Sunlight for the prevention and treatment of hyperbilirubinemia in full-term and late preterm neonates
Horn D, Ellet D, Gautam KS, Sol R. Sunlight for the prevention and treatment of hyperbilirubinemia in full-term and late preterm neonates. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD013277. doi: 10.1002 /14651858.CD013277.pub2. Accessed August 1, 2021.
Description.
This study was being conducted to evaluate the efficacy of daylight administered alone or with filtration or amplification devices for the prevention and treatment of clinical jaundice or laboratory-diagnosed hyperbilirubinemia in full-term and late preterm infants.
Three RCTs (1103 infants) were included in the review as the primary outcome. These studies had a high risk of bias due to small sample size and lack of blinding.
Sunlight with or without filters or amplification compared with no treatment for the prevention and treatment of hyperbilirubinemia in full-term and late preterm neonates.
One study on twice-daily sun exposure (30-60 minutes) compared with no treatment reported a possible reduction in the incidence of jaundice and a possible reduction in the number of days infants were in distress. There were also no data on the safety or adverse effects of the intervention.
Sunlight with or without filtering or amplification compared with other phototherapy sources for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia.
Two studies (621 infants) compared the effects of exposure to filtered sunlight to other phototherapy sources for the treatment of hyperbilirubinemia in infants with confirmed hyperbilirubinemia and found that filtered sunlight phototherapy (FSPT) and conventional or intensive electrophototherapy resulted in effective treatment of similar days FSPT and conventional or intensive electro-phototherapy resulted in effective treatment for similar number of days. It is possible that there is no difference at all in treatment failure requiring exchange transfusion.
Possible harms included a possible increased risk of hyperthermia (body temperature above 37.5°C) with FSPT.
The authors conclude that
Sunlight is an effective adjunct to conventional phototherapy in the LMIC setting and may be preferable to family as it allows for rotational use of limited phototherapy equipment and allows for increased bonding. Sunlight filtration to block harmful UV rays and frequent temperature checks of the baby in sunlight may be warranted for safety. Sunlight may be effective in preventing hyperbilirubinemia, but these studies have not shown that sunlight alone is effective in treating hyperbilirubinemia because of its sporadic availability and the low or very low certainty of the evidence in these studies.
