ArticleBMC pediatrics2026
Impact of an institutional guideline on post-discharge follow-up for neonatal hyperbilirubinaemia: a before-and-after cohort study.
Article in BMC pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNeonatal hyperbilirubinaemia requires timely post-discharge follow-up to prevent bilirubin-induced neurological injury while minimising unnecessary healthcare utilisation. Implementation of the 2022 American Academy of Pediatrics (AAP) guideline at our institution was associated with increased follow-up visits and variability in clinical practice, particularly among low-risk infants. To optimise resource utilisation while maintaining patient safety, we developed an institutional guideline integrating the 2021 Bhutani nomogram with the 2022 AAP guideline, incorporating selective follow-up criteria and simplified phototherapy threshold tools. This study evaluated the impact of the institutional guideline on follow-up practices and neonatal hyperbilirubinemia management outcomes.
methodsWe conducted a retrospective-prospective before-and-after cohort study at Panyananthaphikkhu Chonprathan Medical Center, Thailand, comparing outcomes before (June-November 2024) and after (December 2024-May 2025) guideline implementation. Eligible newborns were ≥ 35 weeks' gestation and discharged without phototherapy. Categorical variables were compared using χ
resultsA total of 274 neonates were included (137 pre-implementation, 137 post-implementation). Post-discharge follow-up was reduced after guideline implementation (34.3% vs 49.6%; RR 0.69, 95% CI 0.52-0.92; p 0.010). Readmission rates were similar between groups (3.6% vs 2.9%; RR 1.24, 95% CI 0.33-4.55; p = 1.00). All readmitted infants required phototherapy and no cases of exchange transfusion occurred.
conclusionsImplementation of an institutional follow-up guideline reduced post-discharge follow-up without any preliminary signal of harm. Local adaptation of international guidelines may improve efficiency and standardisation of care, particularly in resource-constrained settings.
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