Abstract
Background
Neonatal jaundice is a common condition, occurring in approximately 80% of term infants during the first week of life. Timely diagnosis and management are essential to prevent bilirubin-induced neurological damage. In 2022, the American Academy of Pediatrics (AAP) updated its guideline for managing hyperbilirubinemia in infants ≥ 35 weeks’ gestation, raising treatment thresholds and recommending individualized follow-up based on gestational age, neurotoxicity risk factors, and the bilirubin-treatment threshold difference. Evidence from low- and middle-income countries on the clinical impact of these guideline is limited.
Methods
We conducted a prospective observational study at Panyananthaphikkhu Chonprathan Medical Center, Thailand, from February 2024 to January 2025, including 1,104 neonates ≥ 35 weeks’ gestation. All infants underwent total serum bilirubin (TSB) screening within 72 h of birth and were managed according to the 2022 AAP guideline. Phototherapy rates, follow-up recommendations, readmissions, exchange transfusions, and cases of acute bilirubin encephalopathy were recorded. In addition, the infants’ TSB values were retrospectively applied to the 2004 AAP guideline to assess eligibility for phototherapy. Among infants who did not receive phototherapy, TSB values were retrospectively applied to the Bahr 2021 nomogram to determine follow-up recommendations for comparison with management based on the 2022 AAP guideline.
Results
Phototherapy was required in 221 infants (20.0%), representing a 38% relative reduction compared with the rate observed when the 2004 AAP guideline was retrospectively applied (32%; p < 0.001). Follow-up rates decreased from 56.9% under the Bahr 2021 nomogram to 52.7% under the 2022 guideline (absolute reduction, 4.3%; relative reduction, 7.5%; 95% CI, 5.91–9.03; p = 0.044). Readmission occurred in 127 infants (11.5%), most commonly due to suboptimal intake. No cases of acute bilirubin encephalopathy or exchange transfusion were reported.
Conclusions
Implementation of the 2022 AAP guideline reduces phototherapy use and unnecessary follow-up visits without increasing adverse outcomes. With clearly structured follow-up schedules and close monitoring of infants at risk of developing severe jaundice, high-risk newborns can be managed effectively and safely. These findings support the applicability of the guideline in routine clinical practice, including in middle-income countries.
Supplementary Information
The online version contains supplementary material available at 10.1186/s13052-026-02276-9.
Background
Neonatal jaundice is a common condition, occurring in approximately 80% of term infants during the first week of life [1, 2]. It is characterized by elevated total serum bilirubin (TSB) levels that may require timely evaluation and treatment based on the infant’s age and associated neurotoxicity risk factors [3]. Delayed diagnosis and treatment may result in markedly elevated bilirubin concentrations, which can lead to acute bilirubin encephalopathy and, in severe cases, kernicterus [4]. Kernicterus is a permanent and disabling neurologic condition characterized by some or all of the following: choreoathetoid cerebral palsy, upward gaze paresis, enamel dysplasia of the deciduous teeth, sensorineural hearing loss or auditory neuropathy spectrum disorder, and characteristic abnormalities on brain magnetic resonance imaging (MRI) [5]. However, unnecessary serum bilirubin monitoring and overuse of phototherapy also result in adverse effects. These include painful procedures for newborns, infant–family separation, increased parental stress, disruption of breastfeeding [6, 7], increased hospital resource utilization, and a potential increased risk of subsequent childhood epilepsy [8, 9].
In 2022, the American Academy of Pediatrics (AAP) [3] revised its guideline for the management of hyperbilirubinemia in newborns ≥ 35 weeks’ gestation, raising the thresholds for initiating phototherapy and exchange transfusion compared with the 2004 recommendations [4]. In addition to adjusting treatment thresholds, the 2022 AAP guideline recommend determining the timing of follow-up based on the difference between the measured total bilirubin level (either transcutaneous bilirubin [TcB] or TSB), obtained between 24 and 48 h after birth or before discharge if earlier, and the age-specific treatment threshold. This approach also incorporates gestational age and the presence of neurotoxicity risk factors into clinical decision-making.
