Date of Last Revision: 10/22 . foam closure strips for metal roofing | keokuk, iowa arrests newington high school football coach 0 American Academy of Pediatrics and American College of Obstetricians and Gynecologist. OL LI { Most of the included studies only mentioned the use of random allocation, but they did not describe the specific random allocation method. Stigma (plural stigmata) is a finding that may indicate an abnormal condition, such as a sacral dimple without a visible floor being stigma for occult spina bifida. The receiver operating characteristic analysis (for serum bilirubin levels greater than 205.2 micromol/L or greater than 239.4 micromol/L) showed significantly higher areas under the curve for BiliCheck than those for BiliMed (p < 0.001). 1998;101(1 Pt 1):25-31. Use a cupped hand or percussor cup. Reference No. @media print { Maisels MJ, McDonagh AF. The authors concluded that intermittent phototherapy appeared to be as effective as continuous phototherapy for the treatment of neonatal hyperbilirubinemia and was safer than continuous phototherapy. J Fam Pract. There was diagnostic testing or a specialty inpatient consult; or. American Academy of Pediatrics, Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia. Lets review which conditions should be reported and when. Meta-analysis was performed using random- or fixed-effect models. 2007;44(3):354-358. J Perinatol. Although an undescended testicle usually is described as palpable or impalpable, also get the location, if you can. 2005;17(2):167-169. 5 star restaurants st louis. No studies met the inclusion criteria for this review. These ELBW infants had participated in a randomized controlled trial of early DXM therapy thataimed toevaluate effects on chronic lung disease. The longer the newborn has before an auditory function screening, the greater the chance of a successful screening. PDF Clinical Policy: Phototherapy for Neonatal Hyperbilirubinemia Although screening can predict hyperbilirubinemia, there is no robust evidence to suggest that screening is associated with favorable clinical outcomes. Aetna considers measurement of glucose-6-phosphate dehydrogenase (G6PD) levelsmedically necessary for jaundiced infants who are receiving phototherapy, where response to phototherapy is poor, or where the infant is at an increased risk of G6PD deficiency due to family history, ethnic or geographic origin. Weisiger RA. 7. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. [glucose-6-phosphate dehydrogenase (G6PD), uridine diphosphate glucuronosyl transferase 1A1 (UGT1A1), and. Cincinnati Childrens, umbilical hernia: www.cincinnatichildrens.org/health/u/umbilical-herni, Copyright 2023, AAPC This generally refers to an undescended or maldescended testis. --> Newman TB, Maisels MJ. A total of 259 neonates were included in the meta-analysis. In some cases, phototherapy will only be needed for 24 hours or less, in some cases, it may be required for 5 to 7 days. Pediatrics. In particular, polymorphisms across 3 genes involved in bilirubin production and metabolism: Variant gene co-expression including compound and synergistic heterozygosity enhances hyperbilirubinemia risk, contributing to the etiologic heterogeneity and complex nature of neonatal jaundice. Mothers typically are counseled on newborn jaundice signs and when to bring the newborn in. 'New' bilirubin recommendations questioned. 1992;31(6):345-352. If done right, you will hear a popping sound. Usually, hip clicks involve watchful waiting, with the tendons and muscles continuing to develop until the click is no longer felt. Incidence of hyperbilirubinaemia, defined as serum total bilirubin (STB) greater than or equal to 15 mg/dL, was similar between groups (n = 286; risk ratio (RR) 0.94, 95 % CI: 0.58 to 1.52). Only 1 study met the criteria of inclusion in the review. Less than 30 minutes of hands-on care during transport would not be separately reported. These researchers stated that healthcare organizations and health workers should choose intermittent phototherapy as the preferred therapy for neonatal hyperbilirubinemia. Armanian and colleagues (2019) stated that hyperbilirubinemia occurs in approximately 2/3 of all newborns during the first days of life and is frequently treated with phototherapy. phototherapy in the home, applied by a . 