Variability in Screening and Management of Hyperbilirubinemia Across US Hospitals: A BORN Study

In this study, we hypothesize that significant variation in clinical practice and adherence to the 2022 American Academy of Pediatrics (AAP) hyperbilirubinemia guidelines exists, including for direct antiglobulin test (DAT)-positive newborns.

This study was conducted through the Better Outcomes through Research for Newborns Network. Participants completed a 58-item survey inquiring about hospital demographics, screening, and management practices for neonatal hyperbilirubinemia.

One hundred twenty-three birthing hospitals were contacted, with 67 participants (55% response rate). Variation existed throughout the clinical decision-making process, from bilirubin screening to management and follow-up practices. For universal screening, 76% of centers obtained a screening bilirubin between 24 and 48 hours of age, per the AAP guidelines. Sixty-nine percent of centers screen newborn of antibody-positive birthing parents for DAT positivity. Seventy-six percent of responding centers utilized the guideline recommendation to stop phototherapy at 2 mg/dL below the level where phototherapy was initiated, regardless of DAT status. Despite the higher risk for developing rebound hyperbilirubinemia, only 66% of respondents obtained a rebound bilirubin in DAT-positive infants and 49% in infants younger than 48 hours. Despite the guideline's statement, only 24% of respondents utilized a transcutaneous bilirubin measurement at least 24 hours after phototherapy discontinuation.

Significant practice variation and relatively low adherence to the 2022 AAP hyperbilirubinemia guidelines existed, even for DAT-positive newborns. More research is necessary to better understand the barriers to implementation of these guidelines.