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Department

Pediatric Hospitalist Program

Position/Job Title

Pediatric Hospitalist

Description

Background: Neonatal hyperbilirubinemia may require phototherapy. In August 2022, the American Academy of Pediatrics (AAP) updated the recommendations for management of hyperbilirubinemia which included: Increasing the total bilirubin threshold to initiate phototherapy; Obtaining laboratory evaluation for hemolysis in neonates born to mothers with O+ blood type; Decreasing IV fluid therapy in stable neonates; Waiting 12-24 hours before obtaining a bilirubin level after phototherapy in low-risk neonates.

Objectives: To investigate the impact of the AAP guidelines on the management of neonatal hyperbilirubinemia in our medical unit.

Our goals include: Decrease the proportion of neonates who receive unnecessary phototherapy to ≤10%; Keep the proportion of neonates who receive appropriate laboratory evaluation for hemolysis at 100%; Keep the proportion of stable neonates who receive IV fluids during phototherapy to ≤5%; Decrease the proportion of low-risk neonates without hemolysis who receive an early bilirubin level after phototherapy to ≤10%.

Materials & Methods: We included neonates ≥35 weeks gestational age under 14 days of age who were admitted to our pediatric unit or Special Care Nursery from February 2022 to January 2024 with a primary ICD-10 billing code for phototherapy procedure. Data from February 2022 to January 2023 served as 1 year of baseline data prior to adherence to the updated AAP recommendations. Our interventions included attending national quality improvement webinars, distributing handouts in our unit, and installing a smart phrase in the electronic medical record. We performed descriptive analysis to investigate adherence to the guidelines in the intervention period.

Conclusions: The AAP guidelines for neonatal hyperbilirubinemia did not decrease the use of unnecessary phototherapy or evaluation with early bilirubin levels after phototherapy in low-risk neonates to our goal. All neonates continued to receive appropriate investigation for hemolysis and avoid IV fluid therapy. Quality initiatives are required to evaluate clinical factors for initiating unnecessary phototherapy and obtaining unnecessary bilirubin level after phototherapy in low-risk infants.

Publication Date

4-16-2024

Adherence with American Academy of Pediatrics Guidelines for Neonatal Hyperbilirubinemia

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