Pediatric Resident Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia, Pennsylvania, United States
Background: The American Academy of Pediatrics (AAP) provides clinical practice guidelines to manage hyperbilirubinemia in healthy, term newborns. The guidelines aim to reduce the frequency of acute and chronic bilirubin encephalopathy or kernicterus. Transcutaneous bilirubin (TcB) levels measure the yellow color of blanched skin, subcutaneous tissue and have been widely used as a screening tool to determine the need for a serum level. Per the 2004 and 2009 guidelines, methods to avoid missing false negative transcutaneous bilirubin (TcB) levels were stated: TcB value at 70% of phototherapy level, above 75th percentile of the hour-specific Bhutani nomogram, or > 13 mg/dl. Any of these 3 criteria should result in a serum bilirubin. If guideline defined neurotoxicity risk factors for severe hyperbilirubinemia were present, then serum bilirubin was to be obtained at lower levels. Per the 2022 guidelines, the cut-off to obtain serum bilirubin was raised to either a TcB >15 mg/dl or a TcB within 3 mg/dl of the level requiring phototherapy. Objective: To compare the number of serum bilirubin levels drawn, the incidence of phototherapy, and the incidence of readmission for phototherapy using the new 2022 vs. the old 2009 AAP clinical practice guidelines for the management of hyperbilirubinemia in newborns more than 35 weeks of gestation. Design/Methods: Data was collected by retrospective chart review of newborns admitted to the postpartum unit. The study group was divided into “before” and “after” groups. The “before” group included 1,000 newborns born between 01/01/2022 and 09/01/2022 prior to implementing the 2022 bilirubin guidelines. The “after” group includes 1000 newborns born after 01/01/2023 following the implementation of the 2022 bilirubin guidelines. Inclusion criteria were newborns who spent their entire postpartum stay in the postpartum unit with their mothers. Newborns who spent any time in the intensive care unit for any reason other than phototherapy were excluded. Data entry was conducted via Redcap. This study was approved by the institutional IRB (Approval # 2023-1055)