In contrast, the Bahr 2021 nomogram [10] stratifies risk solely according to pre-discharge TSB levels plotted against the infant’s age in hours, without incorporating additional clinical risk factors.
The 2022 updates aim to reduce unnecessary interventions. Early evidence from high-income countries suggests that the revised guideline can reduce the use of phototherapy and hospital admissions without increasing adverse outcomes [11–14]. However, evidence from low- and middle-income countries remains limited, and concerns persist regarding the safety of applying higher treatment thresholds in resource-limited settings. This study aimed to evaluate the clinical impact of implementing the 2022 AAP guideline in a middle-income country, focusing on phototherapy use, hospital admissions, follow-up rates, and complications related to severe hyperbilirubinemia.
Methods
Study design and setting
This prospective cohort study was conducted at Panyananthaphikkhu Chonprathan Medical Center (PCMC), a tertiary neonatal center in Nonthaburi, Thailand, from February 1, 2024, to January 31, 2025.
Study population and eligibility criteria
Eligible participants were healthy neonates born at ≥ 35 weeks’ gestation who roomed-in with their mothers and underwent blood screening for hyperbilirubinemia within 72 h of birth. Enrollment was conducted over a one-year period following approval by the Institutional Review Board of PCMC (IRB No. 030/67).
Exclusion criteria
Neonates were excluded if they required admission to the neonatal intensive care unit (NICU) or sick newborn ward, had medical conditions requiring scheduled follow-up after discharge, or if parental consent was not provided.
Withdrawal criteria
Participants were withdrawn if follow-up until one month of age could not be completed.
Study procedures
Parents of all eligible neonates were informed about the study, and written informed consent was obtained prior to enrollment. All enrolled neonates underwent TSB measurement before discharge within 72 h of birth. The TSB value obtained at that time was compared with the phototherapy and exchange transfusion thresholds according to the 2022 AAP guideline. Clinical management, including decisions regarding phototherapy, exchange transfusion, and follow-up, was based on the measured TSB level and the presence of neurotoxicity risk factors. All neonates who received phototherapy were followed up according to the underlying etiology of hyperbilirubinemia. Neonates who did not receive phototherapy within the first 72 h of life were scheduled for follow-up in accordance with the 2022 AAP recommendations, based on the difference between the infant’s TSB level and the phototherapy threshold and the presence of risk factors for developing significant hyperbilirubinemia.
All neonates were followed for one month to monitor for readmission for phototherapy or exchange transfusion, as well as the development of acute bilirubin encephalopathy.
Follow-up data were obtained through review of electronic medical records (EMRs). In cases when EMR data were incomplete or unavailable, parents were contacted by telephone to obtain additional information regarding the infant’s health status and any complications.
Data collection
Baseline data collected included gestational age, sex, birth weight, mode of delivery, and TSB levels. Clinical outcomes recorded included receipt of phototherapy, hospital readmission, follow-up status, exchange transfusion, acute bilirubin encephalopathy, and the identified cause of jaundice. Additionally, the phototherapy rate within the first 72 h of life was retrospectively determined by applying the 2004 guideline to the observed TSB values for each infant. Among neonates who did not receive phototherapy within the first 72 h, the follow-up rate was retrospectively assessed by applying the Bahr 2021 nomogram.
Study outcomes
The primary outcome was the observed phototherapy rate within 72 h of birth among neonates ≥ 35 weeks’ gestation, to assess the impact of the 2022 AAP hyperbilirubinemia guideline. Secondary outcomes included: (1) comparison of the observed 2022 phototherapy rate with the rate obtained by retrospectively applying the 2004 guideline within the first 72 h of life; (2) comparison of the observed 2022 follow-up rate among infants discharged at 48–72 h who did not receive phototherapy within 72 h with the rate obtained by retrospectively applying the Bahr 2021 nomogram; and (3) evaluation of the causes and rates of readmission, as well as the rates of exchange transfusion and acute bilirubin encephalopathy, following implementation of the 2022 guideline.