2010;15(3):164-168. Approximately 60% of term babies and 85% preterm babies will develop clinically apparent jaundice, which classically becomes visible on day 3, peaks days 5-7 and resolves by 14 days of age in a term infant and by 21 days in the preterm infant. Our providers amend their office note to indicate the patient was admitted due to results then charge an Initial Outpatient Care code (99218-99220) for the day of admission and then 99217 for discharge. Liu et al (2013) examined if 3 variants (388 G>A, 521 T>C, and 463 C>A) of SLCO1B1 are associated with neonatal hyperbilirubinemia. Sometimes issues heal without interventions, such as minor hematomas from the birth process and laceration from the fetal monitoring electrode. 2014;165(1):42-45. Treatment of unconjugated hyperbilirubinemia in term and late preterm infants. PubMed, Embase, Web of science, EBSCO, Cochrane library databases, Ovid, BMJ database, and CINAHL were systematically searched; RCTs evaluating the effect of zinc sulfate versus placebo on the prevention of jaundice in neonates were included. They stated that there is a need for larger trials to determine how effective clofibrate is in reducing the need for, and duration of, phototherapy in term and preterm infants with hyperbilirubinemia. The literature search was done for various randomized control trial (RCT) by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, Scopus, Index Copernicus, African Index Medicus (AIM), Thomson Reuters (ESCI), Chemical Abstracts Service (CAS) and other data base. Behrman RE, ed. Aetna's policy on treatment of hyperbilirubinemia in infants is adapted from guidelines from the American Academy of Pediatrics. Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. .fixedHeaderWrap { Travan L, Lega S, Crovella S, et al. Chawla D, Parmar V. Phenobarbitone for prevention and treatment of unconjugated hyperbilirubinemia in preterm neonates: A systematic review and meta-analysis. More commonly seen in the documentation are: Without a diagnosis, abnormal results of routine screenings should not be coded unless the pediatrician states the abnormal results have implications for future healthcare. Menu penelope loyalty quotes. Can Nurse. Petersen JP, Henriksen TB, Hollegaard MV, et al. Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants. 2006;(4):CD004592. An example is hemangiomas (e.g., strawberry hemangiomas), which do not impinge on vital structures and are not located in the periorbital area, lip, neck, or sacral region. } }. Additionally, no serious adverse reaction was reported. The dose of zinc varied from 5 to 20mg/day and duration from 5 to 7 days. Moreover, these investigators stated that infants with bilirubin levels greater than 25 mg/dL, those who are not responding to phototherapy, and those with evidence of acute bilirubin encephalopathy should be treated with exchange transfusion, with initiation based on an infants age in hours and neurotoxicity risk factors. The therapy may be in the form of a lamp, light panel, or special light blanket. Hulzebos CV, Bos AF, Anttila E, et al. Ludwig MA. Am Fam Physician. list-style-type: upper-alpha; CPT Code for Cataract Removal without Implant For the term neonates, there were significantly lower bilirubin levels in the clofibrate group compared to the control group after both 24 and 48 hours of treatment with a weighted mean difference of -2.14 mg/dL (95 % CI: -2.53 mg/dL to -1.75 mg/dL) (-37 mol/L; 95 % CI: -43 mol/L to -30 mol/L] and -1.82 mg/dL (95 % CI: -2.25 mg/dL to -1.38 mg/dL) (-31 mol/L; 95 % CI: -38 mol/L to -24 mol/L), respectively. 2001;108(1):175-177. Two reviewers screened papers and extracted data from selected papers. UGT1A1 is the rate-limiting enzyme in bilirubin's metabolism. UpToDate[online serial]. 2009;124(4):1162-1171. Armanian AM, Jahanfar S, Feizi A, et al. However, the accuracy of TcB devices in infants exposed to phototherapy is unclear. Early corticosteroid treatment does not affect severity of unconjugated hyperbilirubinemia in extreme low birth weight preterm infants. Guidelines from the Canadian Paediatric Society (2007) found that phenobarbitol, studied as a means of preventing severe hyperbilirubinemia in infants with G6PD deficiency, did not improve clinically important outcomes in a randomized controlled clinical study (Murki et al, 2005). Only one physician may report this code. Zinc sulfate showed no influence on phototherapy requirement (OR=0.90; 95 % CI:0.41 to 1.98; p=0.79), but resulted in significantly decreased duration of phototherapy (MD=-16.69hours; 95 % CI:-25.09 to -8.3hours; p<0.0001). There were no reports of the need for exchange transfusion and incidence of acute bilirubin encephalopathy, chronic bilirubin encephalopathy, and major neurodevelopmental disability in the included studies. For preterm neonates, there was a significantly lower bilirubin level in the 100 mg/kg clofibrate group compared to the control group with a mean difference of -1.37 mg/dL (95 % CI: -2.19 mg/dL to -0.55 mg/dL) (-23 mol/L; 95 % CI: -36 mol/L to -9 mol/L) after 48 hours. Phototherapy is the use of visible light to treat severe jaundice in the neonatal period. 