Hospital readmissions for neonatal hyperbilirubinemia before and after the 2022 American Academy of Pediatrics’ hyperbilirubinemia guideline

The American Academy of Pediatrics (AAP) updated the guideline for management of hyperbilirubinemia in infants born at ≥ 35 weeks of gestation in August 2022. The objective of this study was to compare the number of hospital readmissions for neonatal hyperbilirubinemia and the TSB levels before and after the guideline updates. Single center, retrospective study at a free-standing children’s hospital. Neonates born at ≥35 weeks of gestation and readmitted to the hospital between 24 h and 14 days of age with the primary diagnosis of neonatal hyperbilirubinemia, were divided into two groups: before the updated guideline group (BG group) born between 1 July 2020 and 30 June 2022 and after the updated guideline group (AG group) born between 1 January 2023 and 31 December 2024. The number of patients, baseline characteristics, TSB levels on admission and during hospitalization, and treatments during hospitalization were compared between the two groups. A total of 941 patients were identified, 553 in the BG group, and 388 in the AG group. The mean birth gestational age for readmissions was 38 weeks, and the mean chronological age on readmission was 5.5 days. The median TSB on readmission was 19.9 mg/dl (19.1 for the BG group and 21 for AG). There were 20 patients with TSB levels at or above the exchange transfusion threshold in the BG group and 33 patients in the AG group. There were an additional 29 patients with TSB levels at or above the escalation of care threshold and below the exchange transfusion threshold in the BG group and an additional 41 patients in the AG group. There was a modest but statistically significant difference in the mean TSB levels between the groups. The mean TSB level on readmission for the BG group was 19.1 mg/dl (95% Confidence Interval: 18.8–19.5) and for the AG group 20.9 mg/dl (95% confidence interval: 20.5–21.2) p value < 0.01. The mean highest TSB level in the BG group was19.4 mg/dl (95% confidence interval: 19.1–19.7), and for AG group 21.2 mg/dl (95% confidence interval: 20.9–21.5) p value < 0.01. There was a reduction in re-admissions for neonatal hyperbilirubinemia after the 2022 AAP’s guideline. There were more patients readmitted with significantly higher TSB levels after the updated guideline than before.