Efficacy of aluminium foil reflector-enhanced phototherapy in term neonates with hyperbilirubinemia: A randomized controlled trial

Background The effectiveness of phototherapy for neonatal hyperbilirubinemia depends on irradiance and exposed body surface area. In resource-limited settings, suboptimal light delivery may reduce treatment efficiency. Reflective materials such as aluminium foil may improve light utilization during phototherapy. Objective To evaluate the efficacy and safety of aluminium foil reflector-assisted phototherapy compared with standard LED phototherapy in term neonates with hyperbilirubinemia. Methods In this randomized controlled trial conducted between August 2024 and August 2025 at a tertiary neonatal unit, 90 term neonates requiring phototherapy were randomized to receive either aluminium foil reflector-assisted phototherapy ( n = 45) or standard LED phototherapy ( n = 45). Total serum bilirubin (TSB) was measured at baseline and at 24-h intervals during phototherapy. Primary outcomes were rate of bilirubin reduction at 24 h and total duration of phototherapy. Secondary outcomes included physiological parameters, weight change, and adverse effects. Analysis of covariance was performed to adjust for baseline covariates. Results Baseline TSB levels were similar between groups (15.43 ± 1.77 vs 15.85 ± 1.97 mg/dL; p = 0.111). After 24 h, the mean reduction in TSB was greater in the reflector group (3.91 ± 1.96 vs 2.76 ± 1.40 mg/dL; mean difference 1.15 mg/dL; p = 0.006). The total duration of phototherapy was shorter in the reflector group (32.62 ± 7.89 vs 39.04 ± 6.69 h; mean difference 6.42 h; p < 0.0001). The treatment effect remained significant after adjustment for gestational age and postnatal age using ANCOVA. No significant differences in adverse events were observed. Conclusions Aluminium foil reflector-assisted phototherapy was associated with faster bilirubin reduction and shorter treatment duration without increased adverse effects. This low-cost modification may improve phototherapy efficiency in resource-limited neonatal care settings.