Neonatal jaundice, characterized by elevated levels of conjugated or unconjugated bilirubin in the skin, affects 60% of term and 80% of preterm neonates, making it a leading cause of hospital admissions during the first two weeks of life (Ansong-Assoku et al., 2024; Çamur et al., 2024). While usually physiological and self-resolving, hyperbilirubinemia can lead to kernicterus or death due to bilirubin neurotoxicity, including acute bilirubin encephalopathy (Ansong-Assoku et al., 2024; Negi & Sorte, 2015; Van Rostenberghe et al., 2020).

Diagnostic evaluation includes measuring total serum bilirubin (TSB), capillary bilirubin, and transcutaneous bilirubin (TcB) levels, often assessed using hour-specific nomograms (Ansong-Assoku et al., 2024; Çamur et al., 2024; Darka & Gül, 2024). Phototherapy remains the primary treatment, reducing bilirubin levels through photo-oxidation and photo-isomerization (Dachlan et al., 2015; Olusanya et al., 2018; Santoso et al., 2022). However, phototherapy may cause side effects such as watery diarrhea, dehydration, skin rashes, bronze baby syndrome, and maternal-infant separation, leading to emotional distress (Çamur et al., 2024; Eghbalian et al., 2017).

Enhancing light intensity during phototherapy by incorporating reflective materials, such as white covers, into phototherapy units has been shown to increase bilirubin conversion rates. By redirecting dispersed phototherapy light back toward the infant, this simple and cost-effective approach enhances irradiance, leading to shorter phototherapy duration and reduced hospital stay (Abd Hamid et al., 2013; Kurniasih et al., 2011; Mreihil et al., 2010; Salehzadeh et al., 2011; Van Rostenberghe et al., 2020).

The use of reflective materials, such as white curtains made from plastic aluminum reflectors and white fabric curtains has been found to shorten phototherapy duration. Additionally, these materials help reduce TSB levels more rapidly and enhance the therapeutic effect of phototherapy (Abd Hamid et al., 2013; Babaei et al., 2013; Dachlan et al., 2015; Devpura et al., 2017; Djokomulyanto et al., 2006; Djokomulyanto et al., 2016; Hashim et al., 2015; Khan et al., 2018; Kurniasih et al., 2011; Lahiri et al., 2016; Mohmmed, 2024; Negi & Sorte, 2015; Priya et al., 2022; Sabry et al., 2021; Tadi & Varghese, 2019; Yang et al., 2020). Lower bilirubin levels reduce the need for phototherapy, thus shortening the duration of phototherapy and hospital stay (Abdellatif et al., 2020; Lin et al., 2015; Mrljak et al., 2022). Infant massage has emerged as a safe, non-invasive intervention that promotes bilirubin elimination by enhancing bowel movements (Abdellatif et al., 2020; Doğan et al., 2023; Priyadarshi et al., 2022; Zaki & Thabet, 2019). Studies have demonstrated that massage reduces bilirubin levels, increases defecation frequency, and shortens phototherapy duration without adverse effects (Çamur et al., 2024; Köse et al., 2024).

Demonstrating the effects of white cover and massage on bilirubin levels and phototherapy duration will contribute to the production of evidence for supportive care practices in phototherapy-treated newborns.

This study aims to evaluate the combined effect of white cover and infant massage on bilirubin levels and phototherapy duration, offering an innovative and effective approach to improving neonatal care outcomes.

In terms of newborns receiving phototherapy, does the combined use of a white reflective cover and massage influence bilirubin levels?

Does the integration of a white cover and massage reduce the duration of phototherapy required in term newborns?

Is there an effect of white cover and massage application on the frequency and volume of urination in term newborns undergoing phototherapy?

Does the use of a white cover in conjunction with massage impact the frequency and amount of defecation in term newborns under phototherapy?

Can the application of a white cover and massage contribute to a reduction in the overall length of hospital stay in term newborns receiving phototherapy?

Does the combination of a white reflective cover and massage influence body weight gain during the phototherapy period in term newborns?