Statistical analysis
Descriptive statistics were used to summarize baseline characteristics. Continuous variables were reported as mean ± standard deviation (SD), while categorical variables were presented as frequencies and percentages. Comparisons between categorical variables were performed using the McNemar test. A p-value < 0.05 was considered statistically significant. All analyses were conducted using Stata version 18 (StataCorp, College Station, TX, USA).
Results
During the study period (February 1, 2024, to January 31, 2025), 1,252 neonates born at ≥ 35 weeks’ gestation were assessed for eligibility. Of these, 146 were excluded due to NICU or sick newborn ward admission. A total of 1,106 healthy rooming-in neonates who underwent bilirubin screening were enrolled. After excluding 2 infants lost to follow-up before 1 month of age, 1,104 infants were included in the final analysis (Fig. 1). Baseline demographic and clinical characteristics are shown in Table 1. Overall, 221 infants (20.0%) received phototherapy according to the 2022 AAP guideline. Among infants who received phototherapy, suboptimal intake hyperbilirubinemia was the most common cause of jaundice within the first 72 h, followed by unspecified causes and ABO incompatibility. Other less frequent causes included glucose-6-phosphate dehydrogenase (G6PD) deficiency, prematurity, hemolysis, subgaleal hemorrhage or cephalohematoma, and polycythemia (Table 2).
Fig. 1.
Flow diagram of participant enrollment and inclusion in the final analysis
Table 1.
Demographic and Clinical characteristics
| Characteristics | n = 1,104 |
|---|---|
| Gestational age, week; mean ± SD | 38.61 ± 1.11 |
| Birth weight, grams; mean ± SD | 3063.64 ± 385.78 |
| Gender (male), n (%) | 560 (51) |
| Mode of delivery, n (%) | |
| Normal labor | 571 (52) |
| Cesarean section | 533 (48) |
| Receiving phototherapy according to AAP 2022a, n (%) | 221 (20.0) |
| TSB at initiation of phototherapy, mg/dL; mean ± SD | 10.25 ± 0.07 |
| Age at initiation of phototherapy, hours; mean ± SD | 49.53 ± 0.14 |
| Albumin, g/dl; mean ± SD | 3.9 ± 0.25 |
Note: n, number; %, percentage; SD, standard deviation; TSB, total serum bilirubin; AAP 2022a, American Academy of Pediatrics (AAP) 2022 clinical practice guideline for the management and prevention of hyperbilirubinemia in newborn infants ≥ 35 weeks’ gestation
Table 2.
Causes of neonatal jaundice ≤ 72 h and before discharge among infants receiving phototherapy according to the AAP 2022 guideline
| Cause, n (%) | n = 221 |
|---|---|
| Suboptimal intake hyperbilirubinemia | 80 (36.2) |
| Unspecified | 67 (30.3) |
| ABO incompatibility | 35 (15.8) |
| G6PD deficiency | 19 (8.6) |
| Prematurity | 15 (6.8) |
| Other hemolysis | 13 (5.9) |
| Subgaleal hemorrhage/ Cephalohematoma | 11 (4.9) |
| Polycythemia | 2 (0.9) |
Notes: n, number; %, percentage; G6PD deficiency, Glucose-6-phosphate dehydrogenase deficiency
A total of 127 infants (11.5%) were readmitted for neonatal jaundice after discharge. Suboptimal intake was the predominant cause, followed by unspecified etiologies, G6PD deficiency, and ABO incompatibility (Table 3). Among these infants, 52 (40.9%) had previously received phototherapy prior to discharge. In this subgroup, suboptimal intake remained the leading cause of readmission, followed by ABO incompatibility and G6PD deficiency (Table 4).
Table 3.
