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Therapeutic efficacy of intermittent versus continuous phototherapy in term neonates with hyperbilirubinemia: A
1Department of Pediatrics, Uttar Pradesh University of Medical Sciences, Etawah, India.
Insights
Intermittent phototherapy is as effective as continuous phototherapy for neonatal jaundice, significantly reducing treatment time. This approach supports family-centered care and infant well-being.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Therapeutic Interventions
Background:
- Neonatal jaundice is common due to immature bilirubin metabolism.
- Phototherapy is crucial for reducing bilirubin-induced neurotoxicity.
- Comparing continuous and intermittent phototherapy is essential for optimizing treatment.
Purpose of the Study:
- To compare the efficacy of continuous versus intermittent phototherapy for term neonates with indirect hyperbilirubinemia.
- To evaluate bilirubin reduction rates and total treatment duration.
- To assess the impact on feeding, bonding, and family-centered care.
Main Methods:
- Prospective randomized controlled trial in North India (August 2023 - July 2025).
- 150 term neonates with non-hemolytic indirect hyperbilirubinemia randomized to continuous or intermittent (3h on/3h off) LED phototherapy.
- Total serum bilirubin monitored at 12-h intervals; standardized irradiance (≥30 μW/cm²/nm).
Main Results:
- No significant difference in bilirubin reduction at 12 hours; higher levels at 24 hours in the continuous group (p < 0.001).
- Intermittent phototherapy required significantly shorter total exposure time (13.75 ± 1.18 vs 18.15 ± 1.56 hours; p = 0.001).
- Rebound hyperbilirubinemia and adverse events were similar between groups.
Conclusions:
- Intermittent phototherapy is a viable alternative to continuous phototherapy for treating neonatal jaundice.
- It achieves comparable bilirubin reduction while decreasing treatment duration.
- This method promotes family-centered care, potentially improving feeding and mother-infant bonding.
Abstract:
BackgroundNeonatal jaundice affects most newborns due to immature bilirubin metabolism. Phototherapy continues to be the cornerstone of treatment, having significantly reduced bilirubin-induced neurotoxicity. This study compares continuous and intermittent phototherapy in term neonates with non-hemolytic indirect hyperbilirubinemia to evaluate their relative therapeutic efficacy in achieving effective bilirubin reduction.MethodsThis prospective randomized controlled trial was conducted in the Neonatal Intensive Care Unit of a tertiary care medical university in North India between August 2023 and July 2025. Term neonates (gestational age 37-42 weeks, birth weight ≥2500 g) with non-hemolytic indirect hyperbilirubinemia requiring phototherapy, as per American Academy of Pediatrics guidelines, were enrolled. A total of 150 eligible infants were randomized in equal numbers to receive either continuous phototherapy or intermittent phototherapy (3 h on/3 h off). All participants received standardized double-surface LED phototherapy with an irradiance of ≥30 μW/cm2/nm within a wavelength range of 460-490 nm. Infants were repositioned hourly, and exclusive breastfeeding was actively supported. Total serum bilirubin levels were monitored at 12-h intervals until the predefined discontinuation criteria were met.ResultsBaseline characteristics were comparable (all p > 0.05). Mean baseline TSB was similar (16.07 ± 2.67 vs 15.46 ± 3.04 mg/dL; p = 0.190). Unadjusted bilirubin reduction at 12 h and 24 h did not differ significantly. After adjustment, TSB at 12 h was comparable (p = 0.418), but higher in the continuous group at 24 h (mean difference 0.68 mg/dL; p < 0.001). The total phototherapy exposure time was shorter with intermittent therapy (13.75 ± 1.18 vs 18.15 ± 1.56 h; p = 0.001). Rebound hyperbilirubinemia and adverse events were similar between groups.ConclusionIntermittent phototherapy was as effective as continuous phototherapy in reducing bilirubin levels in term neonates with non-hemolytic indirect hyperbilirubinemia requiring treatment, while reducing total phototherapy exposure time and potentially facilitating feeding, mother-infant bonding, and more resource-efficient family-centered care.
