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Intensive versus conventional phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis of
Yuan Qiao1, Min Song1, Guoying Lu1
1Department of Neonatology, The Fourth Affiliated Hospital of Dali University, Dali, Yunnan, China.
Insights
Intensive phototherapy significantly reduces total serum bilirubin (TSB) levels and treatment duration in newborns with hyperbilirubinemia compared to conventional methods. This approach is particularly effective for preterm infants with severe conditions.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Clinical Research
Background:
- Neonatal hyperbilirubinemia is a common condition requiring effective treatment.
- The clinical efficacy of intensive phototherapy for neonatal hyperbilirubinemia has been inconsistently reported.
- Phototherapy is a cornerstone in managing neonatal hyperbilirubinemia.
Purpose of the Study:
- To systematically evaluate the clinical efficacy of intensive phototherapy versus conventional phototherapy for neonatal hyperbilirubinemia.
- To compare the reduction in total serum bilirubin (TSB) levels and treatment duration between intensive and conventional phototherapy.
Main Methods:
- A meta-analysis was conducted following PRISMA 2020 and MOOSE guidelines.
- Searched multiple databases (Web of Science, PubMed, Embase, ScienceDirect) for comparative studies up to March 2026.
- Analyzed 12 studies (8 RCTs, 4 cohort studies) involving 1,144 neonates, using random-effect models for pooled results.
Main Results:
- Intensive phototherapy showed significantly greater TSB reductions (MD = -21.87) compared to conventional phototherapy (p < 0.001).
- Treatment duration was shorter with intensive phototherapy (MD = -20.23 h, p = 0.034).
- Gestational age and baseline TSB levels were sources of heterogeneity, but study design was not.
Conclusions:
- Intensive phototherapy is clinically superior to conventional phototherapy in reducing TSB levels and treatment duration.
- This method is especially beneficial for preterm neonates with severe hyperbilirubinemia.
- The findings provide robust evidence supporting the use of intensive phototherapy.
Background:
The clinical efficacy of intensive phototherapy for neonatal hyperbilirubinemia remains inconsistently reported across studies.
Method:
The meta-analysis was conducted in accordance with PRISMA 2020 and MOOSE guidelines. We searched Web of Science, PubMed, Embase, and ScienceDirect for eligible comparative studies from the inception of the databases up to March, 2026. The primary outcome was the reduction in total serum bilirubin (TSB) levels from baseline to the completion of phototherapy, and the duration of phototherapy was defined as the secondary outcome. The pooled results were synthesized via random-effect model. Influential publication was determined by performing sensitivity analysis. In addition, the potential sources of heterogeneity were examined by using subgroup analyses. Publication bias was assessed using the funnel plot, Begg's and Egger's tests.
Result:
The 12 included studies (8 RCTs and 4 cohort studies) published between 1995 and 2026, enrolling 1,144 neonates with mean gestational age ranging from 30 to 39 weeks and baseline TSB levels from 172 to 390 μmol/L. Intensive phototherapy achieved significantly greater TSB reductions compared to conventional phototherapy within the same timeframe (MD = -21.87, 95% CI = -29.69 to -14.05, p < 0.001, I2 = 83.9%). Subgroup analysis showed that the gestational age (p = 0.003) and baseline TSB level (p = 0.005) were potential source of heterogeneity, but study design was not (p = 0.106). In addition, the treatment duration from the intensive phototherapy group were shorter than the conventional group (MD = -20.23 h, 95% CI = -38.91 to -1.54, p = 0.034, I2 = 94.7%). No influential publications and significant publication bias were detected across the 12 studies.
Conclusion:
Phototherapy has been established as the cornerstone of clinical management for neonatal hyperbilirubinemia. Intensive phototherapy demonstrates superior clinical efficacy in reducing TSB levels and treatment duration than conventional phototherapy, especially in preterm neonates with severe hyperbilirubinemia.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261324708, Identifier CRD420261324708.
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