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Objective: To compare the effectiveness of various phototherapy systems in lowering serum bilirubin levels in preterm infants. Methods: This randomized clinical trial enrolled 140 preterm infants with gestational age ≤30 weeks and presenting nonhemolytic hyperbilirubinemia. When total serum bilirubin level reached 6.0 mg/dl (102.6 μmol/l), eligible infants were randomly assigned to four study groups: conventional, fiberoptic Wallaby, fiberoptic Biliblanket, and combined phototherapy. Efficacy was assessed by comparing highest serum bilirubin levels, duration of treatment, and number of infants requiring exchange transfusion. Results: Our results confirm that fiberoptic phototherapy, both Wallaby and Biliblanket, had the same effectiveness of conventional phototherapy. The best results have been obtained using combined phototherapy, which allowed to reach lower serum bilirubin levels, a shorter duration of treatment and a significant reduction of exchange transfusions. Conclusion: Our data suggest that combined phototherapy should be the method of choice in treating hyperbilirubinemia in very preterm infants. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]