Impact of an institutional guideline on post-discharge follow-up for neonatal hyperbilirubinaemia: a before-and-after cohort study

BACKGROUND: Neonatal 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. METHODS: or Fisher's exact tests, and continuous variables using Student's t-test. Clinical outcomes were expressed as risk ratios (RRs) with 95% confidence intervals (CIs). All tests were two-sided, with p < 0.05 considered statistically significant. Statistical analyses were performed using Stata version 19. The primary outcome was the proportion scheduled for post-discharge follow-up, and secondary outcome was hospital readmission for hyperbilirubinaemia. RESULTS: A 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. CONCLUSIONS: Implementation 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.