Neonatal hyperbilirubinemia is one of the most common conditions of the newborn that may necessitate treatment with phototherapy. In August 2022, AAP updated its clinical practice guideline for the management of neonatal hyperbilirubinemia.
Notable changes and recommendations include raising the threshold to start phototherapy treatment, different treatment thresholds by gestational age, emphasis on evaluating for hemolysis (including obtaining a direct antiglobulin test in infants born to mothers with O blood type who require phototherapy), waiting at least 12-24 hours before obtaining a follow-up bilirubin level after phototherapy for infants at low risk for rebound hyperbilirubinemia, and an emphasis on breastfeeding and enteral feeding over intravenous fluids (IV) unless the infant meets criteria for escalation of care. As providers implement the new guidelines, it will be important to avoid both overtreatment and the rare need for escalation of care to an exchange transfusion.
This project sought to implement the evidence-based AAP clinical practice guideline in a national QI collaborative designed to improve and standardize care of neonatal hyperbilirubinemia. Using the recommendations in the clinical practice guideline, the QI effort will provide physicians with education about evidence-based best practice, strategies for implementation, and tools to bring about sustainable change, while also assessing the implementation strategies associated the greatest success. Providing multi-disciplinary teams with quality improvement education and tools specific to management of children with hyperbilirubinemia will increase compliance with the evidence-based research and thereby decrease overuse of non-evidence-based therapies and tests.
The primary aim is to assess the impact of implementing a new evidence-based clinical practice guideline for infants with neonatal hyperbilirubinemia. We hypothesize that participating institutions will decrease the proportion of infants who receive phototherapy below treatment threshold, increase the proportion of infants who undergo appropriate direct antiglobulin tests (DAT), decrease the proportion of infants who receive IV fluids during phototherapy, and decrease the proportion of low-risk infants who have early bilirubin follow-up after phototherapy treatment.
Key drivers are broad, evidence-based actions that can be useful in the development of more specific ideas for changes that lead to improvement. The tools and resources associated with these key drivers are meant to be adapted or adopted in your healthcare setting to improve practice.
The measures that were developed in this project are for reference, adaptation and use in your practice.
Analysis and manuscript development is currently underway – check back for project publications!
02/17/2026
American Academy of Pediatrics