1992;89:827-828. 4. Otherwise healthy newborn infants with hyperbilirubinemia without signs of hemolytic disease; gestational age 33 weeks; birth weight . width: 100%; Management of neonatal hyperbilirubinemia. There are implications for future healthcare needs (e.g., having a specialty consult ordered prior to discharge). Semin Fetal Neonatal Med. They stated that a Cochrane review of clofibrate (2012) and metalloporphyrins (2003) found that when added to phototherapy, these medications significantly decreased serum bilirubin levels and duration of phototherapy. Halliday HL, Ehrenkranz RA, Doyle LW. Inpatient treatment may be medically necessary for pre-term infants who present with a TSB greater than or equal to 18 mg/dL. Hyperbilirubinemia, conjugated. padding: 10px; Per the ICD-10-PCS Official Guidelines for Coding and Reporting, only clinically significant conditions are reported. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for reporting methods and results of synthesis with meta-analysis. PDF ACDIS day3-5 track5-9 pres 0517-Rogers-f For additional language assistance: SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), gene analysis, common variant(s) (eg, *5), UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, irinotecan metabolism), gene analysis, common variants (eg, *28, *36, *37), Molecular pathology procedure, Level 1(eg, identification of single germline variant [eg, SNP] by techniques such as restriction enzyme digestion or melt curve analysis) [for assessing risk of neonatal hyperbilirubinemia], Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion), G6PD (glucose-6-phosphate dehydrogenase) (eg, hemolytic anemia, jaundice), gene analysis, Phototherapy (bilirubin) light with photometer, Home visit, phototherapy services (e.g., Bili-lite), including equipment rental, nursing services, blood draw, supplies, and other services, per diem, Injection, phenobarbital sodium, up to 120 mg, Neonatal jaundice due to other excessive hemolysis, Neonatal jaundice from other and unspecified causes, Maternal care for other isoimmunization [not covered for the use of antenatal phenobarbital in red cell isoimmunized pregnant women], Glucose-6-phosphate dehydrogenase (G6PD); quantitative, Glucose-6-phosphate dehydrogenase (G6PD); screen, Genetic susceptibility to other disease [G6PD deficiency], Family history of other endocrine, nutritional and metabolic diseases [G6PD deficiency], Family history of carrier of genetic disease [G6PD deficiency]. Cochrane Database Syst Rev. A heterozygous group was also equally distributed between cases (44.3 %) and controls (42.9 %). Kernicterus in full-term infants--United States, 1994-1998. J Pediatr. They stated that TSB assessment remains necessary, if treatment of hyperbilirubinemia is being considered. J Matern Fetal Neonatal Med. Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia. These are not additional resources. Blood testing done as a diagnostic test, however, meets the requirements for coding the jaundice. Centers for Disease Control and Prevention (CDC). For the G6PD 1388 G>A SNP, individuals carrying the A-allele were associated with a significantly increased risk of neonatal hyperbilirubinemia (adjusted OR=1.49, p< 0.001, 95 % CI: 1.31 to 1.67). phototherapy | Medical Billing and Coding Forum - AAPC Resources text-decoration: underline; All that is needed is watchful waiting. These services include intensive cardiac and respiratory monitoring, continuous and/or frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring, and constant observation by the health care team under direct physician supervision. Coding for this service depends on the provider of the service and whether the visit is in follow-up to an already identified problem or screening for problems. When