The Effect of Intensive Phototherapy on Management of Hyperbilirubinemia in Neonates with the Gestational Age of 34 Weeks and More


1 Department of Pediatrics, Akbarabadi Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Department of Pediatrics, Aliasghar Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

3 Department of Pediatrics, Aliasghar Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran


Background: Neonatal hyperbilirubinemia is one of the most common causes of neonatal morbidity and a global health priority. This study aimed to evaluate the effect of intensive phototherapy on management of hyperbilirubinemia with different etiologies.
Methods: This retrospective cohort study was conducted on 219 neonates with indirect hyperbilirubinemia, who had the indication for phototherapy, admitted to neonatal intensive care unit of Akbar-abadi Hospital, Tehran, Iran, during 2014-2016. The levels of total bilirubin, hemoglobin, reticulocyte, and glucose 6-phosphate dehydrogenase (G6PD) enzyme were examined and direct Coombs test was performed during hospital stay. The participants were assigned to four groups based on the etiology of hyperbilirubinemia and underwent intensive phototherapy.Finally, the level of total bilirubin was compared among the groups to assess the effect of intensive phototherapy.
Results: According to the results of this study, nonhemolytic jaundice was the most frequent cause of hyperbilirubinemia (82.19%). The mean bilirubin levels after 6 and 24 hours of intensive phototherapy were 4 and 6.2 mg/dl, respectively. Intensive phototherapy after 6 hours led to more significant reduction in the total bilirubin level of the neonates with total bilirubin level of higher than 14 mg/dl in comparison to those with the total bilirubin level of 14 mg/dl or less. The total bilirubin level was significantly decreased in all the groups after 6 and 24 hours of intensive phototherapy. Comparison of the rate of decrement of the total bilirubin level among the groups demonstrated that the neonates with ABO incompatibility showed the greatest decline after 6 and 24 hours of treatment (the rate of bilirubin decline: -5.16; P<0.001, the rate of bilirubin decline: -8.48; P<0.001, respectively).
Conclusion: Intensive phototherapy could efficiently lower the total bilirubin level in the neonates with gestational age of 34 weeks and more with hyperbilirubinemia of different causes. Moreover, the efficacy of intensive phototherapy was more significant in the subjects with higher levels of total bilirubin.


1. Mahram M, Oveisi S, Jaberi N. Trans-Cutaneous Bilirubinometery versus serum bilirubin in neonatal jaundice. Acta Med Iran. 2015; 53(12):764-9.

2. Schwoebel A, Gennaro S. Neonatal hyperbilirubinemia. J Perinat Neonatal Nurs. 2006; 20(1): 103-7.

3. Renesme L, Bedu A, Tourneux P, Truffert P. How to assess clinical practice guidelines with AGREE II: The example of neonatal jaundice. Arch Pediatr. 2016; 23(3):241-8.

4. Sgro M, Kandasamy S, Shah V, Ofner M, Campbell D. Severe neonatal hyperbilirubinemia decreased after the 2007 Canadian guidelines. J Pediatr. 2016; 171:43-7.

5. Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001; 344(8): 581-90.

6. Schwartz HP, Haberman BE, Ruddy RM. Hyperbilirubinemia: current guidelines and emerging therapies. Pediatr Emerg Care. 2011; 27(9):884-9.

 7. Edris AA, Ghany EA, Razek AR, Zahran AM. The role of intensive phototherapy in decreasing the need for exchange transfusion in neonatal jaundice. J Pak Med Assoc. 2014; 64(1):5-8.

8. Sachdeva A, Dutta AK. Advances in pediatrics. 2nd ed. London: JP Medical Ltd; 2012.

9. Porter ML, Beth L. Hyperbilirubinemia in the term newborn. Am Fam Physician. 2002; 65(4):599-606.

 10. Watson RL. Hyperbilirubinemia. Crit Care Nurs Clin North Am. 2009; 21(1):97-120.

11. Hansen TW, Rosenkrantz T. Neonatal jaundice treatment & management. Med Scape. 2016; 1:12.

 12. Vreman HJ, Wong RJ, Stevenson DK. Phototherapy: current methods and future directions. Semin Perinatol. 2004; 28(5):326-33.

 13. Hillyer CD, Hillyer C, Strauss R, Luban N. Handbook of pediatric transfusion medicine. Massachusetts: Academic Press; 2004. P. 206.

14. Intensive phototherapy. Available at: URL:; 2017.

15. Newborn nursery at LPCH. Phototherapy. Available at: URL:; 2014.

16. Olusanya BO, Osibanjo FB, Mabogunje CA, Slusher TM, Olowe SA. The burden and management of neonatal jaundice in Nigeria: a scoping review of the literature. Niger J Clin Pract. 2016; 19(1):1-17.

17. Zahedpasha Y, Ahmadpour M, Fuladinejat M, Alizadeh R, Mazlomi A. Single and double versus intensive phototherapy in term newborns with severe hyperbilirubinemia. Iran J Pediatr. 2006, l6(1):19-24.

18. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004; 114(1):297-316.

 19. M Abo El Fotoh WM, Rizk MS. Prevalence of glucose6-phosphate dehydrogenase deficiency in jaundiced Egyptian neonates. J Matern Fetal Neonatal Med. 2016; 29(23):3834-7.

20. De Carvalho M. Treatment of neonatal hyperbilirubinemia. J Pediatr. 2001; 77(Suppl1):S71-80 .

21. Kaplan M, Merlob P, Regev R. Israel guidelines for the management of neonatal hyperbilirubinemia and prevention of kernicterus. J Perinatol. 2008; 28(6): 389-97.

22. Bansal A, Jain S, Parmar VR, Chawla D. Bilirubin rebound after intensive phototherapy for neonatal jaundice. Indian Pediatr. 2010; 47(7):607-9.

23. Norman M, Åberg K, Holmsten K, Weibel V, Ekéus C. Predicting Nonhemolytic Neonatal Hyperbilirubinemia. Pediatrics. 2015; 136(6):1087-94.

24. Marzban A, Mousavinasab N. Correlation between hemolysis and jaundice in glucose 6- phosphate dehydrogenase deficient neonates. Acta Med Iran. 2009; 47(5):379-82.

 25. Behjati-Ardakani S, Sedaghat AN. The association between G6PD deficiency and total serum bilirubin level in icteric neonates. Acta Med Iran. 2007; 45(3):233-5.

26. Mahmodi Z, Mahmodi F. Epidemiology and risk factors for neonatal jaundice in infants admitted to NICU of Imam Sajjad Hospital, Yasooj. Sci J Hamadan Univ Med Sci. 2016; 22(4):346-52 (Persian).

27. Mansouri A, Ghaderpanahi M, Kazemi GM, Moradzadeh R, Tolide IH, Akbarpour S, et al. A casecontrol study on prenatal factors of newborns’ mild jaundice. J Nurse Physic Within War. 2013; 23- 24:17-23 (Persian).

28. Bertini G, Dani C, Tronchin M, Rubaltelli FF. Is breastfeeding really favoring early neonatal jaundice? Pediatrics. 2001; 107(3):E41.