360° phototherapy versus single-surface LED phototherapy with white curtains in neonatal hyperbilirubinaemia: a randomised controlled trial

INTRODUCTION: Neonatal hyperbilirubinaemia is a common condition encountered globally with potential complications such as bilirubin encephalopathy. Phototherapy remains the standard treatment due to its accessibility and effectiveness. This study compares the efficacy of 360° phototherapy versus single-surface LED phototherapy with a white curtain in managing neonatal hyperbilirubinaemia requiring intensive phototherapy. METHODS: A randomised controlled trial was conducted at Hospital Pakar Universiti Sains Malaysia from December 2022 to March 2023 involving 40 neonates requiring intensive phototherapy within the first week of life. Participants were randomised into two groups: an intervention group that received 360° phototherapy ( n = 20) and a control group that received single-surface LED phototherapy with a white curtain ( n = 20). The primary outcome was the mean reduction in serum bilirubin at 4 h, 10 h and 24 h of phototherapy, which was analysed using repeated measures analysis of variance and the log-rank test. Secondary outcomes included phototherapy-related side effects and device ease of use among nurses from the neonatal intensive care unit. RESULTS: Both phototherapy methods significantly reduced serum bilirubin levels over 24 h ( P < 0.001). The 360° phototherapy group showed greater reduction at 4 h (27 ± 6.13 μmol/L, P < 0.001) than the control group (2.61 ± 6.3 μmol/L, P = 0.616). The log-rank test showed a significant difference in phototherapy duration ( P = 0.005). At 24 h, the proportion that required phototherapy was 0 for the 360° phototherapy group and 0.05 for the control group (χ 2 = 7.6, degrees of freedom = 1, P = 0.005, hazard ratio 2.29, 95% confidence interval 1.17-4.51). Safety profiles were comparable. Most nurses reported no difficulty using the 360° device. CONCLUSION: 360° phototherapy achieves therapeutic goals more rapidly with a comparable safety profile.