ORIGINAL ARTICLE Intermittent versus continuous phototherapy for the treatment of neonatal non-hemolytic moderate hyperbilirubinemia in infants more than 34 weeks of gestational age: a randomized controlled trial Monica Sachdeva & Srinivas Murki & Tejo Pratap Oleti & Hemasree Kandraju Received: 21 May 2014 /Revised: 24 June 2014 /Accepted: 27 June 2014 /Published online: 9 July 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Intermittent phototherapy with “12 h on and then 12 h off” schedule in comparison with continuous photo- therapy for neonatal hyperbilirubinemia may save costs and decrease anxiety of parents. In this non-inferiority- randomized controlled trial, healthy late preterm (>34 weeks) and term neonates with neonatal hyperbilirubinemia under phototherapy for 8 h and total serum bilirubin (TSB)<18 mg/ dL were randomized either into intermittent (IPT) or continu- ous (CPT) group. Infants in IPT group received 12 h on and 12 h off cycles of phototherapy. In both arms, phototherapy was continued until TSB<13 mg/dL. Primary outcome was rate of fall of bilirubin. Seventy-five infants (IPT n =36 vs. CPT n =39) were enrolled in the study. The rate of fall of bilirubin was significantly higher with “IPT” phototherapy (p =0.002). Conclusion: In term and late preterm infants with non- hemolytic moderate hyperbilirubinemia, intermittent photo- therapy with 12 h on and 12 h off cycles is as efficacious as continuous phototherapy. Keywords Phototherapy . Moderate hyperbilirubinemia . Intermittent . Day care . Neonate Abbreviations CFL Compact fluorescent lamps CPT Continuous phototherapy IPT Intermittent phototherapy ITT Intention to treat analysis LED Light emission diode PT Phototherapy TSB Total serum bilirubin Introduction Neonatal hyperbilirubinemia is the common reason for admission of late preterm and term neonates to a neo- natal unit. Phototherapy is the most effective therapy for the management of neonatal hyperbilirubinemia. Photo- therapy acts by three mechanisms for reducing the bil- irubin level which include photooxidation, photo and structural isomerization. The photochemical reaction re- quires only few nanoseconds. However, migration and elimination of bilirubin from the skin need longer time, and during this period, the role of phototherapy is only minimal [7]. With this concept, intermittent photothera- py may have a role in the management of neonatal hyperbilirubinemia. There is no optimal time schedule for intermittent phototherapy defined in the literature, and therefore, different studies have looked at various time intervals for their effectiveness at lowering serum bilirubin while allowing ample time for parental-infant interaction [6, 8, Communicated by Patrick Van Reempts Electronic supplementary material The online version of this article (doi:10.1007/s00431-014-2373-8) contains supplementary material, which is available to authorized users. M. Sachdeva : S. Murki : T. P. Oleti (*) : H. Kandraju Department of Pediatrics, Fernandez Hospital, Hyderguda, Hyderabad, India 500029 e-mail: tejopratap@gmail.com M. Sachdeva e-mail: dr_monica06@yahoo.com S. Murki e-mail: srinivasmurki2001@gmail.com H. Kandraju e-mail: drhema4@gmail.com Eur J Pediatr (2015) 174:177–181 DOI 10.1007/s00431-014-2373-8