P3D199: Admissions for Phototherapy Following Clinical Practice Guideline Implementation

Background: Neonatal hyperbilirubinemia requiring treatment has historically been a leading cause of readmission to the hospital in the first week of life, leading to significant health care resource utilization and disruptions in maternal infant bonding. Revised clinical practice guidelines (CPGs) for the management of hyperbilirubinemia in infants 35 weeks or more gestational age were published August 5, 2022. The authors sought to determine the outcomes in terms of admission numbers, infant demographics, and cost following implementation of the new CPGs at Tripler Army Medical Center.

Methods: A retrospective chart review was performed to identify infants admitted to the inpatient pediatric ward who had a serum bilirubin drawn between Aug 2021 and Feb 2023. These charts were reviewed to determine if the patient was admitted for the treatment of neonatal hyperbilirubinemia. Data collected included estimated gestational age (EGA) at delivery, hours of life (HOL) at the time of admission, and serum bilirubin level at the time of admission. The billing department was queried to determine the average cost of an admission for the treatment of neonatal hyperbilirubinemia.

Results: Bilirubin admissions decreased from 15.6% (69/441) of total admissions during the 12 months prior to the new CPG to 4.1% of admissions (8/194) during the five months after the new CGP (P < 0.001, Fisher's exact test). This corresponds to a 74% reduction, which held true for a repeat analysis considering potential seasonality in admission rates. The expected proportion of bilirubin admissions (17/389, 4.4%) was not significantly different from the actual proportion of bilirubin admissions following CGP implementation (7/193, 3.6%, P = 0.826, Fisher's exact test). Average serum bilirubin values and age in HOL were significantly higher and average EGA was significantly lower after the implementation of the new CPGs.

Conclusion: Implementation of the new CGPs led to a significantly lower number of infants requiring admission, leading to significant cost savings, decreased resource utilization, and hopefully improved maternal infant bonding.