Does Phototherapy Affect Ductus Arteriosus Closure in Preterm Infants ≤32 Weeks of Gestation, and Can We Influence This Through Chest Shielding? Review of the Literature and a Meta-Analysis.

Abstract

<b>Background</b>: Persistency of patent ductus arteriosus is the main cardiac condition in the preterm population born before 32 completed weeks of gestation with possible short- and long-term hemodynamic disturbances leading to vast morbidity. Jaundice is present in the majority of very preterms needing phototherapy, that also may have an influence on immature hemodynamics. The objectives of this review and meta-analysis were to find relevant evidence of whether chest shielding during phototherapy does or does not have an impact on the ductus arteriosus patency and hemodynamics. <b>Methods</b>: we reviewed the literature and performed a meta-analysis of five randomized controlled trials regarding chest shielding effect on the ductus arteriosus closure. <b>Results</b>: A total of 452 infants, with a mean gestational age of 28.04 weeks and mean birth weight of 1004.8 g were included in our meta-analysis, where we found an RR of 0.6 for developing PDA during phototherapy and chest shielding (95% CI: 0.37; 0.96. prediction interval: 0.18; 1.99) while development of hemodynamically significant PDA had RR = 0.57, within 95% CI: 0.3; 1.06, and a predictive interval between: 0.11; 2.93. <b>Conclusions</b>: Although the estimated RR may suggest a possible moderate protective role of the chest shield regarding development of PDA during phototherapy, the wideness of the predictive intervals, that include no effect, as well as the small number of eligible trials with heterogeneity between them, make the available data insufficient to evaluate the effectiveness of chest shielding during phototherapy. For more conclusive evidence there is a need for well-designed, blinded, multicenter randomized controlled trials with standardized assessment addressing to a more compact target population, knowing the large physiological differences among preterm infants of different gestational ages.