593 - Shedding a Light: Incidence of and Hospital Utilization Associated with Subthreshold Phototherapy in 2 Freestanding Children's Hospitals

Publication Number: 2578.593

Sanjay Chainani, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Levon H. Utidjian, Childrens Hospital of Philadelphia, Wynnewood, PA, United States; Chris Bonafide, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Neonatal hyperbilirubinemia is the second most common cause of hospitalization in children under 1. Contrary to existing guidelines, phototherapy is often used to treat in infants with unconjugated bilirubin levels below the phototherapy threshold, which is a low value practice with potential for harm.

Objective: We aimed to 1) report the incidence of sub-threshold phototherapy in infants under 2 weeks old with unconjugated hyperbilirubinemia presenting to the Emergency Department (ED) and 2) compare the healthcare utilization metrics (length of stay, duration of phototherapy, and number of lab panels and needlesticks) for infants who received and did not receive sub-threshold phototherapy at 2 hospitals.

Design/Methods: Using electronic medical record data, we conducted a retrospective cohort study of infants with ICD-10 codes for jaundice seen in the ED in urban and suburban freestanding children's hospitals within the same care network between 12/1/2022 and 8/1/2025. We included infants greater than 35 weeks gestation and less than 2 weeks old who were below their phototherapy threshold based on their total bilirubin and neurotoxicity risk factors. We restricted our sample to uncomplicated jaundice by excluding encounters with elevated conjugated bilirubin, fever, ICD-10 codes for infections, ICU admission, greater than 4-day admission, and no bilirubin results.

Results: We identified 702 encounters for unconjugated hyperbilirubinemia in infants below the phototherapy threshold; 261/702 (37.1%) of encounters included phototherapy. Over 50% of those who received phototherapy were ≥2 mg/dL below the guideline-recommended treatment threshold (Table 1). Infants who received phototherapy were more likely to be < 2 mg/dL below threshold (p < 0.001) compared to those who did not. Infants receiving phototherapy were hospitalized for a median 19 hours (IQR 4-24) and received phototherapy for a median 14.8 hours (SD 8). Infants who received phototherapy had more lab panels (3 (1-7) vs 1 (1-1), p< 0.001) and needlesticks (3 (1-4) vs 1 (1-3), p< 0.001) than those who did not (Table 2).

Conclusion(s): In this cohort of infants with unconjugated hyperbilirubinemia, more than one-third of infants with bilirubin levels below the guideline-recommended treatment threshold received phototherapy. Although most hospitalizations were short, the increased duration, labs, and needlesticks for those who received phototherapy may contribute to avoidable pain, resource utilization, and strain on families.

Table 1. Characteristics of Infants Below the Phototherapy Threshold who Received and Did Not Receive Phototherapy


Table 2. Hospital Utilization of Infants Below the Phototherapy Threshold who Received and Did Not Receive Phototherapy