Comparison of Phototherapy and Exchange Transfusion Thresholds According to the Turkish Neonatology Society and the 2022 American Academy of Pediatrics Guidelines in Neonates with Indirect Hyperbilirubinemia

Background: Clinical management of neonatal indirect hyperbilirubinemia is guided by threshold-based recommendations for phototherapy and exchange transfusion. This retrospective, single-center study compared phototherapy and exchange transfusion thresholds according to the Turkish Neonatology Society and the 2022 American Academy of Pediatrics guidelines in neonates hospitalized for indirect hyperbilirubinemia. Methods: This single-center, retrospective cross-sectional study included neonates born at ≥35 weeks of gestation who were admitted to a neonatal intensive care unit solely due to indirect hyperbilirubinemia. Phototherapy and exchange transfusion thresholds were calculated according to both the TNS guideline and the 2022 AAP guideline. Eligibility according to guideline thresholds and admission indications were compared between the two guidelines. Statistical analyses were performed using appropriate non-parametric tests. Results: A total of 344 neonates were included in the analysis. Mean phototherapy and exchange transfusion thresholds were significantly higher according to the AAP 2022 guideline compared with the TNS guideline (p < 0.001 for both). While 89.2% of admissions met eligibility according to the national guideline thresholds, only 36.6% met admission criteria according to the AAP 2022 guideline. Conclusions: Substantial differences exist between national and international guidelines for the management of neonatal indirect hyperbilirubinemia. These differences significantly influence treatment thresholds and hospitalization practices. Real-life comparative data may contribute to future evaluations of guideline-based management strategies.