Implementation of the 2022 AAP guidelines for neonatal hyperbilirubinemia could reduce the need for phototherapy in Italy

Background: The American Academy of Pediatrics (AAP) revised in 2022 its guideline on the management of neonatal hyperbilirubinemia and suggested a significant increase in the thresholds for phototherapy. Our aim was to evaluate if the implementation of these guideline could reduce admissions for hyperbilirubinemia requiring phototherapy in our unit. Methods: We studied 876 infants with gestational age ≥ 35 weeks who were admitted for hyperbilirubinemia requiring phototherapy during the first week of life. Total serum bilirubin (TSB) at the start of phototherapy, which was decided based on the guidelines of the Italian Society of Neonatology, was compared with the TSB thresholds recommended by AAP 2022 guidelines. Results: Seven hundred and thirteen (82%) infants had TSB at the start of phototherapy lower than AAP 2022 threshold (16.2 ± 3.0 vs. 17.7 ± 3.4 mg/dL; P < 0.001) with a mean difference of 1.8 (0.7–2.6) mg/dL. Among them, one hundred and fifteen infants (13%), 226 (26%), and 372 (42%) had TSB slightly (0.1-1-0 mg/dL), moderately (1.1-2.0 mg/dL), or greatly (> 2.0 mg/dL) below AAP threshold. Conclusions: It can be estimated that the implementation of the AAP 2022 guidelines in our unit could reduce the rate of hospitalizations for hyperbilirubinemia requiring phototherapy by 42 to 68%. These findings, along with the short- and long-term neonatal and economic benefits, support the implementation of the AAP 2022 guidelines in our unit.