Clinical Impact of Differences in Phototherapy and Exchange Transfusion Thresholds Between Turkish Neonatology Society and 2022 AAP Guidelines in Neonates with Indirect Hyperbilirubinemia

Background Clinical management of neonatal indirect hyperbilirubinemia is guided by threshold-based recommendations for initiating phototherapy and exchange transfusion. Differences between national and international guidelines may lead to variability in treatment decisions and hospitalization practices. This retrospective, single-center study compared phototherapy and exchange transfusion thresholds according to the Turkish Neonatology Society (TNS) guideline and the 2022 American Academy of Pediatrics (AAP) guideline 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 for treatment and hospitalization according to guideline thresholds was 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 2022 AAP guideline compared with the TNS guideline (p < 0.001 for both). While 89.2% of admissions met eligibility criteria according to national guideline thresholds, only 36.6% met admission criteria when assessed according to the 2022 AAP guideline. Conclusions Substantial differences exist between national and international guidelines for the management of neonatal indirect hyperbilirubinemia. These differences have a significant impact on treatment thresholds and hospitalization practices in clinical settings. Real-world comparative data may contribute to future evaluations and contextual adaptation of guideline-based management strategies.