Comparison of Intermittent Versus Continuous Phototherapy in Neonatal Hyperbilirubinaemia

Abstract

Background: Neonatal jaundice is a common condition characterized by elevated bilirubin levels, which, if untreated, can lead to severe complications such as kernicterus. Phototherapy is a widely used treatment modality, with two primary approaches: continuous and intermittent phototherapy. While both methods aim to reduce bilirubin levels, there is ongoing debate about their relative efficacy and safety.

Objective: This study aimed to compare the efficacy and safety of intermittent versus continuous phototherapy in the management of neonatal hyperbilirubinaemia in terms of bilirubin reduction, treatment duration, and associated complications.

Methods: A quasi-experimental study was conducted at the Department of Paediatrics, Combined Military Hospital, Rawalpindi, from January 2022 to December 2023. The study included 62 full-term neonates with indirect bilirubin levels >15.0 mg/dL but ≤20 mg/dL. Neonates were randomly assigned to receive either intermittent phototherapy (two hours on, two hours off) or continuous phototherapy. Serum indirect bilirubin levels were measured at 24 and 48 hours post-initiation of phototherapy. The total duration of phototherapy, volume of milk consumed, and complications such as hyperthermia and hypocalcaemia were recorded. Data were analyzed using SPSS version 25, with a p-value ≤ 0.05 considered statistically significant.

Results: At 24 hours post-treatment, the median indirect bilirubin level was 12.70 mg/dL (IQR: 1.20) in the intermittent group versus 12.50 mg/dL (IQR: 1.90) in the continuous group (p=0.893). At 48 hours, the levels were 6.40 mg/dL (IQR: 1.10) and 6.50 mg/dL (IQR: 1.10), respectively (p=0.821). The median total duration of phototherapy was significantly shorter in the intermittent group (22.0 hours, IQR: 2.0) compared to the continuous group (45.0 hours, IQR: 3.0; p<0.001). Neonates in the intermittent group consumed more milk (420.0 mL, IQR: 93.0) than those in the continuous group (397.0 mL, IQR: 57.0; p=0.014). Hyperthermia was less frequent in the intermittent group (3.2% vs. 25.8%, p=0.026), as was hypocalcaemia (16.1% vs. 45.2%, p=0.013).

Conclusion: Intermittent phototherapy is as effective as continuous phototherapy in reducing bilirubin levels and offers additional benefits, including a shorter treatment duration, improved feeding, and fewer complications. Intermittent phototherapy should be considered a preferred option for managing neonatal hyperbilirubinaemia in clinical practice.