Trial compares continuous and intermittent phototherapy for jaundice in newborns

Intermittent phototherapy (PT) is not only comparable but potentially superior to continuous PT in managing neonatal jaundice, offering faster bilirubin reduction, lower rebound rates, shorter hospital stays, and reduced incidence of adverse effects, as per a clinical trial published in the European Journal of Pediatrics.

Hande Nur Demirel et al. compared the efficacy of continuous PT and intermittent PT in terms of duration, the rate of total serum bilirubin (TSB) reduction, and rebound bilirubin levels after cessation of phototherapy in treating neonatal indirect hyperbilirubinemia/jaundice. They conducted a single-centre, parallel, randomized, controlled, open-label trial, enrolling newborns of at least 34 weeks’ gestation who received PT in the neonatal intensive care unit. Continuous PT was administered for 6 hours continuously, while intermittent PT consisted of 2 cycles of 1 hour on and 2 hours off within a session of 6 hours.

During the study period, 104 neonates met the inclusion criteria, with 52 newborns receiving continuous PT and 52 receiving intermittent PT. Demographic characteristics at the presentation were similar between groups. The primary cause of indirect hyperbilirubinemia in both groups was ABO incompatibility.

Results showed a median phototherapy duration of 12 hours (range 6 to 15) in the continuous PT group compared to 4 hours (range 2 to 4) in the intermittent PT group. The mean rate of bilirubin decrease was remarkably higher in the intermittent PT group than in the continuous PT group (1.12 ± 0.73 mg/dl/h and 0.51 ± 0.33 mg/dl/h, respectively). The mean rebound bilirubin rate was lower in the intermittent PT group (−0.01 ± 0.17 mg/dl/h) compared to the continuous PT group (0.08 ± 0.28 mg/dl/h) at 8 hours of phototherapy cessation.

Additionally, neonates treated with IPT experienced shorter hospital stays compared to those treated with continuous PT. The incidence of side effects such as skin rash, diarrhoea and increased body temperature was suggestively lower in the intermittent PT group.