Multi-directional phototherapy vs. unidirectional phototherapy from below for severe neonatal jaundice: a randomized pilot trial in home phototherapy

Clinical Snapshot

Key Findings

• P Value: p = 0.05 for treatment time; p < 0.02 for bilirubin reduction rate

• Effect Size: 10-hour reduction in treatment time with multi-directional therapy

• Primary Outcome: Treatment time: 15.1 ± 6.4 h (multi-directional) vs 25.1 ± 11.8 h (unidirectional)

• Nnt Or Sensitivity: Bilirubin reduction rate: 0.40 ± 0.21 vs 0.14 ± 0.10 mg/dL/h

• Confidence Interval: Not reported

Clinical Application

Multi-directional devices may require different equipment but appear feasible for home use Relevant to Australian practice where home phototherapy is increasingly used. Would need TGA approval for new devices and consideration of PBS funding for equipment rental Term and near-term neonates with moderate to severe jaundice suitable for home phototherapy

Abstract

UNLABELLED: Severe neonatal jaundice is a common problem, carrying a risk of neurologic toxicity. Phototherapy has become the standard treatment for jaundiced infants, eliminating the need for exchange transfusion and the risk of neurotoxicity. We hypothesized that treatment with multi-directional phototherapy would be more rapid than with single-direction, high-intensity treatment from below (unidirectional) in the home setting. We performed a prospective, randomized, pilot trial comparing high-intensity multi-directional phototherapy to high-intensity unidirectional treatment in the home setting. Treatment time was determined from device timers. Serum bilirubin levels were obtained daily and as ordered by the pediatrician, serving as a basis for estimating the bilirubin reduction rates. Eight infants were treated with multi-directional phototherapy; nine were treated with unidirectional phototherapy. Multi-directional treatment was more rapid with treatment time of 15.1 ± 6.4 h vs. 25.1 ± 11.8 h; p = 0.05. The estimated rate of bilirubin reduction was more rapid with multi-directional phototherapy 0.40 ± 0.21 vs. 0.14 ± 0.10 mg/dL/h; p < 0.02. CONCLUSION: Multi-directional phototherapy was more rapid than treatment with unidirectional phototherapy in the home setting. TRIAL REGISTRATION: ISRCTN88608924 29 January 2026, retrospectively registered. WHAT IS KNOWN: •Home phototherapy for hyperbilirubinemia is safe and effective. •Treatment times with fiberoptic and wearable devices in the home setting can be lengthy and complicated by overheating and readmission. WHAT IS NEW: •Home phototherapy with multidirectional illumination is more effective than unidirectional undersurface phototherapy. •Multidirectional home phototherapy can lower bilirubin levels at a rate comparable to hospital devices.

References

1. 1.Magee, S., Roberts, M., & Gilbert, G. E. (2019). Multi-directional phototherapy vs. unidirectional phototherapy from below for severe neonatal jaundice: a randomized pilot trial in home phototherapy. European Journal of Pediatrics, 178(6), 841-847. https://doi.org/10.1186/s13052-019-0663-5