Impact of the 2022 American Academy of Pediatrics Hyperbilirubinemia Guideline on Phototherapy Utilization in a Resource-Limited Setting: A Single-Center Pre-Post Study

Background The 2022 American Academy of Pediatrics (AAP) clinical practice guideline for neonatal hyperbilirubinemia raised phototherapy and exchange transfusion thresholds to minimize overtreatment. The real-world effect of these changes in resource-limited Indian settings remains unclear. This study aimed to evaluate the potential reduction in phototherapy use and validate the safety of the 2022 guideline. Methodology This single-center, quasi-experimental, pre-post study was conducted at Subbaiah Institute of Medical Sciences, Shivamogga, India. In part 1 (retrospective simulation), data from 100 consecutive term neonates (≥38 weeks' gestation) without neurotoxicity risk factors who received phototherapy under the 2004 AAP guideline were re-analyzed using the 2022 thresholds. In part 2 (prospective validation), another cohort of 100 consecutive term neonates without risk factors was prospectively managed using the 2022 guideline. Primary outcomes were phototherapy rate and readmission for jaundice within 14 days. Results Of 100 infants treated per the 2004 guideline, 54 (54%) had bilirubin levels below the 2022 phototherapy threshold and would not have required treatment. In the prospective 2022 cohort, only nine (9%) required phototherapy. No infant (0%) required readmission for jaundice. Conclusions Implementation of the 2022 AAP guideline reduced phototherapy use by over 50% compared to the 2004 criteria, without compromising safety. Adoption of the updated guideline in resource-limited settings can prevent unnecessary treatment, conserve resources, and support family-centered neonatal care.