Causes of hospital readmission for neonatal jaundice among infants treated with phototherapy based on the 2022 AAP guideline for infants aged > 72 h
| Cause, n (%) | n = 127 |
|---|---|
| Suboptimal intake | 62 (48.8) |
| Unspecified | 30 (23.6) |
| G6PD deficiency | 15 (11.8) |
| ABO incompatibility | 13 (10.2) |
| Prematurity | 10 (8) |
| Subgaleal hemorrhage/ Cephalohematoma | 6 (4.7) |
| Other Hemolysis | 5 (3.9) |
| Breastmilk jaundice | 3 (2.4) |
| Polycythemia | 1 (0.8) |
Notes: n, number; %, percentage; G6PD deficiency, Glucose-6-phosphate dehydrogenase deficiency
Table 4.
Comparison of readmission rates and causes according to phototherapy use based on the AAP 2004 and AAP 2022 guidelines
| Neonatal jaundice ≤ 72 h and before discharge | Readmission for phototherapy > 72 h n = 127 |
||
|---|---|---|---|
| Received phototherapy according to the AAP 2004a | Received phototherapy according to the AAP 2022a | n (%) | Cause n (%) |
| Yes | No | 39 (31) | Suboptimal intake 20 (51.3) |
| Unspecified 13 (33.3) | |||
| ABO incompatibility 3 (7.7) | |||
| G6PD deficiency 2 (5) | |||
| Prematurity 2 (5) | |||
| Subgaleal hemorrhage/ Cephalohematoma 1 (2.5) | |||
| Yes | Yes | 52 (40) | Suboptimal intake 23 (44.2) |
| ABO incompatibility 10 (19.2) | |||
| G6PD deficiency 9 (17.3) | |||
| Prematurity 7 (13.5) | |||
| Unspecified 6 (11.5) | |||
| Hemolysis 5 (9.6) | |||
| Subgaleal hemorrhage/ Cephalohematoma 3 (5.8) | |||
| No | No | 36 (28) | Suboptimal intake 19 (52.8) |
| Unspecified 11 (30.6) | |||
| G6PD deficiency 4 (11.1) | |||
| Polycythemia 1 (2.8) | |||
| Subgaleal hemorrhage/ Cephalohematoma 1 (2.8) | |||
| Prematurity 1 (2.8) | |||
Notes: n, number; %, percentage; G6PD deficiency, Glucose-6-phosphate dehydrogenase deficiency
AAP 2004a, American Academy of Pediatrics (AAP) 2004 clinical practice guideline for the management and prevention of hyperbilirubinemia in newborn infants ≥35 weeks’ gestation; AAP 2022a, American Academy of Pediatrics (AAP) 2022 clinical practice guideline for the management and prevention of hyperbilirubinemia in newborn infants ≥35 weeks’ gestation.
All infants in this study received phototherapy according to the 2022 AAP guidelines. For comparison, phototherapy eligibility was retrospectively assessed by applying the 2004 guideline to the observed TSB value for each infant. When the two guidelines were compared, a significant reduction in phototherapy use was observed with the 2022 guideline. Based on retrospective application of the 2004 guideline, 358 infants (32%) would have required phototherapy, whereas only 221 infants (20%) received phototherapy according to the 2022 guideline. This difference was statistically significant (p < 0.001). In addition, among infants readmitted for phototherapy (n = 127), 39 (31%) had not received phototherapy within the first 72 h of life under the 2022 guideline despite meeting treatment criteria according to the 2004 AAP guideline. In an exploratory analysis, inclusion of these infants increased the number of infants who would have received phototherapy under the 2022 guideline from 221 to 260 (23.5%), which remained substantially lower than the 32% estimated using the 2004 guideline.
Among neonates who did not receive phototherapy within the first 72 h of life, the follow-up rate based on the 2022 AAP guideline was 582 (52.7%). When the same cohort was re-evaluated using the nomogram developed by Bahr et al., 629 infants (56.9%) met the follow-up criteria. This corresponded to an absolute reduction of 4.3% and a relative reduction of 7.5% (p = 0.044; 95% CI, 5.91–9.03).
