Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Double versus single intensive phototherapy with LEDs in treatment of neonatal hyperbilirubinemia



We investigate whether double phototherapy reduces total serum bilirubin concentration faster than single light during intensive phototherapy with high levels of irradiance using light-emitting diodes.

Study Design:

Eighty-three infants with gestational age 33 weeks and uncomplicated hyperbilirubinemia were randomized to either double (n=41) or single phototherapy (n=42) for 24 h. The mean irradiance was 64.8 μW cm−2 nm−1 from above and 39 μW cm−2 nm−1 from below.


The percentage decreases of total serum bilirubin after 12 h of double vs single phototherapy were (mean (95% confidence interval (CI))) 39% (37 to 42) vs 30% (27 to 32), respectively (P<0.001). After 24 h, the decreases were 58% (56 to 61) vs 47% (44 to 50), respectively (P<0.001). The results were still significant after adjustment for confounding. The only side effect was loose stools.


Even with intensive phototherapy increasing spectral power by increasing the irradiated body surface area, the efficacy of phototherapy is improved.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Prices vary by article type



Prices may be subject to local taxes which are calculated during checkout

Figure 1


  1. Jasprova J, Dal Ben M, Vianello E, Goncharova I, Urbanova M, Vyroubalova K et al. The biological effects of bilirubin photoisomers. PLoS ONE 2016; 11: e0148126.

    Article  Google Scholar 

  2. Maisels MJ . Why use homeopathic doses of phototherapy? Pediatrics 1996; 98: 283–287.

    CAS  PubMed  Google Scholar 

  3. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 297–316.

    Article  Google Scholar 

  4. Boonyarittipong P, Kriangburapa W, Booranavanich K . Effectiveness of double-surface phototherapy versus single-surface phototherapy for neonatal hyperbilirubinemia. J Med Assoc Thai 2008; 91: 50–55.

    PubMed  Google Scholar 

  5. Nuntnarumit P, Naka C . Comparison of the effectiveness between the adapted-double phototherapy versus conventional-single phototherapy. J Med Assoc Thai 2002; 85: s1159–s1164.

    PubMed  Google Scholar 

  6. Sarici SU, Alpay F, Unay B, Ozcan O, Gokcay E . Double versus single phototherapy in term newborns with significant hyperbilirubinemia. J Trop Pediatr 2000; 46: 36–39.

    Article  CAS  Google Scholar 

  7. Garg AK, Prasad RS, Hifzi IA . A controlled trial of high-intensity double-surface phototherapy on a fluid bed versus conventional phototherapy in neonatal jaundice. Pediatrics 1995; 95: 914–916.

    CAS  PubMed  Google Scholar 

  8. Kang JH, Shankaran S . Double phototherapy with high irradiance compared with single phototherapy in neonates with hyperbilirubinemia. Am J Perinatol 1995; 12: 178–180.

    Article  CAS  Google Scholar 

  9. Holtrop PC, Ruedisueli K, Maisels MJ . Double versus single phototherapy in low birth weight newborns. Pediatrics 1992; 90: 674–677.

    CAS  PubMed  Google Scholar 

  10. Hansen T Neonatal Jaundice Treatment & Management. 2016; Available at Accessed 4 March 2016.

  11. Bratlid D, Nakstad B, Hansen TW . National guidelines for treatment of jaundice in the newborn. Acta Paediatr 2011; 100: 499–505.

    Article  CAS  Google Scholar 

  12. Ebbesen F, Madsen P, Stovring S, Hundborg H, Agati G . Therapeutic effect of turquoise versus blue light with equal irradiance in preterm infants with jaundice. Acta Paediatr 2007; 96: 837–841.

    Article  Google Scholar 

  13. Ebbesen F, Vandborg PK, Madsen PH, Trydal T, Jakobsen LH, Vreman HJ . Effect of phototherapy with turquoise vs blue LED light of equal irradiance in jaundiced neonates. Pediatr Res 2016; 79: 308–312.

    Article  Google Scholar 

  14. Doumas BT, Kwok-Cheung PP, Perry BW, Jendrzejczak B, McComb RB, Schaffer R et al. Candidate reference method for determination of total bilirubin in serum: development and validation. Clin Chem 1985; 31: 1779–1789.

    CAS  PubMed  Google Scholar 

  15. Donneborg ML, Knudsen KB, Ebbesen F . Effect of infants' position on serum bilirubin level during conventional phototherapy. Acta Paediatr 2010; 99: 1131–1134.

    Article  CAS  Google Scholar 

  16. Tan KL . The pattern of bilirubin response to phototherapy for neonatal hyperbilirubinemia. Pediatr Res 1982; 670–674.

    Article  CAS  Google Scholar 

  17. Vreman HJ, Wong RJ, Stevenson DK . Phototherapy: current methods and future directions. Semin Perinatol 2004; 28: 326–333.

