Real-World Outcomes of the 2022 American Academy of Pediatrics Hyperbilirubinemia Guideline.

Objectives: To evaluate the clinical impact and adherence to the 2022 American Academy of Pediatrics guideline for neonatal hyperbilirubinemia in comparison with the 2004 guideline.

Methods: We conducted a retrospective study of all infants born at ≥ 35 weeks post-menstrual age during June-July from 2021 to 2023. Infants were categorised into two epochs: Epoch 1 (E1), treated according to the 2004 guidelines (2021-2022), and Epoch 2 (E2), treated according to the 2022 guidelines (2023). We assessed phototherapy rates, hyperbilirubinemia-related outcomes and non-adherence, defined as phototherapy treatment despite bilirubin levels > 2.0 mg/dL below the threshold.

Results: Among 4071 infants, 255 required phototherapy (183 in E1 and 72 in E2). The phototherapy rate decreased from 6.6% in E1 to 5.5% in E2 (p = 0.227). However, a significant increase in lack of adherence was observed in E2, with 47.2% receiving phototherapy below the threshold compared to 26.2% in E1 (p = 0.002). Infants in E2 underwent more skin-breaking procedures (p = 0.016) and had a higher rate of positive direct antiglobulin tests (p = 0.04). No differences were observed in the duration of phototherapy exposure, length of hospital stay or rate of readmissions.

Conclusion: While adherence to guidelines was suboptimal, and rates of phototherapy did not significantly decline, a greater proportion of treated infants had hemolytic risk factors, suggesting more targeted use of phototherapy. Improved efforts are needed to enhance compliance with the guideline, which may in turn help minimise unnecessary interventions.