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Continuous versus intermittent phototherapy in treatment of neonatal jaundice: a randomized controlled trial

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Abstract

Phototherapy (PT) is a widely used treatment for neonatal jaundice, yet the ideal model of application remains controversial. In this study, the effects of continuous phototherapy (CPT) and intermittent phototherapy (IPT) models were compared in the treatment of neonatal indirect hyperbilirubinemia (IHB) and whether IPT is a superior modality is investigated. Single-centre parallel randomized controlled open label trial. A computer-based table of random numbers was used to allocate treatments. Newborns ≥ 34 weeks’ gestation who received phototherapy in our neonatal intensive care unit (NICU) between July 2022 and April 2023 were included. CPT was applied continuously for 6 h, and IPT was applied as 2 cycles of 1 h on and 2 h off in a 6-h session. Rebound TSB was measured 8 h after phototherapy was stopped in both groups. Phototherapy duration, TSB reduction rate and rebound bilirubin rate were compared between intervention groups. One hundered and four neonates met the inclusion criteria during the study period. CPT and IPT were each used in 52 newborns. Demographic characteristics of the study groups, including sex, mode of delivery, birth weight, admission weight, age at postnatal presentation, diet, discharge weight, and history of PT in siblings, were similar (p > 0.05). The most common cause of IHB in both groups was ABO incompatibility. The median phototherapy time was 12 h (6–15) in the CPT group and 4 h (2–4) in the IPT group (p < 0.001). The mean rate of bilirubin decrease was 1.12 ± 0.73 mg/dl/h in those who underwent IPT and 0.51 ± 0.33 mg/dl/h in those who underwent CPT (p < 0.001). The mean rebound bilirubin rate 8 h after phototherapy was 0.08 ± 0.28 mg/dl/h in the CPT group, and −0.01 ± 0.17 mg/dl/h in the IPT group (p = 0.039). The length of hospital stay was longer in the CPT group (p = 0.032). Skin rash, diarrhoea and increased body temperature were less frequent in the IPT group (p < 0.001).

Conclusions: In this study, IPT was found to be at least as effective as CPT in reducing total serum bilirubin. Even though the duration of PT is shorter in IPT, the slower rate of rebound bilirubin, shorter hospital stays and lower incidence of side effects indicated that intermittent phototherapy is superior to continuous phototherapy. Choosing IPT over CPT is a more rational approach in neonatal jaundice.

ClinicalTrials.gov Identifier: NCT 06386731 (registered retrospectively on 23/04/2024)

What is Known:

• PT is common used in the treatment of neonatal jaundice.

• There is no standard model of application for PT.

What is New:

• The IPT model is as effective as CPT.

• Newborns are discharged faster with IPT.

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Data availability

No datasets were generated or analyzed during the current study.

Abbreviations

CPT:

Continuous phototherapy

IHB:

Indirect hyperbilirubinemia

IPT:

Intermittent phototherapy

i Ca:

Ionized calcium

NICU:

Neonatal intensive care unit

LED:

Light emitting diode

PT:

Phototherapy

STB:

Serum total bilirubin

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Goztepe Prof. Dr Suleyman Yalcın City Hospital, Department of Paediatrics, Barbaros Mah, Ardic sokak Kentplus F3/23, 34746, Atasehir, Istanbul, Turkey

    Hande Nur Demirel & Sibel Sevuk Ozumut

  2. Istanbul Medeniyet University, Goztepe Prof. Dr Suleyman Yalcın City Hospital, Department of Paediatrics and Neonatology, Istanbul, Turkey

    Husnu Fahri Ovalı

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  1. Hande Nur Demirel
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Contributions

H N. D. and S S. O. prepared the materials and collected the data. S S. O. and H F. O. analyzed the data, interpreted them and created figures. H N. D. and S S.O. wrote the first draft of the article. H F. O. made criticisms. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sibel Sevuk Ozumut.

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Ethics approval

The study was approved by the local ethics board in concordance with the Declaration of Helsinki. Ethics committee approval was obtained from the Istanbul Medeniyet University Göztepe Training and Research Hospital Clinical Research Ethics Committee dated 15 June 2022 (decision number 2022/0387).

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Written informed consent was obtained from the parents of newborns.

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The authors declare no competing interests. 

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Communicated by Daniele De Luca

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Demirel, H.N., Ozumut, S.S. & Ovalı, H.F. Continuous versus intermittent phototherapy in treatment of neonatal jaundice: a randomized controlled trial. Eur J Pediatr (2024). https://doi.org/10.1007/s00431-024-05610-7

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