the hematoma is extensive or combined with other issues that cause excessive hemolysis, involving additional resources, look to P58 Neonatal jaundice due to other excessive hemolysis. Treatment of jaundice in low birthweight infants. Although inflammation occurs less frequently now than in the past because the medication used has changed, it may occur. } A randomized, triple-blind, placebo-controlled trial of prophylactic oral phenobarbital to reduce the need for phototherapy in G6PD-deficient neonates. Bhutani VK, Stark AR, Lazzeroni LC, et al; Initial Clinical Testing Evaluation and Risk Assessment for Universal Screening for Hyperbilirubinemia Study Group. The increased bilirubin from hemolysis often needs phototherapy, exchange transfusion or both after birth. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. None of the included studies reported any side effects. All but 1 of the included studies were conducted in Iran. Arch Dis Child Fetal Neonatal Ed. Third, since RCTs of included studies centered in a short observation period and did not follow-up the patients in long-term, the methodological quality of clinical trials with probiotics supplementation therapy for neonatal jaundice needed further improvement. A total of 3 small studies evaluating 154 infants were included in this review. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2002. 2017;8:432. 2002;3(1). Procedures included in the services represented by code 99477 include those listed for the Critical Care Services subsection of CPT (codes 99291 and 99292), as well as additional procedures listed in the Inpatient Neonatal and Pediatric Critical Care subsection (codes 99468-99476, 99466-99467). background: #5e9732; Wennberg RP, Ahlfors CE, Bhutani VK, et al. Aetna considers home phototherapy for physiologic jaundice in healthy infants with a gestational age of 35 weeks or more medically necessary if all of the following criteria are met: Note: If levels do not respond by stabilizing (+/- 1 mg/dL) or declining, more intensive phototherapy may be warranted. Documentation should include approximate time spent face-to-face with the family and patient, notation of time spent in counseling, and context of counseling. Ch. CPT offers 3 coding options for initial encounter with ill newborn Arch Dis Child Fetal Neonatal Ed. CPT-4 codes: 59400: Antepartum, intrapartum, and postpartum patient care 59400: SG facility fees for the birth center 99460 or 99463: Initial newborn care in a birth center 99461: Second home visit for newborn care Hospital transfer during labor with no postpartum or newborn services 2023 ICD-10-PCS Procedure Code 6A600ZZ Phototherapy of Skin, Single 2016 2017 2018 2019 2020 2021 2022 2023 Billable/Specific Code ICD-10-PCS 6A600ZZ is a specific/billable code that can be used to indicate a procedure. J Matern Fetal Neonatal Med. In a Cochrane review on early (less than8 days) postnatal corticosteroid treatmentfor preventing chronic lung disease in preterm infants, Halliday et al(2010) concluded that the benefits of early postnatal corticosteroid treatment, especially DXM, may not out-weigh the known or potential adverse effects of this treatment. 1995;96(4 Pt 1):727-729. Wong RJ, Bhutani VK. Aetna considersexchange transfusionmedically necessary forterm andnear-term infantsaccording to guidelines published by the American Academy of Pediatrics (AAP). Accessed July 16, 2002. However, only 1 trial (out of 2) reported significant reduction in bilirubin levels in preterm neonates. Inpatient treatment is not generally medically necessary for preterm infants who present with a TSB less than 18 mg/dL, as these infants can usually be treated with expectant observation or home phototherapy. An alternative to prolonged hospitalization of the full-term, well newborn. The authors concluded that there is a compelling need for the long-term follow-up and reporting of late outcomes, especially neurological and developmental outcomes, among surviving infants who participated in all randomized trials of early postnatal corticosteroid treatment. www.stanfordchildrens.org/en/topic/default?id=developmental-dysplasia-of-the-hip-ddh-90-P02755 hip dysplasia If another physician provides critical care services to the neonate on the same date, that physician must report the services with critical care service codes 99291-99292. } Murki S, Dutta S, Narang A, et al. The authors concluded that zinc sulfate could