Barriers to Implementing the 2022 Clinical Practice Guidelines for Neonatal Hyperbilirubinemia

To assess whether anticipated weekend follow-up and/or bilirubin rate of rise (ROR) were associated with subthreshold phototherapy (STP) following implementation of the 2022 American Academy of Pediatrics clinical practice guidelines (CPG).

A retrospective review of infants 35 or more weeks' gestational age who received inpatient phototherapy between 0 to 14 days of life across 5 hospitals (1 academic and 4 community) in 1 health system from February 2022 to January 2024 was performed. Cases were divided into pre-CPG (6 months before guidelines), washout (0-6 months after guidelines) and post-CPG (6-18 months after guidelines) and compared by hospital site. Cases were sorted by high vs low ROR (≥0.2 mg/dL/h or <0.2 mg/dL/h, respectively) based on the CPG categories and by weekday or weekend follow-up; associations with STP were examined using chi-square and logistic regressions in SPSS.

A total of 1520 cases were identified. Overall STP decreased post-CPG (51% post-CPG vs 64% pre-CPG; P < .001) with significant change only in community sites (74% pre-CPG vs 55% post-CPG; P < .01). Weekend follow-up among all sites was associated with STP both pre-CPG (weekend vs nonweekend, 76% vs 59%; P < .001) and post-CPG (60% vs 48%; P = .010). Infants receiving STP were more likely to have high ROR post-CPG (57% vs 47%; P = .035); when stratified, this difference was only in the academic site (60% post-CPG vs 29% pre-CPG; P = .004).

CPG implementation was associated with overall decreased STP, driven by community hospitals. Weekend follow-up and high ROR were associated with STP postguideline. Real-world uptake of the revised CPG was influenced not only by new clinical thresholds but also by practice setting and anticipated weekend follow-up access.