High- versus low-dose phototherapy for neonatal jaundice

Area of Science:

• Neonatal Medicine
• Pediatric Neurology
• Evidence-Based Medicine

Background:

• Phototherapy is a primary treatment for neonatal hyperbilirubinaemia (jaundice).
• Increasing phototherapy intensity or dosage is common for high bilirubin levels, but its benefits and safety are uncertain.

Purpose of the Study:

• To evaluate the impact of high-dose versus low-dose phototherapy on infant bilirubin levels.
• To assess the effects on kernicterus spectrum disorder (KSD) conditions, including acute bilirubin encephalopathy, kernicterus, cerebral palsy, and neurodevelopmental disabilities.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs), quasi-RCTs, and clustered RCTs.
• Searches conducted across major databases including MEDLINE, Embase, and CENTRAL up to June 2025.
• Included term and preterm infants with hyperbilirubinaemia requiring phototherapy; compared high-dose (spectral irradiance > 30 μW/cm²/nm) to low-dose (< 30 μW/cm²/nm).

Main Results:

• Low to very low-certainty evidence precludes firm conclusions on high-dose phototherapy's effects on acute bilirubin encephalopathy, cerebral palsy, and mortality.
• No studies assessed kernicterus. High-dose phototherapy may offer a small reduction in serum bilirubin at 24 and 48 hours, but clinical significance is unclear.
• Significant heterogeneity was observed in several outcomes, inadequately explained, leading to downgraded evidence certainty.

Conclusions:

• Current evidence is insufficient to establish the benefits or risks of high-dose phototherapy for neonatal jaundice.
• Further high-quality RCTs are necessary to investigate the efficacy and safety of different phototherapy dosages.
• Future research should focus on robust methodologies and include patient-important outcomes to clarify clinical benefits.