Intermittent phototherapy in neonatal hyperbilirubinemia: A pilot randomized controlled trial in Taiwan.

BACKGROUND: Continuous phototherapy (CPT) is standard for neonatal hyperbilirubinemia, but intermittent phototherapy (IPT) regimens may produce fewer side effects with comparable efficacy. METHODS: This prospective randomized controlled study enrolled neonates (GA ≥ 35 weeks) conducted between September 2023 and April 2025. Neonates received IPT (12 h on/12 h off) or CPT until bilirubin fell below threshold. The primary outcome was phototherapy duration. The secondary outcomes were length of hospital stay, bilirubin decline rate and threshold deviation and short-term adverse events. RESULTS: A total of 69 infants were randomized into IPT (n = 35) and CPT (n = 34) groups. No significant differences were observed in duration of phototherapy (3.31 vs. 3.35 days; p = 0.91) or hospitalization length (5.31 vs. 5.26 days; p = 0.91). TSB levels markedly declined in both groups in the first 3 days and successfully reduced levels below the limit by Day 2. While daily TSB decline rates were comparable (p = 0.97), the IPT group demonstrated a significantly faster hourly response on Day 1 (p = 0.018). Conversely, the CPT group achieved a significantly greater negative deviation from the threshold on Day 3 (-3.92 vs. -2.98 mg/dL; p = 0.047). Notably, rebound hyperbilirubinemia requiring retreatment occurred only in the CPT group (n = 2, 5.9%), while the IPT group remained stable. Adverse events were infrequent and similar. CONCLUSION: Our findings suggest that a 12-h IPT regimen may be comparable to CPT, exhibiting potential advantages in the initial hourly response and post-treatment rebound stability within this study cohort. While CPT achieves a deeper mid-treatment clearance, IPT's paced clearance appeared to maintain clinical safety margins without prolonging treatment. Thus, IPT may serve as a feasible alternative to CPT. Further large-scale studies are needed to refine individualized strategies.