Learning & Implementing Guidelines for Hyperbilirubinemia Treatment (LIGHT)

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. (1) As providers implement the new guideline, it will be important to avoid both overtreatment (2) and the rare need for escalation of care to an exchange transfusion. (1)

Project Leadership (including Staff Contact)

Pearl Chang, MD - Project Co Leader
Katie Satrom, MD, FAAP- Project Co leader
Matthew Garber, MD, FHM, FAAP- Project Mentor
Hayes Bakken, MD, FAAP- Expert Workgroup Member
Julie Gallois, MD, FAAP- Expert Workgroup Member
Elisa Hampton, MD- Expert Workgroup Member
Leela Sarathy, MD, FAAP- Expert Workgroup Member
Carole Stipelman, MD, MPH, FAAP- Expert Workgroup Member
Kaitlin Widmer, MD,- Expert Workgroup Member
El Kerns, PhD, MPH- Project Data Scientist
Brittany Jennings, MHA – AAP Staff
Sloane Magee- AAP Staff
Jennifer Monti, PhD- AAP Staff

Project Time Period

Fall 2022- Spring 2024

Project Aims & Measurement

The specific aim of the project is to Improve the evidence-based management of infants ≤14 days of age who receive inpatient phototherapy

Primary Measures

Decrease initiation of subthreshold inpatient phototherapy: Proportion of infants who receive inpatient phototherapy for subthreshold TSB (≥0.3 mg/dL below phototherapy threshold) will be 10% or less

Decrease unnecessary rebound bilirubin measurements in low-risk infants who undergo inpatient phototherapy: Proportion of infants who start inpatient phototherapy at ≥48 hours of age without hemolysis concerns (DAT negative and no other concerns) who have a bilirubin <18 hours after phototherapy discontinuation will be 10% or less.

Increase appropriate obtainment of direct antiglobulin test (DAT): DAT status will be assessed in 100% of infants with blood type O mothers who undergo inpatient phototherapy

Decrease unnecessary IV fluid use: 5% or less of well-appearing infants who receive inpatient phototherapy and do not meet escalation of care threshold (2 mg/dL below exchange transfusion threshold) will receive IV fluids

Balancing Measures

Incidence of reaching escalation of care threshold: % of infants who reach or exceed escalation of care threshold (2 mg/dL below exchange transfusion threshold) at the start of or during inpatient phototherapy

Incidence of total serum bilirubin (TSB) >25 mg/dL: % of infants who have a TSB >25 mg/dL at the start of or during inpatient phototherapy

Phototherapy duration: Number of hours infants undergo inpatient phototherapy (approximated)

Hospitalization duration: Numbers of hours infants are hospitalized during phototherapy admission

Readmission or re-initiation of phototherapy: % of infants who are reinitiated on or readmitted for inpatient phototherapy within 4 days of previous inpatient phototherapy discontinuation

Project Resources

Please check back in Spring 2024 for a comprehensive list of project resources!

Project Results & Publication

Please check back in Spring 2024 for project results and publications!

Last Updated

11/21/2023

Source

American Academy of Pediatrics