Impact of the 2022 AAP Guidelines on Neonatal Hyperbilirubinemia Admissions: A PHIS Study.

Abstract

Objectives: The American Academy of Pediatrics (AAP) 2022 update on the management of hyperbilirubinemia in neonates at or more than 35 weeks of gestation is a clinical practice guideline that sought to safely reduce unnecessary phototherapy in newborns. We assessed hyperbilirubinemia-related hospitalizations and length of stay (LOS) at freestanding US children's hospitals in the year following the guideline's release.

Patients and methods: This cohort study used data from the Pediatric Health Information System database to identify infants aged 2 to 14 days who were hospitalized during the 12 months preceding and following the publication of the revised AAP hyperbilirubinemia guideline. We analyzed changes in the probability of hospitalization for jaundice, following the publication of the guidelines using interrupted time series regression.

Results: There was a significant decrease in the probability of hospitalization for jaundice immediately after the publication of the guidelines (5051 admissions to 3778 admissions; P < .001). Although LOS slightly increased (from 29 to 32 hours [P < .001]) for all infants, there was no difference in LOS for infants without comorbidities. Utilization of intravenous immunoglobulin, exchange transfusions, and the incidence of kernicterus were unchanged pre- and post-guidelines.

Conclusions: Hospitalization for jaundice decreased in children's hospitals during the year immediately following the release of the 2022 hyperbilirubinemia guidelines. LOS did not change in infants without comorbidities. Further studies are needed to evaluate outcomes such as kernicterus and hospitalization over time.