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Objective: Evaluate the efficacy of phototherapy (PT) devices and the outcomes of extremely premature infants treated with those devices. Study Design: This substudy of the National Institute of Child Health and Human Development Neonatal Research Network PT trial included 1404 infants treated with a single type of PT device during the first 24 +/- 12 h of treatment. The absolute (primary outcome) and relative decrease in total serum bilirubin (TSB) and other measures were evaluated. For infants treated with one PT type during the 2-week intervention period (n = 1223), adjusted outcomes at discharge and 18 to 22 months corrected age were determined. Result: In the first 24 h, the adjusted absolute (mean (+/- s.d.)) and relative (%) decrease in TSB (mg dl(-1)) were light-emitting diodes (LEDs) -2.2 (+/- 3), -22%; Spotlights -1.7 (+/- 2), -19%; Banks -1.3 (+/- 3), -8%; Blankets -0.8 (+/- 3), -1%; (P<0.0002), Some findings at 18 to 22 months differed between groups. Conclusion: LEDs achieved the greatest initial absolute reduction in TSB but were similar to Spots in the other performance measures. Long-term effects of PT devices in extremely premature infants deserve rigorous evaluation. Journal of Perinatology (2013) 33, 126-133; doi:10.1038/jp.2012.39; published online 12 April 2012