Impact of 2022 AAP Neonatal Hyperbilirubinemia Guidelines in a Middle-Income Country: A Single-Center Study in Thailand.

Neonatal hyperbilirubinemia (NH) is common and can cause neurological dysfunction. The AAP updated its guideline in 2022 to improve the management of NH, but its impact in middle-income countries with high NH and G6PD deficiency rates remains uncertain. This study evaluated the updated guidelines in such a setting. This retrospective study analyzed infants born in a Thai institution between January 2021-March 2022 (previous guidelines) and January 2023-March 2024 (updated guidelines). Infants <15 days receiving phototherapy or outpatient bilirubin testing were included, while those born <35 weeks, admitted to the NICU, congenital anomalies, or inborn errors of metabolism were excluded. The primary outcome was the phototherapy rate; secondary outcomes included exchange transfusion, readmissions, NH etiologies, bilirubin testing, hospital stay, and outpatient follow-up. Logistic regression identified associated factors. Among 3,607 infants, 463 met inclusion criteria. Phototherapy rates decreased with the updated guideline (14.9% to 11.5%, p = 0.003). Identification of infants with G6PD deficiency declined (16.5% vs 7.3%, p = 0.004), with affected infants having lower odds of receiving phototherapy under the updated guidelines (adjust OR = 0.40; 95% CI: 0.21-0.76, p = 0.005). Readmission rates (6.6% vs 5.5%, p = 0.43), hospital stay, and bilirubin testing showed no significant differences. Outpatient follow-up improved, with more infants requiring only one visit and receiving earlier follow-up. The updated AAP guidelines were associated with reduced phototherapy use and follow-up visits, with a stable readmission rate. Further research is needed to assess their impact on G6PD-related outcomes in middle-income countries.