Background: Neonatal hyperbilirubinemia is a prevalent condition commonly treated with phototherapy. While effective, phototherapy can cause adverse effects such as dehydration and maternal separation, necessitating complementary care strategies. Objectives: This systematic review aims to evaluate the efficacy of foot reflexology and related tactile interventions on bilirubin levels and physiological parameters in neonates undergoing treatment for hyperbilirubinemia. Methods: A systematic search was conducted across five electronic databases (PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library) for studies published between 2019 and 2025. The review followed the PRISMA guidelines and PICOS framework. Twenty studies, including Randomized Controlled Trials (RCTs) and quasi-experimental designs, met the inclusion criteria. Results: The synthesized evidence indicates that foot reflexology is associated with a significant reduction in serum bilirubin levels compared to standard care alone. Additionally, the intervention demonstrated a stabilizing effect on physiological parameters, specifically reducing heart rate (HR) and respiratory rate (RR) while improving oxygen saturation (SpO2). Conclusion: Foot reflexology appears to be a safe and effective complementary therapy that may enhance bilirubin excretion and promote physiological stability in jaundiced neonates.