Background The clinical efficacy of intensive phototherapy for neonatal hyperbilirubinemia remains inconsistently reported across studies. Method The meta-analysis was conducted in accordance with PRISMA 2020 and MOOSE guidelines. We searched Web of Science, PubMed, Embase, and ScienceDirect for eligible comparative studies from the inception of the databases up to March, 2026. The primary outcome was the reduction in total serum bilirubin (TSB) levels from baseline to the completion of phototherapy, and the duration of phototherapy was defined as the secondary outcome. The pooled results were synthesized via random-effect model. Influential publication was determined by performing sensitivity analysis. In addition, the potential sources of heterogeneity were examined by using subgroup analyses. Publication bias was assessed using the funnel plot, Begg’s and Egger’s tests. Result The 12 included studies (8 RCTs and 4 cohort studies) published between 1995 and 2026, enrolling 1,144 neonates with mean gestational age ranging from 30 to 39 weeks and baseline TSB levels from 172 to 390 μmol/L. Intensive phototherapy achieved significantly greater TSB reductions compared to conventional phototherapy within the same timeframe (MD = −21.87, 95% CI = −29.69 to −14.05, p 0.001, I 2 = 83.9%). Subgroup analysis showed that the gestational age ( p = 0.003) and baseline TSB level ( p = 0.005) were potential source of heterogeneity, but study design was not ( p = 0.106). In addition, the treatment duration from the intensive phototherapy group were shorter than the conventional group (MD = −20.23 h, 95% CI = −38.91 to −1.54, p = 0.034, I 2 = 94.7%). No influential publications and significant publication bias were detected across the 12 studies. Conclusion Phototherapy has been established as the cornerstone of clinical management for neonatal hyperbilirubinemia. Intensive phototherapy demonstrates superior clinical efficacy in reducing TSB levels and treatment duration than conventional phototherapy, especially in preterm neonates with severe hyperbilirubinemia. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261324708 , Identifier CRD420261324708.
Qiao et al. (Tue,) studied this question.