Readmission rates after 72 h of age and the causes of neonatal jaundice were analyzed according to phototherapy status under the retrospectively applied 2004 AAP guideline and the actual 2022 AAP guideline (Table 4). Among infants who would have received phototherapy under the retrospectively applied 2004 guideline but did not receive it under the 2022 guideline, 39 (31%) were readmitted, primarily due to suboptimal intake and unspecified causes. Additionally, 52 infants (40%) who received phototherapy under both guidelines were readmitted, with suboptimal intake, ABO incompatibility, and G6PD deficiency as the leading etiologies. Among infants who did not receive phototherapy under either guideline, 36 (28%) were readmitted, most commonly due to suboptimal intake.
Importantly, after implementation of the AAP 2022 guideline, no infants required exchange transfusion, and no cases of acute bilirubin encephalopathy occurred during the study period.
Discussion
Principal findings
This study demonstrates that implementation of the 2022 AAP guideline for neonatal hyperbilirubinemia was associated with a 38% reduction in phototherapy use (32% vs. 20%, p < 0.001) when compared with retrospective application of the same infants’ TSB values to the 2004 thresholds.
Importantly, no cases of acute bilirubin encephalopathy occurred and no infants required exchange transfusion following adoption of the updated recommendations.
Despite this reduction in treatment, the readmission rate was 11.5%, higher than that reported in several previous studies. However, most readmissions were attributable to suboptimal intake hyperbilirubinemia rather than failure of risk stratification. In addition, among infants who did not receive phototherapy within 72 h, application of the 2022 guideline resulted in a modest but significant reduction in recommended follow-up compared with the Bahr 2021 nomogram (absolute reduction 4.3%, relative reduction 7.5%, p = 0.044). Together, these findings suggest that the 2022 guideline safely reduces the use of phototherapy and unnecessary follow-up visits while maintaining protection against severe bilirubin-related complications within a structured follow-up system.
Comparison with previous studies
The initial phototherapy rate in our cohort (20%) remains substantially higher than the rates reported in high-income settings. For example, Sarathy et al. [12] reported 3.9%, and Michienzi et al. [13] observed 4.2% after adopting the 2022 guideline. In contrast, our findings are closer to those reported from Thailand by Vongbhavit et al. [15], who described a rate of 14.9%. These differences likely reflect variations in population risk factors and healthcare context, including the higher prevalence of G6PD deficiency in Thailand [16–19], as well as differences in health system resources and postnatal care practices.
However, in our study, phototherapy use decreased substantially compared with estimates derived from retrospective application of the 2004 AAP guideline. Among infants readmitted for phototherapy, nearly one-third had not received treatment within the first 72 h of life despite meeting the 2004 guideline criteria. Even when these infants were included in an exploratory analysis, the overall phototherapy rate remained markedly lower than that estimated under the 2004 guideline. These findings are consistent with previous reports demonstrating reductions in phototherapy use following implementation of the 2022 guideline. Sarathy et al. [12] reported a 47% reduction (from 3.9% to 2.1%), while Michienzi et al. [13] and Vongbhavit et al. [15] reported decreases from 4.2% to 1.4% and from 14.9% to 11.5%, respectively. Our findings further support the effectiveness of the 2022 AAP guideline in reducing phototherapy use across diverse clinical settings.
The readmission rate in our study (11.5%) exceeded that reported by Michienzi et al. [13] (0.9%) and was approximately ten times higher than rates observed in high-income countries. The primary cause of readmission was suboptimal intake hyperbilirubinemia, underscoring the importance of early feeding adequacy. This disparity may reflect structural, resource-related, and contextual differences. As a middle-income country, Thailand may have limited breastfeeding education and lactation support across the continuum of antenatal and postnatal care, which may delay recognition of feeding problems and contribute to rising bilirubin levels. The absence of routine post-discharge home visits may further delay the identification of jaundice and inadequate intake [20–22]. Additionally, the higher prevalence of G6PD deficiency in Thailand may contribute to increased rates of significant hyperbilirubinemia and subsequent readmission [19]. Another possible explanation is that a subset of infants who would previously have received phototherapy under the 2004 guideline were instead managed without treatment under the 2022 guideline. This shift toward more conservative management may have contributed to the higher readmission rate observed in our cohort.
