Summary of findings 1. Sunlight (with or without filters or amplification) versus no treatment for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates.
| Sunlight (with or without filters or amplification) versus no treatment for the prevention and treatment of hyperbilirubinemia in term and late preterm neonates | ||||||
| Patient or population: term and late preterm neonates Setting: Schenzen Maternity and Child Healthcare Hospital and individual patients' homes in and around Schenzen, China Intervention: sunlight with or without filters or amplification Comparison: no treatment | ||||||
| Outcomesa | Illustrative comparative risksb (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Risk with no treatment | Risk with sunlight with or without filters or amplification | |||||
| Use of conventional phototherapy, if sunlight (with or without filters or amplification) was first used for prevention or early treatmentc | Study population | — | — | — | Not reported | |
| — | — | |||||
| Treatment failure requiring exchange transfusionc,d | Study population | — | — | — | Not reported |
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| — | — | |||||
| Acute bilirubin encephalopathyc,e | Study population | — | — | — | Neither acute nor chronic bilirubin encephalopathy reported | |
| — | — | |||||
| Deathc | Study population | — | — | — | Not reported | |
| — | — | |||||
| Rate of rehospitalization within 7 days of discharge for treatment for hyperbilirubinemia | Study population | RR 0.55 (0.27 to 1.11) | 482 (1 RCT) | ⊕⊝⊝⊝ Very lowf | — | |
| 83 per 1000 | 46 per 1000 (23 to 93) | |||||
| Incidence of jaundice in participantsg | Study population | RR 0.61 (0.45 to 0.82) | 482 (1 RCT) | ⊕⊝⊝⊝ Very lowf | — | |
| 354 per 1000 | 216 per 1000 (159 to 290) | |||||
| Duration of jaundice (days) | The mean duration of jaundice was 6.5 (SD 2.7) days | MD 2.2 lower (2.6 lower to 1.8 lower) | — | 482 (1 RCT) | ⊕⊝⊝⊝ Very lowf | — |
| CI: confidence interval; MD: mean difference; RCT: randomized controlled trial; RR: risk ratio; SD: standard deviation. | ||||||
| GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate. | ||||||
aDuring initial hospitalization unless otherwise noted. bThe basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). cProspectively identified as primary outcome measures. dDefined by receiving an exchange transfusion; or bilirubin level greater than 15 mg/dL in the first 24 hours of life, greater than 17 mg/dL in the first 48 hours of life, or greater than 20 mg/dL after 72 hours of life. eDefined as retrocollis and opisthotonus in association with irritability, drowsiness, poor or no feeding, alternating tone, high‐pitched or shrill cry, lethargy, coma, fever, or seizures, or chronic bilirubin encephalopathy or kernicterus, defined as athetoid cerebral palsy, auditory dysfunction, dental‐enamel dysplasia, paralysis of upward gaze, and, occasionally, intellectual and other disabilities. fSingle center, unblinded study of 482 infants; downgraded twice for very serious study limitations (due to high risk of bias) and once for imprecision. gDefined as bilirubin level greater than 257 µmol/L.