Key messages
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For newborn infants with jaundice:
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It is unclear if high- versus low-dose phototherapy reduces the occurrence of newborn brain injuries, cerebral palsy, or death before leaving the hospital.
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High- versus low-dose phototherapy may slightly reduce bilirubin levels 12 to 48 hours after starting treatment.
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We need larger and better studies to investigate different doses of phototherapy to determine the best amount to use to improve infants' health.
What is neonatal jaundice?
Jaundice (yellowing of the skin and eyes) is the most common condition affecting newborn infants. It is caused by bilirubin (a yellowish pigment) in the blood. Bilirubin is produced by the body during the naturally occurring breakdown of old red blood cells. When the amount of bilirubin is greater than the baby's ability to get rid of it – by peeing or having a bowel movement, it builds up in the body.
What is phototherapy?
Phototherapy (light therapy) is the main treatment for neonatal jaundice. The light from phototherapy devices is absorbed through the skin – just as sunlight is. Phototherapy uses a special light that helps convert bilirubin into a less harmful substance that the baby can excrete when peeing or having a bowel movement. Phototherapy can be given at different doses. We define doses as: the strength of the light; the use of different light devices; or the distance of the light from the baby's skin.
Why is treating jaundice important?
Jaundice can lead to problems with brain development and function. Examples include encephalopathy (damage or disease that affects the brain), which may lead to kernicterus, a form of permanent brain damage that can cause cerebral palsy, which is a movement disorder that affects muscle control. Severe brain injuries from jaundice can cause death.
What did we want to find out?
We wanted to find out whether giving newborn infants a higher dose of phototherapy reduced bilirubin faster and decreased their risk of long-term problems or death due to brain injury or damage.
What did we do?
We searched for studies comparing different doses of phototherapy to see if different doses had different effects. We compared different phototherapy devices; different strengths of light; and different distances between the baby's skin and the phototherapy light. We summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes as well as agreement between studies.
What did we find?
We found 41 studies with 6927 newborn infants who had jaundice treated using phototherapy. The phototherapy treatment in the studies lasted from 16 to 60 hours.
Main results
In babies with jaundice:
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It is unclear if high versus low doses of phototherapy reduce the occurrence of encephalopathy or cerebral palsy.
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High versus low doses of phototherapy:
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May result in little to no difference in death while in the hospital;
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May slightly reduce the level of bilirubin at 24 or 48 hours after treatment;
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May have little to no effect on reducing the level of bilirubin at 72 hours after treatment, but we are very uncertain about these results.
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No studies reported the occurrence of kernicterus.
What are the limitations of the evidence?
Three main factors reduced our confidence in the evidence. First, in around one-third of the studies, it looked like people in the studies were not strictly randomly placed into the different treatment groups. This means that differences between the groups could be due to differences between people rather than between the treatments. Second, the findings about bilirubin levels differed greatly in the studies reporting this outcome, and we do not fully know why even after a detailed assessment. Third, for the outcomes of cerebral palsy and death, there were very few studies and participants included. Because of these, we are unable to draw firm conclusions about how well different doses of phototherapy worked.
How up to date is this evidence?
The evidence is up-to-date to 09 June 2025.
Baca abstrak penuh
Matlamat
To assess the effects of high-dose versus low-dose phototherapy on bilirubin level and associated clinical outcomes that constitute the major conditions in kernicterus spectrum disorder (KSD), such as acute bilirubin encephalopathy and kernicterus, as well as cerebral palsy and neurodevelopmental disabilities in infants with hyperbilirubinaemia; and to assess the effects of high-dose phototherapy, defined as the use of high levels of measured spectral irradiance greater than 30 μW/cm²/nm over the same bandwidth, as well as low-dose phototherapy, defined as measured levels of spectral irradiance below 30 μW/cm²/nm.
Kaedah Pencarian
Searches were conducted up to 09 June 2025 in MEDLINE, Embase, CENTRAL, and two trial registries. We checked reference lists of related reviews and included studies.
Kesimpulan Pengarang
The low- to very low-certainty evidence precluded firm conclusions about the effects of high-dose compared to low-dose phototherapy on acute bilirubin encephalopathy, moderate or severe cerebral palsy and all-cause mortality. No studies evaluated kernicterus. It is unclear how small reductions in serum bilirubin at 12 to 48 hours translate to clinically important benefits. Further RCTs with robust randomisation methods and detailed documentation of population and intervention, with inclusion of patient-important outcomes are needed to improve the certainty of the evidence.
Funding
This Cochrane review had no dedicated funding.
Registration
Protocol (2001) DOI: 10.1002/14651858.CD0033; Protocol (2020) DOI: 10.1002/14651858.CD003308.pub2;
