Dani Carlo, Fusco Monica, Andreini Marco, Pepe Giuseppe, Pratesi Simone
Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Florence, Italy.
Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, Firenze, 50134, Italy.
Ital J Pediatr. 2025 May 28;51(1):162. doi: 10.1186/s13052-025-02002-x.
The American Academy of Pediatrics (AAP) revised in 2022 its guideline on the management of neonatal hyperbilirubinemia and suggested a significant increase in the thresholds for phototherapy. Our aim was to evaluate if the implementation of these guideline could reduce admissions for hyperbilirubinemia requiring phototherapy in our unit.
We studied 876 infants with gestational age ≥ 35 weeks who were admitted for hyperbilirubinemia requiring phototherapy during the first week of life. Total serum bilirubin (TSB) at the start of phototherapy, which was decided based on the guidelines of the Italian Society of Neonatology, was compared with the TSB thresholds recommended by AAP 2022 guidelines.
Seven hundred and thirteen (82%) infants had TSB at the start of phototherapy lower than AAP 2022 threshold (16.2 ± 3.0 vs. 17.7 ± 3.4 mg/dL; P < 0.001) with a mean difference of 1.8 (0.7-2.6) mg/dL. Among them, one hundred and fifteen infants (13%), 226 (26%), and 372 (42%) had TSB slightly (0.1-1-0 mg/dL), moderately (1.1-2.0 mg/dL), or greatly (> 2.0 mg/dL) below AAP threshold.
It can be estimated that the implementation of the AAP 2022 guidelines in our unit could reduce the rate of hospitalizations for hyperbilirubinemia requiring phototherapy by 42 to 68%. These findings, along with the short- and long-term neonatal and economic benefits, support the implementation of the AAP 2022 guidelines in our unit.
美国儿科学会（AAP）于2022年修订了新生儿高胆红素血症管理指南，并建议显著提高光疗阈值。我们的目的是评估实施这些指南是否能减少本单位因高胆红素血症需要光疗而住院的人数。
我们研究了876例胎龄≥35周、在出生后第一周因高胆红素血症需要光疗而入院的婴儿。根据意大利新生儿学会的指南确定光疗开始时的总血清胆红素（TSB），并与AAP 2022指南推荐的TSB阈值进行比较。
713例（82%）婴儿光疗开始时的TSB低于AAP 2022阈值（16.2±3.0 vs. 17.7±3.4mg/dL；P<0.001），平均差异为1.8（0.7-2.6）mg/dL。其中，115例（13%）、226例（26%）和372例（42%）婴儿的TSB略低于（0.1-1.0mg/dL）、中度低于（1.1-2.0mg/dL）或大幅低于（>2.0mg/dL）AAP阈值。
据估计，在本单位实施AAP 2022指南可使因高胆红素血症需要光疗的住院率降低42%至68%。这些发现，连同新生儿的短期和长期益处以及经济益处，支持在本单位实施AAP 2022指南。