Suboptimal intake hyperbilirubinemia was the leading cause of both early phototherapy (36.2%) and readmission (48.8%), consistent with previous reports [23, 24]. These findings underscore the critical importance of effective lactation support and early feeding assessment [25–27].
The most important finding of our study was that, although the 2022 AAP guideline raised the thresholds for initiating phototherapy and exchange transfusion compared with the 2004 recommendations, it reduced unnecessary phototherapy without increasing the rates of exchange transfusion or acute bilirubin encephalopathy. These findings are consistent with previous studies conducted in high-income countries [11–14].
The absence of increased complications may be explained by the structured and comprehensive risk assessment incorporated into the 2022 AAP guideline. This includes universal TSB screening before discharge, consideration of neurotoxicity risk factors when determining the need for phototherapy, and a structured follow-up system. Follow-up recommendations are based on the difference between the predischarge TSB level and the phototherapy threshold, as well as the presence of risk factors for developing significant hyperbilirubinemia.
Strengths and limitations
This study has several strengths. It prospectively evaluated implementation of the 2022 AAP guideline in a real-world clinical setting and included detailed analysis of treatment thresholds, follow-up recommendations, and clinical outcomes. The retrospective application of the 2004 guideline and the Bahr 2021 nomogram allowed a structured assessment of differences in treatment and follow-up strategies.
However, several limitations must be acknowledged. First, comparisons with the 2004 AAP guideline and the Bahr 2021 nomogram were based on retrospective application of treatment thresholds rather than parallel real-time implementation,
which may not fully capture factors influencing clinical decisions. Second, the study was conducted at a single center, potentially limiting generalizability to other populations with different demographic characteristics, healthcare systems, or breastfeeding support structures. Finally, although no severe neurologic outcomes occurred, the study was not powered to detect very rare adverse events.
Clinical implications and future perspectives
These findings have important clinical implications. The 2022 AAP guideline appears to safely reduce phototherapy use without increasing severe complications when coupled with a structured, risk-based follow-up system. By minimizing unnecessary phototherapy, clinicians may reduce maternal–infant separation and its associated adverse effects, including impaired bonding, reduced breastfeeding success, maternal depression, and potential long term neurologic complications.
Nevertheless, the relatively high phototherapy and readmission rates in our study, which were primarily attributable to suboptimal intake hyperbilirubinemia, highlight the need to strengthen early feeding assessment and breastfeeding support, particularly in low-and-middle income settings. Enhanced lactation counseling may further reduce phototherapy and readmission rates while preserving the benefits of higher treatment thresholds. Future research should include multicenter validation in diverse populations, evaluation of breastfeeding and maternal outcomes following reduced phototherapy exposure, and development of interventions to improve early feeding success. Such efforts will help refine implementation strategies and ensure that the benefits of the 2022 guideline are fully realized while maintaining patient safety.
Conclusions
Implementation of the 2022 AAP guideline reduces phototherapy use and unnecessary follow-up visits without increasing adverse outcomes. With clearly structured follow-up schedules and close monitoring of infants at risk of developing severe jaundice, high-risk newborns can be managed effectively and safely. These findings support the applicability of the guideline in routine clinical practice, including in middle-income countries.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
We would like to thank the patients and their families for participation in this study.
Authors’ contributions
KA. contributed to the conceptualization and design of the study including developed the statistical analysis plan. All authors contributed to data collection. KA and NL analyzed the data, interpreted the results, conducted the literature review, and participated in text editing and finalization of the manuscript. All authors read and approved the final manuscript.
Funding
This study was supported by research funding from Panyananthaphikkhu Chonprathan Medical Center (PCMC) (Contract No. 526/2567).
Data availability
Not applicable.
