目的:新生儿高胆红素血症治疗指南有助于降低显著高胆红素血症的发生率。然而,最近的证据表明,光疗的过度治疗和潜在危害已经为美国儿科学会临床实践指南的修订和伴随的光疗阈值的增加提供了信息.预计这些变化将安全地减少过度使用;然而,到目前为止,这些指南的确切效果尚未确定.
方法:我们在2022年1月至2023年6月期间,在8家医院的网络中,对妊娠≥35周的新生儿进行了回顾性研究。结果包括指南发布前后的光疗率和血清总胆红素(TSB)测量值,以及临床结果,包括逗留时间,再入院,和光疗的持续时间。
结果:在我们的22000名新生儿队列中,我们观察到光疗利用率下降了47%,从3.9%到2.1%(P<.001)。TSB测量值减少了23%,从712到551测量每1000个新生儿(P<.001),没有增加门诊TSB测量值。我们没有观察到接受光疗的再入院率增加,住院时间仅增加1小时(P<.001)。
结论:我们的研究表明,更新的美国儿科学会2022高胆红素血症指南的发布可能显着减少了光疗的使用和血清胆红素的测量。专门的质量改进举措可能有助于确定哪些实施策略最有效。需要进一步的人群水平研究来确认正在进行的指南摄取的安全性。
OBJECTIVE: Guidelines for the management of neonatal hyperbilirubinemia have helped to reduce rates of significant hyperbilirubinemia. However, recent evidence suggesting overtreatment and potential harms of phototherapy have informed the American Academy of Pediatrics clinical practice
guideline revision and the accompanying increase in phototherapy thresholds. These changes are predicted to safely reduce overuse; however, to date, the exact effect of these
guidelines has not been established.
METHODS: We conducted a retrospective study of newborns born at ≥35 weeks\' gestation across a network of 8 hospitals between January 2022 and June 2023. Outcomes included rates of phototherapy and total serum bilirubin (TSB) measurements before and after
guideline publication, as well as clinical outcomes, including length of stay, readmissions, and duration of phototherapy.
RESULTS: In our cohort of >22 000 newborns, we observed a 47% decrease in phototherapy utilization, from 3.9% to 2.1% (P < .001). TSB measurements were reduced by 23%, from 712 to 551 measurements per 1000 newborns (P < .001), without an increase in outpatient TSB measurements. We did not observe an increase in readmissions receiving phototherapy, and length of stay increased by only 1 hour (P < .001).
CONCLUSIONS: Our study reveals that the publication of the updated American Academy of Pediatrics 2022 hyperbilirubinemia guidelines has likely yielded a significant reduction in phototherapy use and serum bilirubin measurement. Dedicated quality improvement initiatives may help determine which implementation strategies are most effective. Further population-level studies are needed to confirm safety with ongoing
guideline uptake.