Although phototherapy (PT) is a standard treatment for neonatal jaundice, no validated clinical methods for determination of bilirubin phototherapy products are available. Thus, the aim of our study was to establish a such method for clinical use. To achieve this aim, a LC-MS/MS assay for simultaneous determination of Z-lumirubin (LR) and unconjugated bilirubin (UCB) was conducted. LR was purified after irradiation of UCB at 460 nm. The assay was tested on human sera from PT-treated neonates. Samples were separated on a HpLc system with a triple quadrupole mass spectrometer detector. The instrument response was linear up to 5.8 and 23.4 mg/dL for LR and UCB, respectively, with submicromolar limits of detection and validity parameters relevant for use in clinical medicine. exposure of newborns to pt raised serum LR concentrations threefold (p < 0.01), but the absolute concentrations were low (0.37 ± 0.16 mg/dL), despite a dramatic decrease of serum UCB concentrations (13.6 ± 2.2 vs. 10.3 ± 3.3 mg/dL, p < 0.01). A LC-MS/MS method for the simultaneous determination of LR and UCB in human serum was established and validated for clinical use. This method should help to monitor neonates on PT, as well as to improve our understanding of both the kinetics and biology of bilirubin phototherapy products. Neonatal jaundice is a very prevalent condition during the newborn period. In fact, virtually all newborn infants develop some degree of hyperbilirubinemia (>1 mg/dL, 17 μmol/L) during the first week of life. In up to one third of neonates, the total serum bilirubin concentrations exceed 13 mg/dL (220 μmol/L), depending on the geographical region as well as ethnicity 1-3. Phototherapy (PT) with a blue-green light is the treatment of choice since its discovery in the 1950's 4,5. PT results in transformation of non-polar molecule of bilirubin into more polar derivatives-bilirubin photoisomers (and subsequently Z-lumirubin (LR) as the final product of the photo-rearrangement), and other bilirubin oxidation products (Fig. 1). Although PT is used worldwide for decades in routine clinical practice, and in general this treatment modality is considered safe for neonatal infants 6 , certain health safety concerns have been raised recently, especially in extremely low-birth weight neonates. These include, in particular, increased mortality rates in those neonates treated with aggressive PT 7-9. In addition, a significant increased risk of late-onset solid tumors in childhood infants treated with PT in the neonatal period has been reported recently 10 , a phenomenon likely related to DNA damage caused by blue-green light therapy PT 11. Based on this data, there is a need for a robust, accurate, and sensitive quantitative analytical method for the determination of bilirubin photoisomers; as well as photo-rearrangement and photooxidation products formed during PT. Quite surprisingly, these methods are still lacking, mainly because these bilirubin products are both chemically and photochemically unstable, and their determination require...