Intermittent Phototherapy

Jessica Madden

Intermittent Phototherapy

Phototherapy has been the mainstay of treatment for neonatal jaundice (hyperbilirubinemia) for several decades.  The current newborn medicine “standard of care” is to keep jaundiced newborns under phototherapy lights continuously, with only short breaks for feeding. In cases of severe jaundice, newborns are often unable to come out from under phototherapy at all, thus cannot be held by their parents and/or breastfeed.  

What is intermittent phototherapy?

Intermittent phototherapy allows babies to come out of phototherapy for segments of time. In some cases phototherapy is scheduled or “cycled,” i.e. a baby might be scheduled to go under phototherapy lights for 15 minutes every hour, and then have a 45 minute scheduled “break” before it resumes. In other cases of intermittent phototherapy, light treatment is prescribed for a certain number of hours each day, but is not put on a strict schedule or regimen. For example, parents might be told their baby should be under phototherapy lights for 14 out of every 24 hours, but these 14 hours can be scheduled for whenever it works best for a newborn and their family.

Does intermittent phototherapy work as well as continuous (traditional) phototherapy?

The earliest studies of intermittent phototherapy focused on term (37 weeks’ gestation and greater) and late preterm newborns (34-36 weeks’ gestation) with non-hemolytic jaundice. In a 2015 study of 75 newborns in India, phototherapy using a “12 hour on/12 hour off” regimen was found to actually be superior to continuous phototherapy.  Per a more recent meta-analysis of intermittent phototherapy, which included 716 newborns and was published in 2021, intermittent phototherapy was found to be as effective and safer than continuous phototherapy.

What are some benefits of intermittent phototherapy?

  • Increased time that mother-baby dyads can be in direct skin-to-skin contact
  • Improved breastfeeding outcomes
  • Better thermoregulation
  • Lights can be adjusted with babies’ natural circadian rhythms
  • Reduced length of treatment

Can intermittent phototherapy be used for newborns with hemolytic jaundice?

ABO incompatibility, which is the most common cause of hemolytic jaundice, happens when a mother has a different blood type than her fetus. In ABO incompatibility maternal antibodies cross the placenta and attack fetal red blood cells. Bilirubin levels rise as a result of red blood cell destruction and the majority of babies with hemolysis due to ABO incompatibility become jaundiced enough to need phototherapy treatment. Newborns with this problem develop more severe and prolonged jaundice than babies whose hyperbilirubinemia results from non-hemolytic processes and, as a result, often need to be under phototherapy lights for several days to weeks.

Intermittent phototherapy has been found to be as effective as continuous phototherapy for babies with hemolytic jaundice. Researchers in China compared bilirubin levels in groups of newborns with hemolytic jaundice who received continuous phototherapy versus intermittent phototherapy for 72 hours in a 2019 study. Both groups of babies had comparable bilirubin levels prior to the initiation of treatment and there was no difference in bilirubin levels at the end of treatment.

Is intermittent phototherapy safe and effective for premature babies?

Premature babies are at a higher risk of developing jaundice than full-term babies and are currently treated with the same “dose” of phototherapy as those born full-term. Research has shown that cycled, or intermittent, phototherapy is as effective as continuous phototherapy in ELBW (extremely low birth weight, <1000g) infants. In a recent multicenter trial of cycled versus intermittent phototherapy that included 304 ELBW infants, intermittent phototherapy lowered neonates’ bilirubin levels as well as traditional continuous phototherapy regimens. In this study, infants received phototherapy for only 15 minutes per hour (a 15 minute on/45 minute off regimen). The authors of this study state the following at the end of their paper: “Based on the findings of all major phototherapy trials to date, cycled phototherapy is an evidence-based treatment option for ELBW infants.”

In conclusion, an increasing body of scientific literature supports that intermittent phototherapy is a safe and effective option for treating hyperbilirubinemia in all populations of newborns, including “at risk” infants such as those who are ELBW and babies with hemolytic disorders. One of the most important benefits of intermittent phototherapy is that is allows ample time for breastfeeding, skin-to-skin care, and mother-infant bonding.

Future research will need to focus on exploring intermittent phototherapy regimens in an effort to find the optimal “dose” for newborns. It’s entirely possible that, in the future, newborns with jaundice may only need treated with a few hours of intensive phototherapy every day to decrease their bilirubin levels. In the meantime, phototherapy devices such as the NeoLight Skylife System can be used to provide cycled phototherapy that promotes mother-infant bonding and breastfeeding both in the hospital and home settings.