Comparison of phototherapy rates and clinical outcomes between 2022 and 2004 American Academy of Pediatrics Clinical Practice Guidelines for the management of neonatal hyperbilirubinemia

Abstract

Background: The American Academy of Pediatrics (AAP) has revised new guidelines for managing hyperbilirubinemia in infants of 35 or more weeks of gestation (AAP 2022), which adjust treatment criteria by raising the bilirubin threshold, as no evidence of neurotoxicity was found at lower bilirubin levels. This change may reduce the need for phototherapy and allow infants to be discharged earlier to home and family.

Objective: To compare the rate of phototherapy, duration of phototherapy, length of hospital stay, age, and bilirubin levels at the start of treatment, as well as the readmission rate for hyperbilirubinemia in infants, using the clinical practice guidelines from AAP 2022 and AAP 2004.

Methods: This study used an interrupted time series quasi-experimental design, including infants of 35 or more weeks of gestation born between November and December 2023 under the AAP 2004 guidelines (control group) and between February and April 2024 under the AAP 2022 guidelines (intervention group) at Sukhothai Hospital, Thailand. Statistical analyses included t-tests and exact probability tests.

Results: A total of 290 infants were included, with 145 infants in the intervention group and 145 infants in the control group. No significant difference was found in the rate of phototherapy (20.7% vs. 23.5%, p=0.336), the duration of phototherapy (30 hours, p=0.927), or the length of hospital stay (4 days, p=0.324) between the two groups. However, infants in the intervention group were older at treatment initiation (110.0 ± 46.66 hours vs. 80.9 ± 29.12 hours, p=0.003), had higher bilirubin levels (18.5 ± 2.98 mg/dL vs. 16.9 ± 1.82 mg/dL, p=0.011), and had a higher rate of readmission for jaundice (53.3% vs. 26.5%, p=0.026) compared to infants in the control group.

Conclusion: The AAP 2022 guidelines did not reduce the rate or duration of phototherapy, or the length of hospital stay for infants with hyperbilirubinemia, compared to the AAP 2004 guidelines. Infants under the AAP 2022 guidelines were older at treatment initiation, had higher bilirubin levels, and were readmitted more frequently. Post-discharge follow-up is important, as some infants may require readmission due to higher bilirubin levels.