Declarations
Ethics approval and consent to participate
All procedures were performed according to the Declaration of Helsinki and approved by the Ethics Committee, PCMC, Srinakharinwirot University. Informed consent was obtained from all individual participants included in the study.
Consent for publication
Not applicable.
Disclosure
The author reports no conflicts of interest in relation to this work and has no known competing financial interest or personal relationship that could have appeared to influence the work reported in the research.
Competing interests
The authors declare that they have no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S, et al. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr. 2013;162(3):477–e4821. [DOI] [PubMed] [Google Scholar]
- 2.Keren R, Tremont K, Luan X, Cnaan A. Visual assessment of jaundice in term and late preterm infants. Arch Dis Child Fetal Neonatal Ed. 2009;94(5):F317–22. [DOI] [PubMed] [Google Scholar]
- 3.American academy of pediatrics. Clinical practice guidelines: management of hyperbilirubinemia in newborn infants born at 35 or more weeks of gestation. Pediatrics. 2022;150(2).
- 4.American Academy of Pediatrics. Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2004;114(1):297–316. [DOI] [PubMed] [Google Scholar]
- 5.Perlman JM, Volpe JJ. Bilirubin. In: Volpe JJ, Inder TE, Darras BT, et al. editors. Volpe’s Neurology of the Newborn. 6th ed. Philadelphia: Elsevier; 2018. pp. 730–62. [Google Scholar]
- 6.Kemper K, Forsyth B, McCarthy P. Jaundice, terminating breast-feeding, and the vulnerable child. Pediatrics. 1989;84:773–8. [PubMed] [Google Scholar]
- 7.Waite WM, Taylor JA. Phototherapy for the treatment of neonatal jaundice and breastfeeding duration and exclusivity. Breastfeed Med. 2016;11(4). 10.1089/bfm.2015.0170. [DOI] [PubMed]
- 8.Newman TB, Wu YW, Kuzniewicz MW, et al. Childhood seizures af ter phototherapy. Pediatrics. 2018;142(4):e20180648. [DOI] [PubMed] [Google Scholar]
- 9.Maimburg RD, Olsen J, Sun Y. Neonatal hyperbilirubinemia and the risk of febrile seizures and childhood epilepsy. Epilepsy Res. 2016;124:67–72. [DOI] [PubMed] [Google Scholar]
- 10.Bahr TM, Henry E, Christensen RD, Minton SD, Bhutani VK. A new hour-specific serum bilirubin nomogram for neonates ≥ 35 weeks of gestation. J Pediatr. 2021;236:28–e331. 10.1016/j.jpeds.2021.05.039. [DOI] [PubMed] [Google Scholar]
- 11.Jameel A. Impact of the 2022 AAP guidelines on neonatal hyperbilirubinemia admissions: a PHIS study. Hosp Pediatr. Published online 2025. 10.1542/hpeds.2024-008205. [DOI] [PubMed]
- 12.Sarathy L, Chou JH, Romano-Clarke G, Darci KA, Lerou PH. Bilirubin measurement and phototherapy use after the AAP 2022 newborn hyperbilirubinemia guideline. Pediatrics. 2024;153(4):e2023063323. 10.1542/peds.2023-063323. PMID: 38482582. [DOI] [PubMed]
- 13.Michienzi MR, Tomasini DK, Fisher CC, Ponnapakkam AP. Implementation of the Revised American Academy of Pediatrics Clinical Practice Guidelines for Hyperbilirubinemia Decreases Necessity for Serum Bilirubin and Phototherapy. Jt Comm J Qual Patient Saf. 2025;51(2):95–100. 10.1016/j.jcjq.2024.10.013. Epub 2024 Nov 1. PMID: 39694723. [DOI] [PubMed] [Google Scholar]
- 14.Balasubramanian R, Nguyen K, Wells S, Schutzman DL. Effect of the 2022 AAP Guideline for managing hyperbilirubinemia in the newborn. Am J Perinatol. 2025 Aug 7. 10.1055/a-2663-5668. Epub ahead of print. PMID: 40701575. [DOI] [PubMed]