not reduce the TSB on 3 days and 7 days, the incidence of hyperbilirubinemia and phototherapy requirement, but resulted in significantly decreased duration of phototherapy. The extracted information of RCTs should include efficacy rate, serum total bilirubin level, time of jaundice fading, duration of phototherapy, duration of hospitalization, adverse reactions. Pace EJ, Brown CM, DeGeorge KC. You are using an out of date browser. This study compared oral zinc with placebo. The authors concluded that limited low-quality evidence indicated that probiotic supplementation may reduce the duration of phototherapy in neonates with jaundice. Revision Log See Important Reminder . If this is your first visit, be sure to check out the. 2010;(1):CD001146. Available at: http://www.natus.com/information/breath_analysis/. Aetna considers massage therapy experimental and investigational for the treatment ofneonatal hyperbilirubinemia because its effectiveness has not been established. text-decoration: line-through; 04/29/2022 2007;12(5):1B-12B. registered for member area and forum access. According to available guidelines, inpatient treatment may be considered medically necessary for healthy full-term infants who present with aTSB greater than or equal to 20 mg/dL in the first post-natal week. All searches were re-run on April 2, 2012. Mehrad-Majd H, Haerian MS, Akhtari J, et al. According to available guidelines, no further measurement of bilirubin is necessary in most cases. Aggressive vs. conservative phototherapy for infants with extremely low birth weight. Casnocha Lucanova L, Matasova K, Zibolen M, Krcho P. Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. eMedicine J. PDF Coding Guidelines and Policy Update - AmeriHealth 1993;32:264-267. 6A650ZZ - Phototherapy, Circulatory, Single - ICD List 2023 Approximately 2 ml of peripheral venous blood was taken from all subjects. This indicated that cure may have been achieved in a minority of patients. } The correlation between TSB and TcB was found to be moderately close (r = 0.4 to 0.5). Canadian Paediatric Society, Fetus and Newborn Committee. The authors found a moderate correlation between TcB and TSB during phototherapy with a marginal improvement in the post-phototherapy phase. Understanding why a pediatrician documents a finding enables you to determine if it should be coded. Two reviewers independently assessed studies for inclusion, and discrepancies were resolved with consensus. OL OL LI { Neonatal hyperbilirubinemia: An evidence-based approach. Porter ML, Dennis BL. Johnson LH. 2001;108:31-39. Coding for Newborn Care Services (99460, 99461, & 99463) | AAFP If approved, tin-mesoporphyrin could find immediate application in preventing the need for exchange transfusion in infants who are not responding to phototherapy." 2004;114(1):297-316. If the lining closes and the fluid has nowhere to go, its a noncommunicating hydrocele. It is an option to provide conventional phototherapy in hospital or at home at TSB levels 2 - 3 mg/dL below those shown, but home phototherapy should not be used in any infant with risk factors. 2019;32(1):154-163. These researchers stated that additional large, well-designed RCTs are needed in neonates that compare effects of enteral supplementation with prebiotics on neonatal hyperbilirubinemia with supplementation of milk with any other placebo (particularly distilled water) or no supplementation. Last Review In preterm infants, phototherapy should be initiated at 50 to 70 % of the maximum indirect levels below: Footnotes* Complications include but are not limited to prenatal asphyxia, acidosis, hypoxia, hypoalbuminemia, meningitis, intraventricular hemorrhage, hemolysis, hypoglycemia, or signs of kernicterus. Clofibrate in combination with phototherapy for neonatal hyperbilirubinemia is considered experimental and investigational. In a Cochrane review, these investigators examined if administration of prebiotics reduces the incidence of hyperbilirubinemia among term and pre-term infants compared with enteral supplementation of milk with distilled water/placebo or no supplementation. PDF CP.MP.150 Phototherapy for Neonatal Hyperbilirubinemia - Health Net Oregon Chu and colleagues (2020) stated that phototherapy devices have been found to be an effective method for treating neonatal hyperbilirubinemia. cpt code for phototherapy of newborn - colspiritlifecoaching.com Schuman AJ, Karush G. Fiberoptic vs conventional home phototherapy for neonatal hyperbilirubinemia. TcB consistently under-estimated TSB levels significantly. 