Li Rui, Li Tingting, Yan Xudong, Feng Jing, Yu Zhangbin, Chen Cheng
Division of Neonatology, Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, China.
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.
Ital J Pediatr. 2024 Mar 4;50(1):37. doi: 10.1186/s13052-024-01613-0.
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.
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.
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.
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.
对于新生儿高胆红素血症，家庭光疗（HPT）仍是住院光疗（IPT）的一个有争议的替代方案。为指导基于证据的临床决策，我们对随机临床试验（RCT）和队列研究进行了荟萃分析，并评估了HPT和IPT的相对风险与益处。
检索了PubMed、Embase、Web of Science、Cochrane图书馆、中国知网数据库、万方数据库、维普数据库、ClinicalTrials.gov以及国际临床试验注册平台试验，检索时间从建库至2023年6月2日。我们纳入了RCT和队列研究，并遵循系统评价和荟萃分析的首选报告项目指南。使用Cochrane协作偏倚风险工具和纽卡斯尔-渥太华量表评估研究质量。结局指标为光疗持续时间、每日胆红素水平降低情况、换血治疗、再次入院、家长压力量表以及并发症。我们使用固定效应或随机效应荟萃分析模型，评估异质性（I），进行亚组分析，评估发表偏倚，并对证据质量进行分级。
纳入了9项研究（998例患者）（4项RCT，5项队列研究）。HPT与更长的光疗持续时间相关（标准化均数差[SMD]=0.55，95%可信区间[CI]：0.06 - 1.04，P = 0.03）。队列研究亚组分析得出一致结果（SMD = 0.90；95% CI：0.69至1.11，P < 0.001，I = 39%）；RCT之间无显著差异（SMD = -0.04；95% CI：-0.15至0.08，P = 0.54，I = 0%）。HPT组再次入院率更高（风险比[RR]=4.61；95% CI：1.43 - 14.86，P = 用固定效应或随机效应荟萃分析模型，评估异质性（I），进行亚组分析，评估发表偏倚，并对证据质量进行分级。
纳入了9项研究（998例患者）（4项RCT，5项队列研究）。HPT与更长的光疗持续时间相关（标准化均数差[SMD]=0.55，95%可信区间[CI]：0.06 - 1.04，P = 0.03）。队列研究亚组分析得出一致结果（SMD = 0.90；95% CI：0.69至1.11，P < 0.001，I = 39%）；RCT之间无显著差异（SMD = -0.04；95% CI：-0.15至0.08，P = 0.54，I = 0%）。HPT组再次入院率更高（风险比[RR]=4.61；95% CI：1.43 - 14.86，P = 0.01）。每日胆红素降低情况（加权均数差[WMD]= -0.12，95% CI：-0.68至0.44，P = 0.68）或并发症无显著差异（RR = 2.29；95% CI：0.31 - 16.60，P = 0.41）。证据质量非常低。HPT与较低的家长压力相关（SMD = -0.44，95% CI：-0.71至-0.16，P = 0.002）。纳入的3项研究均未报告换血治疗情况。
目前的证据并不强烈支持HPT对新生儿高胆红素血症的疗效，因为关于长期结局的高质量数据稀缺。未来的研究应优先开展设计良好、大规模、高质量的RCT，以全面评估HPT的风险和益处。
