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 r2=0.17).conclusion:national guidelines complemented by statewide learning collaboratives can decrease or modify outcomes among all birth facilities and impact clinical practice behavior.