108 - Impact of a Neonatal Bilirubin Algorithm on the Management of Hyperbilirubinemia in Premature Infants < 35 Weeks Gestational Age

Phototherapy treatment (PT) is the gold standard therapy for the management of hyperbilirubinemia in preterm infants. Initially thought to be a benign intervention, recent evidence has demonstrated that PT has numerous adverse effects in preterm infants, suggesting that limiting excessive exposure to PT may be important. Due to lack of clinical guidelines and a bilirubin nomogram (NM) for preterm infants, providing appropriate, but not excessive PT exposure has been challenging.
 

Objective:

Among preterm infants, we assessed the impact of a bilirubin NM on (1) PT utilization, (2) PT duration and (3) associated bilirubin and PT adverse effects.

Design/Methods: This was a single-center, retrospective cohort study of infants born < 35 weeks’ gestational age (GA). We developed a NM for preterm infants based on existing consensus guidelines and implemented it in 12/1/2017. For infants who required PT, infant demographics and medical factors, bilirubin levels at PT initiation and cessation and duration (hours), and bilirubin and PT related adverse effects were abstracted from the medical record. We compared outcomes of infants cared for “pre-NM” from 10/2016-11/2017 and “post-NM” from 12/2017-07/2021, using t, chi-square, and Fisher’s exact tests
 

Results: PT utilization decreased from 58.9% in the pre-NM cohort to 37.8% in the post-NM cohort (p < 0.0001). Among the 512 infants who required PT, 176 were cared for in the pre-NM cohort and 336 infants in the post-NM cohort. There were no significant differences in demographics or infant characteristics. Average duration of PT was lower in the post-NM cohort compared to pre-NM (37.9 vs. 55.5, p = < .0001) (Table 1). PT was initiated later among infants in the post-NM cohort (2.2 days vs. 2 days, p = 0.02), initiated at a higher bilirubin level (10.4 vs. 9.2, p = < .0001) and discontinued at lower bilirubin levels (6.9 vs. 7.6, p = 0.001) compared to infants in the pre-NM cohort (Table 2). Regarding infant morbidities, compared to infants in the pre-NM cohort, in the post-NM cohort, ROP occurred less often among infants 29-31 weeks GA (20% vs. 9%, p = 0.04), bilateral passing of the hearing screen was higher among infants 32-34 week GA (98.3% vs. 91.4%, p = 0.03) and serum calcium values were higher 24 hours before (6.6 vs. 4.9, p = < 0.0001), during (7.5 vs. 5.7, p = < 0.0001), and 48 hours after PT (7.6 vs. 5.8, p = < 0.0001) (Table 3). There were no differences in other secondary outcomes.
 

Conclusion(s):

Implementation of a preterm bilirubin NM significantly decreased PT use and duration, as well as certain bilirubin and PT associated adverse effects.
 



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