697 - Clinical Impacts after Implementing the 2022 Clinical Practice Guidelines for the Management of Neonatal Hyperbilirubinemia

Publication Number: 697.4153

Jinsuparng Menawat, Faculty of medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Krung Thep, Thailand; Pracha Nuntnarumit, Faculty of Medicine Ramathibodi Hospital, Bangkok, Krung Thep, Thailand

Background: The 2022 American Academy of Pediatrics (AAP) guidelines for managing hyperbilirubinemia recommended safely raising the phototherapy thresholds. We have developed our hospital guidelines following the 2022 AAP guidelines with a slightly modified post-discharge follow-up protocol for neonates who have not received phototherapy. Since Thai neonates have a high prevalence of G6PD deficiency and genetic polymorphisms that significantly increase the risk of severe hyperbilirubinemia, therefore, the clinical impacts after implementing the new guidelines are needed.

Objective: To determine the safety and practicality of the new guidelines for managing hyperbilirubinemia

Design/Methods: We conducted a prospective cohort study of all neonates born at ≥35 weeks of gestations at Ramathibodi Hospital, Thailand, between March and December 2023, managed by the Ramathibodi hyperbilirubinemia guidelines, and followed up per protocol during the first month of life. The primary outcomes were rates of all phototherapy during birth hospitalization and readmission for phototherapy between the period after implementing the new guidelines and the historical data when the 2004 AAP guidelines were used. Secondary outcomes included causes of hyperbilirubinemia and any missed cases of severe hyperbilirubinemia after birth-hospitalization discharge.

Results: There were 1,858 neonates included during the study period. Phototherapy rate during birth hospitalization did not change compared to the retrospective data (7.2% vs 7.0%, respectively). Subthreshold phototherapy was observed in 82%. There was a slight increase in the readmission for phototherapy (3.7% vs 2.5%), with suboptimal intake hyperbilirubinemia as a leading cause (66.2%). Per follow-up protocol after discharge, three neonates with total serum bilirubin levels exceeding the escalation of care threshold were detected, caused by suboptimal intake hyperbilirubinemia in 2 and suboptimal intake hyperbilirubinemia with G6PD deficiency in 1. No cases of acute bilirubin encephalopathy or requiring exchange transfusion were detected.

Conclusion(s): Implementing the new guidelines for managing hyperbilirubinemia did not decrease phototherapy rates due to a large number of subthreshold phototherapy cases. Our modified follow-up protocol is probably safe for detecting neonates at risk of developing subsequence severe hyperbilirubinemia.

Ramathibodi post-discharge follow-up guideline for neonates who have not received phototherapy