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 relies on guideline-based thresholds for phototherapy and exchange transfusion. In 2022, the American Academy of Pediatrics (AAP) updated its guideline, raising treatment thresholds for neonates born at ≥35 weeks of gestation. In Türkiye, clinical practice is guided by the Turkish Neonatology Society (TNS) guideline, which applies lower treatment thresholds. 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. Guideline compliance and admission indications were compared. 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 were compliant with the TNS guideline, only 36.6% met the admission criteria based on the AAP 2022 guideline. Approximately 64.4% of hospitalized neonates did not have an admission indication according to the AAP 2022 recommendations. 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.