2009;124(4):1172-1177. The lining of the abdomen pouches into the scrotum to surround the testicle. It may not display this or other websites correctly. Do not subtract direct (conjugated) bilirubin. 2003;(1):CD004207. It is also important to note that thereare serious health risks associatedwith corticosteroid therapy. (Codes may be selected based on time spent in counseling and coordination of care when documentation indicates more than 50% of face-to-face time was spent in these activities.) Phototherapy for Jaundice in Newborns - What You Need to Know - Drugs.com Accessed July 16, 2002. 2011;128(4):e1046-e1052. } There is a new code for sacral dimples, Q82.6 Congenital sacral dimple, which can be coded in the professional encounter if they affect care, such as when an ultrasound is ordered and there is no finding of occult spina bifida. Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. For more information about congenital hydrocele, visit: www.webmd.com/parenting/baby/tc/congenital-hydrocele-topic-overview#1. Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: US Preventive Services Task Force recommendation statement. US Preventive Services Task Force; Agency for Healthcare Research and Quality. Newborn/neonate - Age ranges from birth to 28 days Anomaly - Developmental deformity Congenital - Condition present at birth, however, may not manifest until later in life 5 Neonatal Coding Guidelines Newborn/perinatal conditions are never reported on the mother's record, and likewise, pregnancy } Morris and colleagues (2008) compared aggressive versus conservative phototherapy for infants with extremely low birth weight. Testicles develop in the abdomen. Hyperbilirubinemia in the term infant: When to worry, when to treat. Pediatrics. They performed a systematic review of RCTs of probiotic supplementation for prevention or treatment of jaundice in neonates (any gestation or weight) using the Cochrane methodology. Description 2016;36(10):858-861. Synthesis Without Meta-analysis (SWIM) guidelines were used for reporting methods and results of synthesis without meta-analysis. A total of 10 publications (11 studies) were eligible. If separately documented in the mother's chart, you may report these services in addition to the services provided to the infant. 2006;117(2):474-485. However, if significant time beyond that typical of the infant preventive service is spent in counseling, physicians may also report a problem-oriented service (99212-99215) with modifier -25 to indicate the significant and separately identifiable services provided on the same date. 2016;109(3):203-212. 1990;10(4):435-438. Results were summarized as per GRADE guidelines. color: red A total of 9 RCTs (prophylactic: 6 trials, n=1,761; therapeutic: 3 trials, n=279) with low- to high-risk of bias were included. Jaundice, Coombs, and Phototherapy AAP Clinical Practice Guideline - Summary Bhutani Nomogram Guidelines for Phototherapy FAQs About Phototherapy Moreover, they stated that as the quality of included studies and the limitations of samples, the long-term safety and efficacy still need to be confirmed by long-term and high-quality research. Approximately 10 to 20 percent of newborns have an umbilical hernia. 1998;101(6):995-998. These researchers systematically evaluated the safety and efficacy of probiotics supplement therapy for pathological neonatal jaundice. Malpresentations are almost always noted on the inpatient record. The pediatrician will spend time evaluating the condition, and at some point, a code in the Q53 Undescended and ectopic testicle range will be used. } They considered all RCTs that studied neonates comparing enteral feeding supplementation with prebiotics versus distilled water/placebo or no supplementation. The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. Ip S, Glicken S, Kulig J, et al. Each payer can develop its own diagnosis-related group. Compared with hospital-based phototherapy, home-based phototherapy appeared more effective for the treatment of neonatal hyperbilirubinemia in reducing the rate of total serum bilirubin (standard mean difference [SMD] = 0.32, 95 % CI: -0.22 to 0.86, p = 0.04); however, there was no signicant difference in duration of phototherapy (SMD = 0.59, 95 % CI: 0.28 to 0.90, p = 0.06) in the 2 groups.