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published a revision of its clinical practice guidelines on the management of hyperbilirubinaemia in the newborn infant 35 or more weeks gestation published in 2004&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This revision&#44; among other things&#44; changed the thresholds for the treatment of hyperbilirubinaemia and established a clear basis for its management&#58; risk groups&#44; indication of venous blood collection for measurement of serum bilirubin based on transcutaneous bilirubin values&#44; interval between follow-up assessments the appropriate timing for initiation and discontinuation of phototherapy or other treatments&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our hypothesis was that the implementation of a new protocol based on the latest guidelines would result in a reduction in the number of blood draws and admission for phototherapy in the maternity ward of our hospital without an accompanying increase in the short-term neurologic complications or hearing loss associated with hyperbilirubinaemia&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a retrospective&#44; observational and inferential cohort study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The revised guidelines of the AAP from 2022 were introduced in our maternity ward in December of the same year&#46; Thus&#44; we compared 2 periods&#58; October-November 2022&#44; before implementation&#44; and February-March 2023&#44; after implementation&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The study universe corresponded to the neonates born at or after 35 weeks of gestation with birth weights greater than 2<span class="elsevierStyleHsp" style=""></span>kg admitted to the maternity ward of a tertiary care hospital&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The data were analysed with the statistical package R version 4&#46;3&#46;1 for Windows&#46; We compared continuous variables with the Student <span class="elsevierStyleItalic">t</span> test and qualitative variables with the &#967;<span class="elsevierStyleSup">2</span> test&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The total number of newborns hospitalised in the maternity ward in the study periods was 1329&#46; Of this total&#44; 699 were admitted in the first period and 630 in the second &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">We assessed neurotoxicity risk factors in both cohorts to determine whether the two groups were comparable&#46; The risk factors considered for this purpose were preterm birth and a positive direct Coombs test&#44; and we did not find statistically significant differences between the periods&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the first period&#44; a total of 299 blood draws were performed&#44; compared to 130 in the second&#46; The number of neonates that underwent blood draws for measurement of serum bilirubin was 99 in the first period &#40;14&#37; of admitted newborns&#41; compared to 58 in the second &#40;9&#46;2 of admitted newborns&#41;&#46; The number of newborns managed with phototherapy was 34 in the first period compared to 10 in the second period&#44; for a total of 862<span class="elsevierStyleHsp" style=""></span>h of phototherapy in the first period compared to 350 in the second period &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">We found statistically significant differences in the total number of blood draws&#44; the number of newborns that had blood drawn and the number of newborns admitted for phototherapy&#44; all of which were lower in the second period&#46; However&#44; we did not find statistically significant differences in the hours of phototherapy between the two periods&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">When we analysed short-term complications in each period&#44; we found that none had occurred in either&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The changes to the hyperbilirubinaemia management protocol based on the guidelines of the AAP of September 2022 were associated with an improvement in care quality&#46; They achieved a significant reduction in the number of diagnostic tests and painful procedures performed in newborns&#44; the length of stay&#44; the number of phototherapy treatments and the separation of mother and child&#44; without an associated increase in complications&#44; at least in the short term&#46; The main limitation of the study was the short duration of follow-up&#46; Additional studies need to be performed in the future to assess the long-term impact complications associated with the implemented changes to be able to confirm and broaden our conclusions&#46;</p></span>"
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                  \t\t\t\t">Phototherapy &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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