    Article  Google Scholar 

  18. Onishi S, Isobe K, Itoh S, Manabe M, Sasaki K, Fukuzaki R et al. Metabolism of bilirubin and its photoisomers in newborn infants during phototherapy. J Biochem 1986; 100: 789–795.

    Article  CAS  Google Scholar 

  19. Ennever JF, Costarino AT, Polin RA, Speck WT . Rapid clearance of a structural isomer of bilirubin during phototherapy. J Clin Invest 1987; 79: 1674–1678.

    Article  CAS  Google Scholar 

  20. Linfield DT, Lamola AA, Mei E, Hwang AY, Vreman HJ, Wong RJ et al. The effect of hematocrit on in vitro bilirubin photoalteration. Pediatr Res 2016; 79: 387–390.

    Article  CAS  Google Scholar 

  21. Ebbesen F, Madsen PH, Vandborg PK, Jakobsen LH, Trydal T, Vreman HJ . Bilirubin isomer distribution in jaundiced neonates during phototherapy with LED light centered at 497 nm (turquoise) vs 459 nm (blue). Pediatr Res 2016; 80: 511–515.

    Article  CAS  Google Scholar 

  22. Mreihil K, Madsen P, Nakstad B, Benth JS, Ebbesen F, Hansen TW . Early formation of bilirubin isomers during phototherapy for neonatal jaundice: effects of single vs double fluorescent lamps vs photodiodes. Pediatr Res 2015; 78: 56–62.

    Article  CAS  Google Scholar 

  23. Hansen TW, Nietsch L, Norman E, Bjerre JV, Hascoet JM, Mreihil K et al. Reversibility of acute intermediate phase bilirubin encephalopathy. Acta Paediatr 2009; 98: 1689–1694.

    Article  Google Scholar 

  24. Aydemir O, Soysaldi E, Kale Y, Kavurt S, Bas AY, Demirel N . Body temperature changes of newborns under fluorescent versus LED phototherapy. Indian J Pediatr 2014; 81: 751–754.

    Article  Google Scholar 

  25. Bertini G, Perugi S, Elia S, Pratesi S, Dani C, Rubaltelli FF . Transepidermal water loss and cerebral hemodynamics in preterm infants: conventional versus LED phototherapy. Eur J Pediatr 2008; 167: 37–42.

    Article  Google Scholar 

  26. Aycicek A, Kocyigit A, Erel O, Senturk H . Phototherapy causes DNA damage in peripheral mononuclear leukocytes in term infants. J Pediatr (Rio J) 2008; 84: 141–146.

    Article  Google Scholar 

  27. Mohamed WW, Niazy WH . Genotoxic effect of phototherapy in term newborn infants with hyperbilirubinemia. J Neonatal Perinatal Med 2012; 5: 381–387.

    Google Scholar 

  28. Tozzi E, Tozzi-Ciancarelli MG, Di Giulio A, D'Alfonso A, Farello G, Spennati GF et al. In vitro and in vivo effects of erythrocyte phototherapy on newborns. Biol Neonate 1989; 56: 204–209.

    Article  CAS  Google Scholar 

  29. Kahveci H, Dogan H, Karaman A, Caner I, Tastekin A, Ikbal M . Phototherapy causes a transient DNA damage in jaundiced newborns. Drug Chem Toxicol 2013; 36: 88–92.

    Article  CAS  Google Scholar 

  30. Tatli MM, Minnet C, Kocyigit A, Karadag A . Phototherapy increases DNA damage in lymphocytes of hyperbilirubinemic neonates. Mutat Res 2008; 654: 93–95.

    Article  CAS  Google Scholar 

  31. Sirota L, Straussberg R, Gurary N, Aloni D, Bessler H . Phototherapy for neonatal hyperbilirubinemia affects cytokine production by peripheral blood mononuclear cells. Eur J Pediatr 1999; 158: 910–913.

    Article  CAS  Google Scholar 

  32. Kurt A, Aygun AD, Kurt AN, Godekmerdan A, Akarsu S, Yilmaz E . Use of phototherapy for neonatal hyperbilirubinemia affects cytokine production and lymphocyte subsets. Neonatology 2009; 95: 262–266.

    Article  CAS  Google Scholar 

  33. Brewster DH, Tucker JS, Fleming M, Morris C, Stockton DL, Lloyd DJ et al. Risk of skin cancer after neonatal phototherapy: retrospective cohort study. Arch Dis Child 2010; 95: 826–831.

    Article  Google Scholar 

Download references


We thank the nurses, doctors in charge and the laboratory technicians for their excellent assistance.

Author information

Authors and Affiliations


Corresponding author

Correspondence to M L Donneborg.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Donneborg, M., Vandborg, P., Hansen, B. et al. Double versus single intensive phototherapy with LEDs in treatment of neonatal hyperbilirubinemia. J Perinatol 38, 154–158 (2018).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links