Therapeutic efficacy of intermittent versus continuous phototherapy in term neonates with hyperbilirubinemia: A randomized controlled trial

Background Neonatal jaundice affects most newborns due to immature bilirubin metabolism. Phototherapy continues to be the cornerstone of treatment, having significantly reduced bilirubin-induced neurotoxicity. This study compares continuous and intermittent phototherapy in term neonates with non-hemolytic indirect hyperbilirubinemia to evaluate their relative therapeutic efficacy in achieving effective bilirubin reduction. Methods This prospective randomized controlled trial was conducted in the Neonatal Intensive Care Unit of a tertiary care medical university in North India between August 2023 and July 2025. Term neonates (gestational age 37–42 weeks, birth weight ≥2500 g) with non-hemolytic indirect hyperbilirubinemia requiring phototherapy, as per American Academy of Pediatrics guidelines, were enrolled. A total of 150 eligible infants were randomized in equal numbers to receive either continuous phototherapy or intermittent phototherapy (3 h on/3 h off). All participants received standardized double-surface LED phototherapy with an irradiance of ≥30 μW/cm 2 /nm within a wavelength range of 460–490 nm. Infants were repositioned hourly, and exclusive breastfeeding was actively supported. Total serum bilirubin levels were monitored at 12-h intervals until the predefined discontinuation criteria were met. Results Baseline characteristics were comparable (all p > 0.05). Mean baseline TSB was similar (16.07 ± 2.67 vs 15.46 ± 3.04 mg/dL; p = 0.190). Unadjusted bilirubin reduction at 12 h and 24 h did not differ significantly. After adjustment, TSB at 12 h was comparable ( p = 0.418), but higher in the continuous group at 24 h (mean difference 0.68 mg/dL; p < 0.001). The total phototherapy exposure time was shorter with intermittent therapy (13.75 ± 1.18 vs 18.15 ± 1.56 h; p = 0.001). Rebound hyperbilirubinemia and adverse events were similar between groups. Conclusion Intermittent phototherapy was as effective as continuous phototherapy in reducing bilirubin levels in term neonates with non-hemolytic indirect hyperbilirubinemia requiring treatment, while reducing total phototherapy exposure time and potentially facilitating feeding, mother–infant bonding, and more resource-efficient family-centered care.