Intermittent or continuous phototherapy for neonatal jaundice fails to lower bilirubin

A new study published in Cochrane Database of Systematic Reviews suggests that there is no significant bilirubin decrease found among intermittent and continuous phototherapy.

Neonatal jaundice may be treated effectively and broadly using phototherapy. Although intermittent phototherapy has been suggested as an equally effective option with the added benefit of enhanced mother feeding and bonding, it is often used continually. It is uncertain if intermittent phototherapy is more effective than continuous phototherapy. As a result, Sasi Bhushan Gottimukkala and colleagues carried out a research to evaluate the efficacy and safety of intermittent phototherapy in comparison to continuous phototherapy.

On January 31, 2022, searches were made in the following databases: CENTRAL through CRS Web, MEDLINE via Ovid, and Embase via Ovid. Moreover, reference lists of retrieved papers and clinical trials databases were searched for random controlled trials (RCTs) and quasi-randomized trials. RCTs, cluster RCTs, and quasi RCTs comparing intermittent and continuous phototherapy in jaundiced newborns (both term and preterm) up to the age of 30 days were conducted by researchers. Using any technique, at any dose, and for any period of time as specified by the authors, intermittent phototherapy was contrasted with continuous phototherapy. The principal results of interest were kernicterus and the rate of reduction of serum bilirubin. The GRADE technique was used to rate the evidence's degree of confidence.

The key findings of this study were:

1 600 babies from 12 RCTs were included in the analysis.

One research is still being conducted, while four are waiting to be classified.

Regarding the rate of bilirubin drop in newborn jaundiced newborns, intermittent phototherapy and continuous phototherapy showed little to no difference.

There was no evidence of bilirubin-induced brain damage in one investigation of 60 babies (BIND).

Because the confidence of these findings is relatively poor, it is unclear if either intermittent or continuous phototherapy lowers BIND.

Infant mortality and treatment failure showed minimal to no difference.

The hazards of continuous phototherapy and the possible advantages of a little lower bilirubin level are uncertain, however continuous phototherapy seems to be more beneficial in premature newborns. A reduction in the overall number of exposure hours is linked to intermittent phototherapy. Although intermittent regimens have some theoretical advantages, significant safety consequences were unaddressed. Before it can be stated that intermittent and continuous phototherapy treatments are equally helpful in preterm and term newborns, large, well-designed, prospective studies are required.

Reference:

Gottimukkala, S. B., Lobo, L., Gautham, K. S., Bolisetty, S., Fiander, M., & Schindler, T. (2023). Intermittent phototherapy versus continuous phototherapy for neonatal jaundice. In Cochrane Database of Systematic Reviews (Vol. 2023, Issue 3). Wiley. https://doi.org/10.1002/14651858.cd008168.pub2