The Effect of Acupressure on Hyperbilirubinemia in Newborns: A Randomized Controlled Trial

One of the most common problems encountered in the neonatal period is neonatal jaundice, which develops due to an increase in indirect bilirubin (Özdemir and Yılmaz, 2019). Jaundice (hyperbilirubinemia) is defined as the yellowing of the skin and the whites of the eyes due to the accumulation of bilirubin in the skin and mucous membranes of newborns (Kılıç and Yılmaz, 2021). Jaundice is a common condition seen in 60% of term infants and more than 80% of preterm infants (Muniyappa and Kelley, 2020). Hyperbilirubinemia (HB), which is frequently seen in newborns, especially in the indirect form, is a mild health problem in most cases (Olcar, 2019; Yılmaz, 2019). HB in newborns usually progresses cephalocaudally (from head to toe); it starts in the face and spreads to the body as serum bilirubin levels increase (Turkish Neonatology Association [TND], 2022). Symptoms such as lethargy and feeding difficulties may occur in infants with severe HB. If not treated promptly, serious neurological complications such as kernicterus may occur. Early diagnosis, close monitoring, and treatment are vital to prevent potential damage in newborns (Muniyappa and Kelley, 2020).

Various treatment methods have been developed to reduce bilirubin levels. Among these methods, the most commonly used are blood exchange, phototherapy, and drug treatments (Garg et al., 2019; Kılıç and Yılmaz, 2021). To support neonatal HB treatment, studies evaluating the effectiveness of non-pharmacological and complementary applications, in addition to pharmacological methods, have also been conducted (Öztürk, 2025; Coşkun and Karakoç., 2025; Wu et al., 2022).

Acupressure is a complementary treatment method that aims to control symptoms by applying pressure to specific points on the meridians (İskender and Çalışkan, 2020). During the application, sensitive pressure is applied to specific points on the body using the hands and fingers, and in some cases, special tools; this aims to regulate energy flow and support the body's natural healing processes (Dincer et al., 2022; Harris et al., 2020). These stimuli, applied through touch, can activate receptors in the skin of infants with HB and be transmitted to the brain centers via reflex pathways. This can stimulate the parasympathetic nervous system and the vagus nerve, accelerating bowel movements, contributing to the regulation of the digestive system, and helping to expel meconium more quickly (Roth and Sullivan, 2006). In this regard, it is crucial to correctly identify the appropriate acupressure points during the treatment process (Bayraktar, 2023).

The application of acupressure has been used in various clinical settings in the neonatal and pediatric populations, and its effects on different physiological outcomes have been investigated. The effects of acupressure on pain (Altıntaş, 2023; Oğul, 2023; Özkan and Balcı, 2018), infantile colic (Özgören, 2021), and chemotherapy-induced nausea and vomiting (Balcı, 2018) in the pediatric group have been examined in various studies. However, it has been determined that studies evaluating the effect of acupressure on HB in newborns (Wu et al., 2022) are quite limited. Therefore, the aim of this study is to evaluate the effect of acupressure applied to newborns on HB. In this context, the potential contributions of acupressure to reducing serum bilirubin levels and supporting the treatment process will be examined, and it is aimed that the findings will provide scientific evidence regarding the effectiveness of acupressure as a complementary approach in the management of hyperbilirubinemia and guide clinical practice.

Inclusion criteria

• Gestational age ≥38 weeks
• Diagnosed with neonatal hyperbilirubinemia
• Hospitalized in the neonatal unit for at least 24 hours
• Birth weight ≥2500 g
• Written informed consent obtained from parents

Exclusion criteria

• Preterm newborns
• Congenital metabolic disease or congenital anomalies
• Hemodynamically unstable newborns
• Newborns whose parents did not provide consent
• Newborns with any condition preventing acupressure application