Chest shielding in preterm neonates under phototherapy-a randomised control trial

Area of Science:

• Neonatal Medicine
• Pediatric Cardiology
• Clinical Trials

Background:

• Patent ductus arteriosus (PDA) is a common concern in preterm neonates.
• The effect of chest shielding during phototherapy on PDA manifestation is not well-established.
• Phototherapy is a standard treatment for neonatal jaundice.

Purpose of the Study:

• To investigate whether shielding the precordium affects the incidence of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates undergoing phototherapy.
• To evaluate the impact of chest shielding on cardiac dimensions in this population.

Main Methods:

• An open-label randomized controlled trial was conducted with preterm neonates (≤32 weeks gestation) requiring phototherapy.
• The intervention group received standard care plus chest shielding with aluminum foil during phototherapy.
• The control group received only standard care. Echocardiography was used to assess hsPDA and cardiac dimensions.

Main Results:

• No significant difference in the incidence of hsPDA was observed between the chest shield group (7.8%) and the standard care group (10%), with a relative risk of 0.78 (95% CI 0.22-2.75).
• The left atrium to aortic ratio was significantly smaller in the chest shield group (1.5 ± 0.1) compared to the standard group (1.8 ± 0.2; p=0.03).
• Neonate characteristics showed the chest shield group had lower birth weight and higher incidence of being small-for-gestational age.

Conclusions:

• Chest shielding of the precordium in preterm neonates during phototherapy does not alter the incidence of hemodynamically significant patent ductus arteriosus.
• While not affecting hsPDA incidence, chest shielding did show a significant difference in the left atrium to aortic ratio, warranting further investigation.