Intermittent versus Continuous phototherapy for neonatal nonhemolytic hyperbilirubinemia in neonates 28 to 34 weeks of gestational age A non inferiority randomized control trial.

Neonatal jaundice occurs in 60% term and 80% preterm infants. Continuous Phototherapy(CPT) reduces kernicterus and improves neurodevelopmental outcomes across all gestations. However alterations in mesenteric, cerebral blood flow, DNA damage, risk of carcinogenesis and higher mortality in ELBW babies have been reported. Intermittent Phototherapy(IPT) is a proven non-inferior alternative to CPT in Term and Late Preterm babies. CTRI Registration will be done and the study will be conducted from April 2023-December 2024. With 80 % power and an alpha error of 5 % that indicated intermittent PT is not inferior to continuous PT in terms of rate of fall of bilirubin, 45 neonates will be enrolled in each group with the help of computer generated randomisation. Infants with gestations 28 – 34 weeks of gestations with nonhemolytic hyperbilirubinemia during NICU stay will be enrolled with infants in IPT group receiving  phototherapy for 6 hour cycles. While infants in CPT group will receive phototherapy for 24 hours. Total serum bilirubin (TSB) will be done every 12- 24 h in both groups until criteria for stopping PT is met. Primary outcomes will be -Rate of fall of bilirubin. Data will be presented as number and percentage, mean and standard deviation or median and interquartile range as appropriate. Relevant tests of significance will be applied. Multiple regression analysis will be used to adjust for confounding. p value of <0.05 will be considered statistically significant Intermittent phototherapy may possibly avoid cerebral, splanchnic hemodynamic fluctuations in VLBW infants with preserved skin integrity. Improved KMC hours, decreased mother infant separation can be gained in infants between 28-34 weeks gestation. Finally, it may help NICU to treat more babies with limited phototherapy units across all gestations.