Intermittent phototherapy vs continuous phototherapy for treatment of neonatal hyperbilirubinemia: A randomized...

Though safe, phototherapy has short and long-term side-effects. This randomized control trial (RCT), evaluated the efficacy and safety of intermittent versus continuous phototherapy in treatment of neonatal hyperbilirubinemia. The aim of this study was to compare intermittent versus continuous phototherapy for treatment of nonhemolytic neonatal hyperbilirubinemia and the primary objective was to compare rate of decline of bilirubin between neonates treated with intermittent versus continuous phototherapy.

RCT conducted over two years. All late preterm (≥ 35 weeks) and term neonates requiring phototherapy as per AAP 2004 guidelines (Low and Medium risk groups) were eligible for inclusion and were randomized to either continuous or intermittent phototherapy using serially numbered opaque sealed envelopes, after informed parental consent.

Among 130 neonates, randomized in a 1:1 allocation ratio, mean (±SD) TSB at enrolment was 17.1 (±1.1) and 17.3 (±1.3) mg/dl; p value 0.35, and the rate of fall of bilirubin was 0.14 (0.08 to 0.20 IQR) and 0.16 (0.10 to 0.18 IQR) mg/dl/hr; p value 0.88 in the continuous and intermittent phototherapy groups respectively. The mean (95% CI) difference between the two groups was 0.010 (-0.0165 to 0.0365) mg/dl/hr, within the pre-defined limits of non-inferiority (Δ=0.05 mg/dl/h). The median duration of phototherapy was lower, (24 (12 to 24) hours in the intermittent phototherapy group as compared to 34 (26 to 44) hours in the continuous phototherapy group; p value 0.09.

Intermittent phototherapy (with 12 hours on and 12 hours off cycles), along with clinical and lab monitoring was as effective as continuous phototherapy in the treatment of non-hemolytic neonatal hyperbilirubinemia.