P1.163: Hospital admissions for neonatal hyperbilirubinemia before and after the 2022 American Academy of Pediatrics’ hyperbilirubinemia guideline

Background: The American Academy of Pediatrics (AAP) updated the guideline for management of hyperbilirubinemia in infants born at ≥ 35 weeks of gestation in August 2022. This resulted in a higher total serum bilirubin (TSB) threshold to initiate phototherapy. The objective of this study was to compare the number of hospital admissions for neonatal hyperbilirubinemia and the TSB levels before and after the guideline.

Methods: Single center, retrospective study at a free-standing children’s hospital. Neonates born at ≥35 weeks of gestation and admitted to the hospital between 24 hours and 14 days of age with the primary diagnosis of hyperbilirubinemia, were divided in two groups: before the guideline group born between 7/1/2020 and 6/30/2022 and after the guideline group born between 1/1/2023 and 12/31/2024. The number of patients, baseline characteristics and highest TSB level during hospitalization, were compared between the two groups.

Results: A total of 957 patients were identified, with 394 admissions during the 2 years after the guideline and 563 during the same period before the guideline, representing a 30% reduction in the number of admissions over 2 years after the guideline. Table 1 presents the baseline patient characteristics including gestational age at birth, sex and chronological age on admission. The mean highest TSB level after the guideline (21.2 mg/dl, 95% Confidence Interval: 20.9-21.5) was significantly higher than before the guideline (19.4 mg/dl, 95% Confidence Interval: 19.1-19.7) (figure 1).

Conclusion: There was a large reduction in the number of hospital admissions for neonatal hyperbilirubinemia after the 2022 AAP’s hyperbilirubinemia guideline. Patients were admitted with higher TSB levels after the guideline than before the guideline.