Secondary outcomes
  • Need for recommencement of phototherapy after initial cessation for increased serum bilirubin.
  • Rate of rehospitalisation within seven days of discharge for recommencement of phototherapy.
  • Costs (however defined in individual studies).
  • Parent-infant bonding.
  • Maternal satisfaction.
  • Nursing satisfaction (as defined in individual studies).
  • Co-interventions (e.g. fluid supplementation, cessation of breast milk).

Search methods for identification of studies

Electronic searches

We used the standard search strategy for the Cochrane Neonatal Review Group. We searched the Cochrane Neonatal Review Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) January 2013, Issue 1, part of The Cochrane Library, MEDLINE (from 1966 to 15 February 2013), CINAHL (from 1982 to 15 February 2013) and EMBASE (from 1988 to 15 February 2013), using the following strategy.

Medical Subject Heading (MeSH) search terms "Jaundice" OR the text words "hyperbilirubin$"
AND
MeSH search term "Infant" OR the text words "neonat$", "infant", "term", "newborn"
AND
MeSH search term "Phototherapy" OR text words "biliblanket", "wallaby", "phototherapy", "fiber optic"

AND

MeSH search term "randomised controlled trial".

Searching other resources

We searched previous reviews (including cross-references). Searches were not restricted to publications in the English language or to published data.

We searched for abstracts online from the Pediatric Academic Societies Annual Meetings (Abstract2view) from 2000 to 2013.

We searched for ongoing trials on the following websites: ClinicalTrials.gov and Controlled-Trials.com External Web Site Policy.

Data collection and analysis

We used the standard methods of The Cochrane Collaboration and its Neonatal Review Group (Higgins 2011).

Selection of studies

Both review authors worked independently to search for trials for inclusion.

Data extraction and management

Both review authors extracted data independently and, when required, resolved differences by discussion. It was planned to contact study investigators to ask for additional information or data if required, once missing data had been identified.

Assessment of risk of bias in included studies

Both review authors worked independently to assess trials for methodological quality. Studies were assessed using the following key criteria: allocation concealment (blinding of randomisation), blinding of intervention, completeness of follow-up and blinding of outcome measurement, with a rating assigned as follows: low risk—adequate (any truly random process, e.g. random number table; computer random number generator); high risk—inadequate (any non-random process, e.g. odd or even date of birth; hospital or clinic record number); unclear risk—no or unclear information provided (Higgins 2002).

In addition, we planned to evaluate the following issues and enter the findings into the risk of bias table.

  • Sequence generation: Was the allocation sequence adequately generated? 
  • Allocation concealment: Was allocation adequately concealed? 
  • Blinding of participants, personnel and outcome assessors: Was knowledge of the allocated intervention adequately prevented during the study? At study entry? At the time of outcome assessment? Although it is impossible to completely blind participants (parents) or health professionals to the nature of the intervention, outcome assessors can be blinded.
  • Incomplete outcome data: Were incomplete outcome data adequately addressed? 
  • Selective outcome reporting: Are reports of the study free of the suggestion of selective outcome reporting? 
  • Other sources of bias: Was the study apparently free of other problems that could put it at high risk of bias?

Measures of treatment effect

We planned to perform statistical analyses using Review Manager software (RevMan 2011). We planned to analyse categorical data using risk ratio (RR), risk difference (RD), the number needed to treat for an additional beneficial outcome (NNTB) and the number needed to treat for an additional harmful outcome (NNTH). We planned to analyse continuous data using weighted mean difference (WMD). We planned to report the 95% confidence interval (CI) for all estimates.

Unit of analysis issues

We planned to include in the review cluster-randomised trials. We planned to confirm that the order of treatments had been randomly assigned (Higgins 2002). We planned to attempt to access paired and unpaired data (Higgins 2002). We planned to impute the correlation coefficient from data provided in the included studies in this meta-analysis. If this information was not available, we planned to assume a value of 0.4 and conduct a sensitivity analysis by successively using r = 0.3 and r = 0.5.

Dealing with missing data

We planned to attempt to contact study authors to ask for missing data.

Assessment of heterogeneity

If sufficient included studies were identified, we planned to assess heterogeneity using the I2 statistic and the Chi2 test. If we found statistical heterogeneity, we planned to look for an explanation. Apart from the planned subgroup analyses detailed below, no other a priori specific potential causes of heterogeneity were explored.

