Extreme hyperbilirubinemia and rescue exchange transfusion in California from 2007 to 2012

Objective: To evaluate the impact of statewide learning collaboratives that used national guidelines to manage jaundice on the serial prevalence of extreme hyperbilirubinemia (EHB, total bilirubin ⩾25 mg dl −1 ) and exchange transfusions introduced in California Perinatal Quality Care Collaborative (CPQCC) hospitals in 2007. Study Design: Adverse outcomes were retrieved from statewide databases on re-admissions for live births ⩾35 weeks’ gestation (2007 to 2012) in diverse CPQCC hospitals. Individual and cumulative select perinatal risk factors and frequencies were the outcomes measures. Results: For 3 172 762 babies (2007 to 2012), 92.5% were ⩾35 weeks’ gestation. Statewide EHB and exchange rates decreased from 28.2 to 15.3 and 3.6 to 1.9 per 100 000 live births, respectively. From 2007 to 2012, the trends for TB>25 mg dl −1 rates were −0.92 per 100 000 live births per year (95% CI: −3.71 to 1.87, P =0.41 and R 2 =0.17). Conclusion: National guidelines complemented by statewide learning collaboratives can decrease or modify outcomes among all birth facilities and impact clinical practice behavior.