Intermittent versus continuous phototherapy for the treatment of non-hemolytic moderate hyperbilirubinemia in term infants: a randomized controlled trial

Background: Phototherapy is the most effective treatment for neonatal jaundice and intermittent phototherapy is as effective as continuous phototherapy but with fewer complications and more benefits. This study compared the hospital length of stay, duration of phototherapy and the reducing rate of total serum bilirubin after 24 and 36 hours of phototherapy in two groups. Methods: The current double-blinded randomized controlled trial was conducted on 60 icteric term neonates from November 2016 to June 2017. A total of 60 icteric term neonates were randomly divided into two groups. In the continuous group, the phototherapy device was turned on for 24 hours and in the intermittent phototherapy group, the phototherapy device was turned on for 18 hours and off for eight hours. Inclusion criteria were term neonates with non-hemolytic hyperbilirubinemia admitted to the neonatal ward of Loghman Hospital, Tehran, Iran. Infants were excluded for any of the following reasons: Hemolytic anemia, prematurity, sepsis, sever hyperbilirubinemia (total bilirubin>18 mg/dl), direct hyperbilirubinemia and onset of jaundice within the first 24 hours of life. In both arms, phototherapy continued until total serum bilirubin reached<11 mg/dL. Both early and late complications were compared including the length of hospital stay, duration of phototherapy, the rate of kernicterus, decreasing rate of serum bilirubin after 24 and 36 hours. Results: The demographic parameters did not differ significantly between the intermittent and continuous phototherapy groups. The length of hospital stay was 2.3±0.60 and 2.46±0.93 days in the continuous and intermittent groups, respectively (P=0.516) and there was not significant differences between them. The duration of phototherapy was 45.26±16.39 and 46±11.82 hours in the continuous and intermittent groups, respectively, and they had no significant differences (P=0.843). The rate of serum bilirubin cessation in the two groups was similar after 36 hours. Conclusion: According to the current study results, intermittent phototherapy was as effective as continuous phototherapy to treat icteric full-term neonates. The intermittent phototherapy also helps to maintain mother-infant bonding and it is useful to maintain breastfeeding.