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

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.