Implementation of the Revised American Academy of Pediatrics Clinical Practice Guidelines for Hyperbilirubinemia Decreases Necessity for Serum Bilirubin and Phototherapy

Background: The initial hyperbilirubinemia management recommendations published by the American Academy of Pediatrics (AAP) in 2004 and updated in 2009 led to wide variations in clinical practice among providers, with variable results. In August 2022 AAP published updated clinical practice guidelines for the management of hyperbilirubinemia. The aim of this project was to determine the effect of adaptation of the AAP guidelines on laboratory testing, readmission rates, and phototherapy.

Methods: Existing institutional protocol was updated to incorporate the revised AAP guidelines. The primary outcome was percentage of serum bilirubin labs obtained. Balancing measures included monthly readmission rate, need for escalation of care, and percentage of patients requiring additional labs or phototherapy. Statistical process control charts measured changes in quality over time. Chi-square analysis evaluated differences between pre- and postintervention periods.

Results: A total of 2,301 infants were evaluated, 1,662 of which were included in the postintervention analysis. A clinically and statistically significant decrease was seen in the percentage of patients with serum bilirubin evaluation, from 21.3% to 8.8% (p < 0.001). There was a decrease in need for phototherapy, from 4.2% to 1.4% (p < 0.001), but duration of treatment was longer when initiated. The authors simultaneously saw no changes in readmission rate or additional laboratory evaluation, with no incidence of bilirubin-induced encephalopathy or escalation of care.

Conclusion: Implementation of the revised 2022 AAP guidelines was associated with a decrease in serum bilirubin evaluation and phototherapy initiation. This integrated protocol may represent a sustainable standardized approach to management of hyperbilirubinemia.