Effect of irradiance and delivery configuration on phototherapy efficacy in preterm infants: a network meta-analysis and meta-regression of randomized trials

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Abstract

BACKGROUND: To compare the effectiveness and safety of different phototherapy strategies in preterm infants using a network meta-analysis of randomized controlled trials, and to explore whether treatment and population-level characteristics modify the rate of bilirubin decline. METHODS: We performed a systematic review and frequentist random-effects network meta-analysis of randomized controlled trials enrolling preterm infants (< 37 weeks' gestation). Phototherapy interventions were grouped based on light source and delivery configuration. Prespecified network meta-regression analyses were conducted to explore potential effect modification by irradiance intensity, delivery configuration, gestational age, birth weight, and baseline bilirubin. The primary outcome was rate of total serum bilirubin decline within 24 h of treatment initiation. This network meta-analysis was prospectively registered in PROSPERO (CRD420261307223). RESULTS: Twenty randomized trials were included. Double surface phototherapy led to increased TSB reduction (mean difference 0.17 mg/dl/h, 95% CI 0.11-0.22). Higher irradiance strategies demonstrated greater point estimates, although most pairwise comparisons did not reach statistical significance. Meta-regression did not identify statistically significant effect modification, but effect directions were consistent. CONCLUSIONS: In preterm infants, phototherapy efficacy appears to be more closely related to irradiance intensity and exposed body surface area than to device category alone. CLINICAL TRIAL NUMBER: Not applicable.

Abstract as published, via PubMed.