Abstract
Introduction: Phototherapy is used to manage neonatal hyperbilirubinemia in early life. We aimed to compare between intermittent and continuous phototherapy in reducing TSB, rate of fall of bilirubin, duration of phototherapy and duration of hospitalisation in neonates with non-haemolytic hyperbilirubinemia. 
 Methods: Total 190 neonates who were > 34 weeks and birth weight ≥ 2000 gm were included. They were randomised into group A (continuous phototherapy) and group B (intermittent phototherapy). Group A received phototherapy for three hours and 45 minutes off and group B received phototherapy for three hours and then three hours off. TSB levels estimation were done in both groups and compared after each 12 hours, 24 hours, and 48 hours of commencing phototherapy. 
 Results: The mean TSB at presentation was 15.64 ± 2.19 mg/dl for continuous and 15.03 ± 1.07 mg/dl for intermittent group. Mean TSB at 12, 24, 48 hours were 13.26 ± 2.4 mg/dl, 10.8 ± 1.72 mg/dl, 10.16 ± 0.95 mg/dl respectively for continuous and 12.6 ± 1.65 mg/dl, 10.04 ±1.8 mg/dl, 9.1 ± 0.66 mg/dl respectively for intermittent group (p < 0.05). The mean rate of fall in serum bilirubin was 0.22 ± 0.12 mg/dl/hr for group A and 0.21 ± 0.08 mg/dl/hr for group B (p = 0.45). There was not much difference in mean duration of hospitalisation in both groups (p = 0.547). 
 Conclusions: Intermittent phototherapy is a non-inferior option to continuous phototherapy, in the management of non-haemolytic hyperbilirubinemia with additional advantages of less interrupted mother infant bonding and decreased irradiance.
Highlights
Phototherapy is used to manage neonatal hyperbilirubinemia in early life
Phototherapy helps to reduce the rise of serum bilirubin concentration, regardless of maturity, presence or absence of haemolysis, or degree of skin pigmentation.[1]
The efficiency of phototherapy is related to the starting bilirubin concentration and efficiency will fall as the level of serum bilirubin decreases
Summary
Phototherapy is used to manage neonatal hyperbilirubinemia in early life. We aimed to compare between intermittent and continuous phototherapy in reducing TSB, rate of fall of bilirubin, duration of phototherapy and duration of hospitalisation in neonates with non-haemolytic hyperbilirubinemia. Phototherapy helps to reduce the rise of serum bilirubin concentration, regardless of maturity, presence or absence of haemolysis, or degree of skin pigmentation.[1] About 97% of full term and preterm neonates demonstrate a biochemical hyperbilirubinemia Phototherapy acts by photoisomerisation, which reduces the level of bilirubin by degradation of bilirubin. A prolonged on and off schedule may not be as effective as continuous therapy, but an on-off cycle of less than one hour is apparently as effective as continuous treatment.[4] The efficiency of phototherapy is related to the starting bilirubin concentration and efficiency will fall as the level of serum bilirubin decreases. It seems one to three hours period of phototherapy discounting would favour a more intense bilirubin rebound into the skin and theoretically increases the effect of phototherapy. One to three hours of phototherapy discounting would make time for nursing care of the baby, feeding, kangaroo mother care, building mother and infant bonding, saves time and work load on nurses and reduces the cost of phototherapy.[5]
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