Clinical, economic, and organisational impact of the novel AAP 2022 neonatal hyperbilirubinemia guidelines in an Italian third-level neonatology unit.

UNLABELLED: Neonatal hyperbilirubinemia (HB) is universally screened in Italy to reduce the risks of subsequent neurological damage. The 2022 American Academy of Paediatrics revised guidelines set higher phototherapy thresholds and offer follow-up recommendations that ultimately reduce HB overtreatment in newborns born at ≥ 35 weeks' gestational age. While assessing the implementation of AAP guidelines at our centre, we compared the clinical and economic outcomes between the AAP 2022 guidelines and current Italian recommendations. We retrospectively applied the American guidelines to newborns managed according to current Italian recommendations, born at our centre between November 2024 and February 2025. Clinical characteristics, bilirubin levels, and interventions were recorded. The Institutional Treasury provided healthcare costs for hospitalisation and interventions. Clinical decisions and subsequent costs were compared. Nine-hundred and four newborns (50% females, median gestational age 39 weeks) were enrolled. Forty-eight (5.3%) patients presented bilirubin-induced risk factors. The bilirubin level informing a clinical decision was performed at a median of 51 (interquartile range 44-58) hours-of-life. AAP guidelines potentially reduced phototherapy by 69.8% (p < 0.001), accounting for a 98 bed-days reduction. Post-discharge bilirubin checks increased by 37.9% (p = 0.004). A 4-month reduction of 16,591.58 € in variable costs and a significant improvement in resource rationalisation were calculated.

CONCLUSION: The AAP 2022 guidelines potentially reduce HB treatment and shift bilirubin surveillance to the outpatient department, enhancing neonatal care efficiency and reducing healthcare costs. These analytical outcomes encouraged the adoption of the AAP guidelines at our centre. Longitudinal surveillance will clarify the safety and actual extent of this change of reference guidelines in our practice.

WHAT IS KNOWN: • The risk of bilirubin-induced neurological damage (BIND) in healthy term and near-term newborns has been overestimated in the past. The AAP revised its hyperbilirubinemia guidelines, providing higher hourly bilirubin thresholds for newborns without risk factors for BIND. • Despite reports on the safety and efficacy of the AAP 2022 guidelines, their implementation was not officially encouraged in Italy, making their adoption a choice to be evaluated at a facility level.

WHAT IS NEW: • Simulation on retrospective data of AAP 2022 guidelines promises a reduction in healthcare costs and rationalisation of healthcare system resources. • The favourable cost-effectiveness analysis prompted the adoption of AAP 2022 guidelines at our centre. Longitudinal surveillance will help clarify the actual extent of economic impact and to assess real-life safety and efficacy of the guidelines.