Assessment of reporting biases

To determine whether selective reporting might have occurred, we planned to look for prespecified outcomes in trial registries and compare them with reported outcomes. If discrepancies were noted, we planned to attempt to contact the corresponding author.

In assessing for duplication bias, we planned to closely examine articles from repeated authors or sites and compare sample size, characteristics and details of studies. If overlap was apparent, we planned to attempt to contact the corresponding author.

If we were not successful in contacting study authors, we planned to include in our conclusions possible sources of reporting bias.

We planned to attempt to determine whether publication bias was present by plotting results of studies and determining whether they were published. If skewing was seen, with positive results being published and negative results not being published, we planned to report this. 

We planned to determine the range of languages, locations and citation sources to examine potential bias.

Data synthesis

We planned to carry out an intention-to-treat analysis based on the first assigned method of phototherapy. For the meta-analysis, we planned to report WMD and 95% CI for continuous variables. For categorical outcomes, we planned to report RR and 95% CI. For significant findings, we planned to report RD, NNTB and NNTH.

We planned to use the fixed-effect model for meta-analysis.

Subgroup analysis and investigation of heterogeneity

We planned to perform subgroup analyses if possible based on the following.

  • Method of phototherapy.
    • Fibreoptic.
    • Conventional.
    • Light-emitting diode.
    • Other.
  • Duration of hospital-based phototherapy before discharge for home phototherapy.
    • No hospital phototherapy.
    • Less than 24 hours of hospital phototherapy before discharge.
    • More than 24 hours of hospital phototherapy before discharge.
  • Age of initiation of home phototherapy.
  • Criteria for readiness for home phototherapy, however defined in individual studies.

Sensitivity analysis

We planned to perform a sensitivity analysis (data permitting) to see whether results differ according to the quality of included studies (e.g. adequacy of randomisation: quasi-randomised vs randomised).

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Results

Description of studies

The above search strategy failed to identify any studies that met the predefined selection criteria.

Results of the search

All records identified in the electronic search could be excluded easily on the basis of title and abstract alone. No additional records were identified through other sources. The above search strategy failed to identify any studies that met the selection criteria.

Included studies

No study that could be included in this review was identified. No planned or ongoing studies were identified.

Excluded studies

No study that needed to be assessed for exclusion was identified.

Risk of bias in included studies

As no study was included, risk of bias was not assessed.

Allocation (selection bias)

As no study was included, allocation was not assessed.

Blinding (performance bias and detection bias)

As no study was included, blinding was not assessed.

Incomplete outcome data (attrition bias)

As no data were included, attrition bias could not be assessed.

Selective reporting (reporting bias)

As no study was included, reporting bias could not be assessed.

Other potential sources of bias

As no study was included, no assessment for other sources of bias could be undertaken.

Effects of interventions

No study was included; therefore effects of interventions could not be determined.

Discussion

No studies that met the selection criteria for this review were identified. With the potential to use the new light-emitting diode blanket systems, it is likely that home phototherapy is just as effective as hospital-based systems. Potential problems with home phototherapy include increased risk of bilirubin encephalopathy, increased duration of phototherapy and increased risk of readmission to hospital. Home phototherapy is cheaper to perform than hospital-based phototherapy, as it releases valuable bed space; however, it has the potential for increased costs due to required equipment and support personnel and risk of readmission. Home phototherapy may facilitate establishment of the parent-infant bond. More research is required to assess the risks and benefits of home-based phototherapy for non-haemolytic jaundice in infants at more than 37 weeks' gestation.

Summary of main results

No studies met the predefined criteria for inclusion in this review.

Overall completeness and applicability of evidence

Not applicable, as no studies with predefined criteria were found.

Quality of the evidence

Not applicable, as no studies with eligible criteria were found.

Potential biases in the review process

Not applicable, as no studies with eligible criteria were found.

Agreements and disagreements with other studies or reviews

Not applicable, as no studies with eligible criteria were found.

Authors' conclusions

Implications for practice

No high-quality evidence is currently available to support or refute the practice of home-based phototherapy for non-haemolytic jaundice in infants at more than 37 weeks' gestation.

Implications for research

High-quality randomised controlled trials are required to determine the risks and benefits of home-based phototherapy for non-haemolytic jaundice in infants at more than 37 weeks' gestation.

