Summary of findings 2. Sunlight (with or without filters or amplification) versus other sources of phototherapy for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia.
| Sunlight (with or without filters or amplification) versus other sources of phototherapy for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia | ||||||
| Patient or population: infants with confirmed hyperbilirubinemia Setting: Island Maternity Hospital in Lagos, Nigeria and Bowen University Teaching Hospital in Ogbomoso, Nigeria Intervention: sunlight with or without filters or amplification Comparison: other sources of phototherapy | ||||||
| Outcomesa | Anticipated absolute effectsb (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with other sources of phototherapy | 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 in either study | |
| — | — | |||||
| Treatment failure requiring exchange transfusionc,d | Study population | RR 1.00 (0.06 to 15.73) | 621 (2 RCTs) | ⊕⊕⊝⊝ Lowe | — | |
| 3 per 1000 | 3 per 1000 (0 to 51) | |||||
| Acute bilirubin encephalopathyc,f | Study population | RR not estimable RD 0.00 (−0.02 to 0.02) |
174 (1 RCT) | ⊕⊕⊝⊝ Lowe | — | |
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Hyperthermia while receiving sunlight or conventional phototherapyg | Study population | RR 4.39 (2.98 to 6.47) | 621 (2 RCTs) | ⊕⊕⊕⊝ Moderateh | — | |
| 87 per 1000 | 382 per 1000 (260 to 564) | |||||
| Deathc | Study population | RR not estimable RD 0.00 (−0.01 to 0.01) |
447 (1 RCT) | ⊕⊕⊝⊝ Lowe | — | |
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Proportion of days of effective treatmenti | Study population | RR 1.02 (0.97 to 1.06) | 621 (2 RCTs) | ⊕⊝⊝⊝ Very lowj | — | |
| 896 per 1000 | 914 per 1000 (869 to 950) | |||||
| Hypothermia while receiving sunlight or conventional phototherapyk | Study population | RR 1.06 (0.55 to 2.03) | 621 (2 RCTs) | ⊕⊕⊕⊝ Moderateh | — | |
| 52 per 1000 | 55 per 1000 (28 to 105) | |||||
| CI: confidence interval; RCT: randomized controlled trial; RD: risk difference; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDuring initial hospitalization unless otherwise noted. bThe risk in the intervention group (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. eDowngraded twice for very serious imprecision. fDefined as retrocollis and opisthotonus in association with irritability, drowsiness, poor or no feeding, alternating tone, high‐pitched or shrill cry, lethargy, coma, fever, or seizure. gDefined as temperature greater than 38 °C. hDowngraded once for serious risk of bias (lack of blinding of intervention). iDefined in individual studies. jDowngraded twice for serious risk of bias (lack of blinding of intervention) and twice for indirectness. kDefined as temperature less than 35.5 °C.