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Jump to Key Points Updated guidelines for newborn jaundice are helping physicians avoid unnecessary treatment, but a study of pediatricians presented at Pediatric Hospital Medicine (PHM) 2026 found that some important risk factors may still be overlooked.
A group of pediatricians in New Jersey was surveyed on how they were applying the American Academy of Pediatrics 2022 guidelines for newborn hyperbilirubinemia (jaundice). More than 70% of respondents identified major risk factors for severe jaundice, but fewer than half recognized Down syndrome as one.
A small percentage of respondents (12.5%) said they would start phototherapy earlier than the guidelines recommend, but 18%-33% skipped questions regarding testing protocols and phototherapy management altogether.
The results suggest that while most pediatricians are familiar with key aspects of the guidelines, some gaps remain in how they are applied in practice, according to Aimee Lariviere, MD, associate professor of pediatrics at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, and lead author of the study.
- 2022 AAP jaundice thresholds ↑ phototherapy cutoff vs 2004.
- Survey: >70% identified major severe jaundice risk factors.
- <50% recognized Down syndrome as a severe jaundice risk factor.
- 12.5% would start phototherapy earlier than guideline thresholds.
- 18%-33% omitted bilirubin testing/phototherapy management questions.
Lariviere said those gaps could lead to unnecessary treatment when clinicians rely on older bilirubin thresholds.
The American Academy of Pediatrics updated its newborn jaundice guidelines in 2022, raising the bilirubin levels at which physicians should start phototherapy. The guidelines had not been updated since 2004 and were changed to reduce unnecessary treatment and its burden on newborns and their families.
“If pediatricians are still using old guidelines, they’re treating earlier unnecessarily,” Lariviere said. “The treatment itself is correct, but that baby may not have needed that treatment at that moment. We don’t want to put a kid under the lights if we don’t have to.”
Lariviere and her colleagues sent surveys to members of the New Jersey Chapter of the American Academy of Pediatrics in November 2024 to assess how pediatricians were applying the updated recommendations.
The 28-question survey assessed physicians’ knowledge of risk factors for severe jaundice, bilirubin testing before and after discharge, phototherapy thresholds, and follow-up practices. About 120 pediatricians responded out of the 1890 chapter members who received the survey.
The survey found that 78.3% of pediatricians correctly answered questions about bilirubin levels and phototherapy thresholds, whereas 80% identified factors that can increase the risk for brain damage. However, about 20% did not answer neurotoxicity and phototherapy threshold questions.
Ricardo Quinonez, MD, attending and division chief for Pediatric Hospital Medicine at Texas Children’s Hospital and Baylor College of Medicine, both in Houston, said the 2022 update reflected evidence that some newborns were being treated even though their risk for serious complications was very low.
Quinonez said the biggest change in the 2022 guidelines was that the bilirubin levels requiring treatment went up for all ages and all risk factors.
“We were probably hospitalizing too many kids who otherwise probably just didn’t need phototherapy before then,” he said.
“Phototherapy and referral to the hospital should be reserved for those babies that have significant risk factors or really high bilirubin levels that, per the AAP [American Academy of Pediatrics] guidelines, require referrals,” he said. “These guidelines allow them to keep babies at home, which is the place they should be.”
No financial disclosures were reported.
