Clinical outcomes of the 2022 AAP hyperbilirubinemia guideline in term and late-preterm infants: a prospective study in Thailand.

backgroundNeonatal jaundice is a common condition, occurring in approximately 80% of term infants during the first week of life. Timely diagnosis and management are essential to prevent bilirubin-induced neurological damage. In 2022, the American Academy of Pediatrics (AAP) updated its guideline for managing hyperbilirubinemia in infants ≥ 35 weeks' gestation, raising treatment thresholds and recommending individualized follow-up based on gestational age, neurotoxicity risk factors, and the bilirubin-treatment threshold difference. Evidence from low- and middle-income countries on the clinical impact of these guideline is limited.

methodsWe conducted a prospective observational study at Panyananthaphikkhu Chonprathan Medical Center, Thailand, from February 2024 to January 2025, including 1,104 neonates ≥ 35 weeks' gestation. All infants underwent total serum bilirubin (TSB) screening within 72 h of birth and were managed according to the 2022 AAP guideline. Phototherapy rates, follow-up recommendations, readmissions, exchange transfusions, and cases of acute bilirubin encephalopathy were recorded. In addition, the infants' TSB values were retrospectively applied to the 2004 AAP guideline to assess eligibility for phototherapy. Among infants who did not receive phototherapy, TSB values were retrospectively applied to the Bahr 2021 nomogram to determine follow-up recommendations for comparison with management based on the 2022 AAP guideline.

resultsPhototherapy was required in 221 infants (20.0%), representing a 38% relative reduction compared with the rate observed when the 2004 AAP guideline was retrospectively applied (32%; p < 0.001). Follow-up rates decreased from 56.9% under the Bahr 2021 nomogram to 52.7% under the 2022 guideline (absolute reduction, 4.3%; relative reduction, 7.5%; 95% CI, 5.91-9.03; p = 0.044). Readmission occurred in 127 infants (11.5%), most commonly due to suboptimal intake. No cases of acute bilirubin encephalopathy or exchange transfusion were reported.

conclusionsImplementation of the 2022 AAP guideline reduces phototherapy use and unnecessary follow-up visits without increasing adverse outcomes. With clearly structured follow-up schedules and close monitoring of infants at risk of developing severe jaundice, high-risk newborns can be managed effectively and safely. These findings support the applicability of the guideline in routine clinical practice, including in middle-income countries.