P1.162: Examining the Influence of an Evidence-Based Bilirubin Discharge Bundle On The Readmission Rates of Late Preterm and Term Newborns with Hyperbilirubinemia In An Inner city Neonatal Care Setting.

Background: Hyperbilirubinemia, characterized by elevated bilirubin levels resulting from the breakdown of red blood cells, is a common neonatal condition that can lead to bilirubin-induced neurologic dysfunction (BIND) or kernicterus if left untreated. The American Academy of Pediatrics (AAP) recommends universal screening for bilirubin and, in 2022, updated guidelines for managing hyperbilirubinemia in late preterm and term newborns. Nevertheless, hyperbilirubinemia remains a leading cause of neonatal readmission, with a California study estimating a readmission rate of 10 per 1,000 live births. This study aims to evaluate the impact of a bilirubin discharge bundle (BDB) on neonatal readmission rates due to hyperbilirubinemia .

Methods: This study employs a retrospective and prospective comparative design. It examines newborn outcomes before and after the implementation of BDB. The retrospective cohort comprises newborns born from January 1, 2017, to December 31, 2022, while the prospective cohort includes births from March 1, 2023, to December 31, 2024. Eligible newborns were born at 35–42 weeks of gestation in the newborn nursery, excluding preterm infants ( < 35 weeks), those with major congenital malformations, and NICU admissions. A bilirubin discharge bundle (BDB) was developed in accordance with the 2022 AAP recommendations. Readmission and other outcomes were monitored both before and after the implementation of BDB. There is also a quality improvement aspect to monitoring BDB utilization overall and ensuring the appropriate use of BDB. The study was conducted in a Neonatal care setting, with IRB approval from Rutgers IRB and University Hospital OCRA

Results: Baseline data from the study institution revealed a 6.7% neonatal readmission rate, with 90% of cases attributed to hyperbilirubinemia. Following the BDB implementation, the readmission rate decreased to 3.86%, with 86.7% of readmissions still attributed to hyperbilirubinemia. The Bilirubin discharge bundle was utilized in 88.7% of cases; however, its appropriate use remains below the 85% target, with an accuracy rate of 65%. Stakeholder feedback was overwhelmingly positive (100%), supporting the continued use of this approach. The BDB promotes adherence to best practices, improving neonatal outcomes and reducing preventable readmissions

Conclusion: The findings of this study reaffirm the critical role of standardized discharge processes in reducing neonatal readmissions due to hyperbilirubinemia. The significant reduction in readmission rates post-BDB implementation underscores the effectiveness of structured protocols in newborn care. While demographic shifts and quality control challenges were noted, the overall impact of the BDB remains positive.