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Updated: Sep 11, 2025
Biochemical Measurement of Neonatal Hypoxia
Published on: August 24, 2011
Impact of 2022 AAP Neonatal Hyperbilirubinemia Guidelines in a Middle-Income Country: A Single-Center Study in
Kannikar Vongbhavit1, Sudaruch Rearkyai1, Pornpimon Janyoungsak1
1Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, HRH Princess Maha Chakri Sirindhorn Medical Center, Nakhonnayok, Thailand.
Introduction:
Neonatal hyperbilirubinemia (NH) is common and can cause neurological dysfunction. The AAP updated its guideline in 2022 to improve the management of NH, but its impact in middle-income countries with high NH and G6PD deficiency rates remains uncertain. This study evaluated the updated guidelines in such a setting.
Methods:
This retrospective study analyzed infants born in a Thai institution between January 2021-March 2022 (previous guidelines) and January 2023-March 2024 (updated guidelines). Infants <15 days receiving phototherapy or outpatient bilirubin testing were included, while those born <35 weeks, admitted to the NICU, congenital anomalies, or inborn errors of metabolism were excluded. The primary outcome was the phototherapy rate; secondary outcomes included exchange transfusion, readmissions, NH etiologies, bilirubin testing, hospital stay, and outpatient follow-up. Logistic regression identified associated factors.
Results:
Among 3,607 infants, 463 met inclusion criteria. Phototherapy rates decreased with the updated guideline (14.9% vs. 11.5%, p = 0.003). Identification of infants with G6PD deficiency declined (16.5% vs. 7.3%, p = 0.004), with affected infants having lower odds of receiving phototherapy under the updated guidelines (adjust OR = 0.40; 95% confidence interval: 0.21-0.76, p = 0.005). Readmission rates (6.6% vs. 5.5%, p = 0.43), hospital stay, and bilirubin testing showed no significant differences. Outpatient follow-up improved, with more infants requiring only one visit and receiving earlier follow-up.
Discussion:
The updated AAP guidelines were associated with reduced phototherapy use and follow-up visits, with a stable readmission rate. Further research is needed to assess their impact on G6PD-related outcomes in middle-income countries.