- 15.Vongbhavit K, Rearkyai S, Janyoungsak P, Panburana J. Impact of 2022 AAP Neonatal Hyperbilirubinemia Guidelines in a Middle-Income Country: A Single-Center Study in Thailand. Neonatology 2025 Aug 13:1–16. 10.1159/000547630. Epub ahead of print. PMID: 40815110. [DOI] [PubMed]
- 16.Phompradit P, Kuesap J, Chaijaroenkul W, Rueangweerayut R, Hongkaew Y, Yamnuan R, et al. Prevalence and distribution of glucose-6-phosphate dehydrogenase (G6PD) variants in Thai and Burmese populations in malaria endemic areas of Thailand. Malar J. 2011;15:368. 10.1186/1475-2875-10-368. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Charoenkwan P, Tantiprabha W, Sirichotiyakul S, Phusua A, Sanguansermsri T. Prevalence and molecular characterization of glucose-6-phosphate dehydrogenase deficiency in northern Thailand. Southeast Asian J Trop Med Public Health. 2014;45:187–93. [PubMed] [Google Scholar]
- 18.Nuchprayoon I, Sanpavat S, Nuchprayoon S. Glucose-6-phosphate dehydrogenase (G6PD) mutations in Thailand: G6PD Viangchan (871G > A) is the most common deficiency variant in the Thai population. Hum Mutat. 2002;19:185. 10.1002/humu.9010. [DOI] [PubMed] [Google Scholar]
- 19.Bentz MG, Carmona N, Bhagwat MM, Thimmig LM, Saleh J, Eke U, et al. Beyond Asian: Specific East and Southeast Asian races or ethnicities associated with jaundice readmission. Hosp Pediatr. 2018;8(5):269–73. 10.1542/hpeds.2017-0234. [DOI] [PubMed] [Google Scholar]
- 20.Meara E, Kotagal UR, Atherton HD, Lieu TA. Impact of early newborn discharge legislation and early follow up visits on infant outcomes in a state of Medicaid problems. Pediatrics. 2004;113(6):1619–27. 10.1542/peds.113.6.1619. [DOI] [PubMed] [Google Scholar]
- 21.Escobar GJ, Green JD, Hulac P, Kincannon E, Bischoff K, Gardner MN. Rehospitalization after birth hospitalization: patterns among infants of all gestations. Arch Dis Child. 2005;90(2):125–31. 10.1136/adc.2003.039974. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Welt SI, Cole JS, Myers MS, Sholes DM Jr, Jelovsek FR. Feasibility of postpartum rapid hospital discharge: a study from a community hospital population. Am J Perinatol. 1993;10(5):384–7. 10.1055/s-2007-994768. [DOI] [PubMed] [Google Scholar]
- 23.Xavier R, V. C., M., Cherian VJ. Breastfeeding jaundice: how big is the problem? Int J Contemp Pediatr. 2016;3(2):498–503. 10.18203/2349-3291.ijcp20160948. [Google Scholar]
- 24.Tanticharoenwiwat P, Techasatid W. Outcome analysis of jaundice fast-track system implementation in Thammasat University Hospital. J Med Assoc Thai. 2014;97(5):500-5. PMID: 25065088. [PubMed]
- 25.Farhat R, Rajab M. Length of postnatal hospital stay in healthy newborns and re-hospitalization following early discharge. North Am J Medi Sci. 2011;3:146–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Hanin EA, Rayan H, Hani T, et al. Breastfeeding and readmission for hyperbilirubinemia in late preterm and term infants in Beirut, Lebanon. Indian Pediatr. 2022;59:218–21. 10.1007/s13312-022-2472-y. [PubMed] [Google Scholar]
- 27.Seagraves K, Brulte A, McNeely K, et al. Supporting breast feeding to reduce newborn readmissions for hyper bilirubinemia. Nurs Womens Health. 2013;17:498–507. [DOI] [PubMed] [Google Scholar]
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Supplementary Materials
Data Availability Statement
Not applicable.