Acknowledgements

  • None noted.

Contributions of authors

Ujjwala Malwade (UM) wrote the protocol. Luke Jardine (LJ) edited the protocol. Both review authors carried out searches independently.

Declarations of interest

No conflicts of interest have been identified.

Differences between protocol and review

  • None noted.

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References to studies

Included studies

  • None noted.

Excluded studies

  • None noted.

Studies awaiting classification

  • None noted.

Ongoing studies

  • None noted.

Other references

Additional references

AAP 2004

American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114(1):297-316.

Bhutani 2011

Bhutani VK, Committee on Fetus and Newborn. American Academy of Pediatrics. Phototherapy to prevent severe neonatal hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.. Pediatrics October 2011;128(4):e1046-52.

Eggert 1985

Eggert LD, Pollary RA, Folland DS, Jung AL. Home phototherapy treatment of neonatal jaundice. Pediatrics 1985;76(4):579-84.

Grabert 1986

Grabert BE, Wardwell C, Harburg SK. Home phototherapy: an alternative to prolonged hospitalisation of the full-term, well newborn. Clinical Pediatrics 1986;25(6):291-4.

Hansen 2000

Hansen TW. Kernicterus in term and near-term infants—the specter walks again. Acta Paediatrica 2000;89(10):1155-7.

Higgins 2002

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 2002;21(11):1539-58.

Higgins 2011

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Verson 5.10 [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane-handbook.org.

Ip 2004

Ip S, Chung M, Kulig J, O'Brien R, Sege R, Glicken S, et al; American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics 2004;114(1):e130-53.

Keren 2009

Keren R, Tremont K, Luan X, Cnaan A. Visual assessment of jaundice in term and late preterm infants. Archives of Disease in Childhood (Fetal Neonatal) September 2009;94(5):F317-22.

Kliegman 2011

Kliegman RM, Stanton BMD, St Geme J, Schor NF, Behrman RE. Nelson Textbook of Pediatrics. 19th edition. St Louis, MO: Elsevier Saunders, 2011.

Kumar 2010

Kumar P, Murki S, Malik GK, Chawla D, Deorari AK, Karthi N, et al. Light emitting diodes versus compact fluorescent tubes for phototherapy in neonatal jaundice: a multi center randomized controlled trial. Indian Pediatrics 2010;47(2):131-7.

Kumar 2011

Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD007969. DOI: 10.1002/14651858.CD007969.pub2.

Mills 2009

Mills JF, Tudehope D. Fibreoptic phototherapy for neonatal jaundice. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD002060. DOI: 10.1002/14651858.CD002060.

Moerschel 2008

Moerschel SK, Cianciaruso LB, Tracy LR. A practical approach to neonatal jaundice. American Family Physician 2008;77(9):1255-62.

Mreihil 2010

Mreihil K, McDonagh AF, Nakstad B, Ruud Hansen TW. Early isomerization of bilirubin in phototherapy of neonatal jaundice. Pediatric Research 2010;67(6):656-9.

RevMan 2011

Review Manager (RevMan) [Computer program]. Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.

Slater 1984

Slater L, Brewer MF. Home versus hospital phototherapy for term infants with hyperbilirubinaemia: a comparative study. Pediatrics 1984;73(4):515-9.

Tudehope 2000

Jackson CK, Tudehope D, Willis L, Law T, Venz J. Home phototherapy for neonatal jaundice—technology and teamwork meeting consumer and service need. Australian Health Review 2000;23(2):162-8.

Zainab 2003

Zainab K, Adlina S. Effectiveness of home versus hospital phototherapy for term infants with uncomplicated hyperbilirubinaemia: a pilot study in Pahang, Malaysia. Medical Journal of Malaysia 2004;59(3):395-401.

Other published versions of this review

  • None noted.

Classification pending references

  • None noted.

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Data and analyses

  • None noted.

Sources of support

Internal sources

  • No sources of support provided

External sources

  • Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA
  • Editorial support of the Cochrane Neonatal Review Group has been funded with federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201100016C

This review is published as a Cochrane review in The Cochrane Library, Issue 6, 2014 (see http://www.thecochranelibrary.com External Web Site Policy for information).  Cochrane reviews are regularly updated as new evidence emerges and in response to feedback.  The Cochrane Library should be consulted for the most recent version of the review.