Phenobarbitone for prevention and treatment of unconjugated hyperbilirubinemia in preterm neonates: a systematic review and meta-analysis.
OBJECTIVE
To evaluate the role of phenobarbitone in the management of unconjugated hyperbilirubinemia during first two weeks of life in preterm neonates.


METHODS
Meta-analysis.


METHODS
A study was eligible for inclusion in the metaanalysis if it randomized preterm neonates into control and treatment groups. Standard search strategy of the Cochrane Neonatal Review Group was used. For categorical and continuous data the odds ratio (OR) and weighted mean difference (WMD) were calculated, respectively. 95% confidence intervals were used and a fixed effects model was assumed for the metaanalysis.


METHODS
Peak serum bilirubin, duration of phototherapy, need of phototherapy and exchange transfusion, neurodevelopmental outcome and adverse effects.


RESULTS
A total of 19 potentially relevant studies were identified. Of these, 3 studies (497 neonates) were included in the metaanalysis. Peak serum bilirubin was significantly lower in phenobarbitone group (mean difference: -1.78 mg/dL, 95% CI: -2.29 to -1.27). Duration of phototherapy was shorter (mean difference: -14.75 h, 95% CI: -26.67 to -2.83). Need of phototherapy (OR: 0.33, 95% CI: 0.13 to 0.81) and exchange transfusion (OR: 0.30, 95% CI: 0.14 to 0.64) were also reduced in phenobarbitone group.


CONCLUSIONS
Phenobarbitone reduces peak serum bilirubin, duration and need of phototherapy and need of exchange transfusion in preterm very low birthweight neonates. Further studies are warranted to evaluate adverse effects and neurodevelopmental outcome.
Chawla
Deepak
D
Department of Pediatrics, Government Medical College Hospital, Chandigarh, India. drdeepakchawla@hotmail.com
Parmar
Veena
V
D001663:Bilirubin / Q000097:blood; D005078:Exchange Transfusion, Whole Blood; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D010634:Phenobarbital / Q000627:therapeutic use*; D010789:Phototherapy; D047928:Premature Birth; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D001663:Bilirubin; D010634:Phenobarbital