655 - Danish Practices in Neonatal Hyperbilirubinemia Management: A National Assessment of Diagnostics, Treatment and Follow-Up

Publication Number: 1632.655

Emil L. Oehrstroem, Pediatric Department, North Denmark Regional Hospital, Aalborg, Nordjylland, Denmark; Bo Moelholm M. Hansen, Nordsjællands Hospital, Hillerød, Hillerød, Hovedstaden, Denmark; Rikke Wiingreen, Department of Pediatrics, Nordsjællands Hospital, Hillerød, Denmark., Copenhagen, Hovedstaden, Denmark; Finn Oluf. Ebbesen, Department of Pediatrics, Aalborg University Hospital,Denmark, Aalborg, Nordjylland, Denmark; Mette Line Donneborg, The North Denmark Regional Hospital, Hjoerring, Denmark, Aalborg, Nordjylland, Denmark

Background: Neonatal hyperbilirubinemia is one of the most common conditions managed in neonatal wards worldwide. Despite its prevalence, diagnostic practices, treatment modalities, and follow-up procedures vary considerably, even within a single country. A Danish national guideline for neonatal hyperbilirubinemia has existed since 2012, based on the American Academy of Pediatrics and Norwegian guidelines. However, its interpretation and implementation differ among departments. To our knowledge, no previous study has examined actual clinical practices across Denmark.

Objective: This study aimed to investigate current procedures for diagnosis, treatment, and follow-up of uncomplicated neonatal hyperbilirubinemia in neonates with gestational age ≥35 weeks across all Danish neonatal and maternity departments.

Design/Methods: A questionnaire was developed and revised by two pediatric consultants with expertise in neonatal hyperbilirubinemia. All departments were contacted, and the survey was distributed via email to relevant personnel. Subsequently, all neonatal departments were invited for follow-up interviews to elaborate on their responses.

Results: Twenty-five of 29 departments (86%) completed the survey, and 18 of 22 neonatal wards (82%) participated in interviews. Regarding screening, 9% screen all newborns, 59% screen those with risk factors, and 14% rely solely on clinical signs. Transcutaneous bilirubin measurement is used in 64% of wards. All departments provide single, continuous phototherapy, using blankets in 82% and overhead lights in 14%. Irradiance is routinely measured in 36% of wards. The first bilirubin sample after phototherapy is taken at 24 hours in 55%, 48 hours in 23%, and at intermediate intervals in the remainder. Twelve of 22 hospitals (55%) offer home phototherapy as standard, and three (14%) under specific circumstances. Follow-up for treated infants is routine in 55% of wards, while 45% have no standardized protocol.

Conclusion(s): Screening, treatment, and follow-up practices for neonatal hyperbilirubinemia vary markedly across Denmark. Although all departments use continuous, single phototherapy, only one-third measure irradiance. More than half offer home phototherapy, while follow-up practices remain inconsistent. These findings underscore the need for greater uniformity in national guideline implementation.