Need for Cautious Adoption of American Academy of Pediatrics Guidelines for Management of Neonatal Hyperbilirubinemia in Different Parts of the World

Background: Early hospital discharge (<72 hours following birth) of healthy-term and near-term infants is favored to promote family care but may have increased hyperbilirubinemia-related hospital readmissions.In this study, we compared the 2009 and 2022 American Academy of Pediatrics (AAP) discharge guidelines in the United Arab Emirates (UAE) for the impact on hyperbilirubinemia-related readmissions.Materials and methods: This was a retrospective cohort single-center study conducted in the UAE.We reviewed records from the period January 2021 to November 2021; the infants included those with a gestational age (GA) 35 weeks and a birth weight (BW) 2,500 gms and GA 36 weeks/BW 2,000 gms.Infants were classified into risk zones based on pre-discharge transcutaneous bilirubin (TcB) or total serum bilirubin (TSB) levels (AAP 2009 hyperbilirubinemia nomograms).We compared the 2009 and 2022 AAP discharge thresholds for the needs for follow-up and readmissions for hyperbilirubinemia.Results: We studied 895 newborns; 672 (75%) were born at term with a mean ( standard deviation) GA of 38 1.3 weeks.Most (75.3%) were classified as appropriate for GA and 637 (71%) attended the 1st follow-up as recommended.Based on the 2009 AAP guidelines, 13 (2.9%)out of 447 (70%) were low risk; 12 (6.6%)out of 183 (29%) were low-intermediate risk; and 3 out of 7 (42.9%)were high-intermediate risk.A total of 49 (5.5%) infants were readmitted to the hospital for phototherapy.Unlike in the United States, the 2022 guidelines would have recommended follow-up visits within 2 days in a larger number [579 (64.7%)] than the 2009 recommendations [308 (34.4%)] in UAE; the overall need for phototherapy would also have been higher.However, the frequency of severe hyperbilirubinemia requiring phototherapy would have remained similar.Our population did not have more specific risk factors such as scalp bleeds, ABO isoimmunization, or glucose-6-phosphate dehydrogenase deficiency for developing severe neonatal hyperbilirubinemia.We did have a high number of missed follow-up appointments. Conclusion:In our region, the adoption of the 2022 AAP early hospital discharge guidelines may have increased the number of follow-up visits within 2 days after discharge from the hospital and the overall need of phototherapy.These guidelines need to be specifically evaluated in different ethnic groups in various parts of the world.