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Jaundice01:25

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Updated: Jun 5, 2026

Electroretinogram Recording for Infants and Children under Anesthesia to Achieve Optimal Dark Adaptation and International Standards
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Published on: September 3, 2020

A National Quality Improvement Collaborative to Reduce Subthreshold Phototherapy for Jaundice.

Katherine M Satrom1, Ellen Kerns2, Makayla Schissel3

  • 1Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.

Pediatrics
|June 3, 2026
PubMed
Summary

Subthreshold phototherapy for infant jaundice decreased significantly after implementing new guidelines, but the target of 10% was not met. Further research is needed to understand barriers to reducing unnecessary neonatal phototherapy.

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Area of Science:

  • Neonatal Medicine
  • Pediatric Quality Improvement
  • Evidence-Based Practice

Background:

  • Subthreshold phototherapy for neonatal hyperbilirubinemia is frequently used, leading to overtreatment.
  • The 2022 American Academy of Pediatrics guidelines aimed to standardize treatment thresholds.
  • Reducing unnecessary phototherapy is crucial for infant well-being and healthcare resource optimization.

Purpose of the Study:

  • To decrease inpatient subthreshold phototherapy use in neonates to 10% of all phototherapy encounters within 12 months.
  • To evaluate the effectiveness of a quality improvement collaborative in reducing unnecessary phototherapy.
  • To analyze changes in phototherapy utilization following the implementation of new clinical guidelines.

Main Methods:

  • A North American quality improvement collaborative involving 146 hospitals was established.
  • Data from 33,384 inpatient phototherapy encounters (February 2022-January 2024) were analyzed.
  • Interventions included QI coaching, webinars, EHR tools, and clinical algorithms; analysis used interrupted time series and SPC.

Main Results:

  • Subthreshold phototherapy encounters decreased from 48.2% to 41.1% post-guideline implementation.
  • Overall phototherapy encounters decreased by 33.3%, with median monthly encounters per site dropping from 12 to 8.
  • Modest increases observed in escalation-of-care thresholds and peak bilirubin levels >25 mg/dL.

Conclusions:

  • While subthreshold phototherapy use decreased, the goal of reaching 10% was not achieved within 12 months.
  • The quality improvement initiative demonstrated a reduction in overall phototherapy use.
  • Further investigation into barriers preventing the reduction of unnecessary neonatal jaundice treatment is warranted.