What this presentation covers Key definitions Background Scope Key priorities for implementation Costs and savings Discussion Find out more
Term – 37 weeks or more gestational age Near-term – 35 to 36 weeks gestational age Preterm – less than 37 weeks gestational age Kernicterus – clinical features of acute or chronic bilirubin encephalopathy, including cerebral palsy, hearing loss and visual problems Prolonged jaundice – jaundice lasting more than more than 14 days in term babies and more than 21 days in preterm babies Significant hyperbilirubinaemia – an elevation of the serum bilirubin to a level requiring treatment Visible jaundice – jaundice detected by visual inspection Key definitions
Background Approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life. For most babies, this early jaundice is harmless. Babies with very high bilirubin levels are at risk of developing kernicterus. Kernicterus is also known to occur at lower levels of bilirubin in term babies who have risk factors, and in preterm babies.
Scope Recognition, assessment and treatment of neonatal jaundice for all babies with jaundice from birth up to 28 days of age. Special attention has been given to the recognition and management of neonatal jaundice in babies with dark skin tones.
Key priorities for implementation Information for parents and carers Care for all babies Additional care for babies at risk How to measure bilirubin in all babies with jaundice How to manage hyperbilirubinaemia Care of babies with prolonged jaundice
Factors that influence the development of significant hyperbilirubinaemia How to check the baby and what to do if they suspect jaundice The importance of recognising jaundice in the first 24 hours and of seeking urgent medical advice The importance of checking the babys nappies for dark urine or pale chalky stools The fact that neonatal jaundice is common and usually transient and harmless Reassurance that breastfeeding can usually continue. Information for parents and carers
Examine all babies for jaundice at every opportunity especially in the first 72 hours. Identify babies as being more likely to develop significant hyperbilirubinaemia if they have any of the following factors: gestational age under 38 weeks a previous sibling with neonatal jaundice requiring phototherapy mothers intention to breastfeed exclusively visible jaundice in the first 24 hours of life. Care for all babies
Ensure babies with factors associated with an increased likelihood of developing significant hyperbilirubinaemia: receive an additional visual examination by a healthcare professional during the first 48 hours of life Additional care for babies at risk
Do not rely on visual inspection alone to estimate the bilirubin level in a baby with jaundice. Measuring bilirubin in all babies with jaundice
Use a transcutaneous bilirubinometer (TCB) in babies with a gestational age of 35 weeks or more and postnatal age of more than 24 hours. If a TCB is not available, measure the serum bilirubin. If a TCB measurement indicates a bilirubin level greater than 250 micromol/litre check the result by measuring the serum bilirubin. Do not use an icterometer. How to measure the bilirubin level - 1
Always use serum bilirubin measurement : to determine the bilirubin level in babies with jaundice in the first 24 hours of life to determine the bilirubin level in babies less than 35 weeks gestational age for babies at or above the relevant treatment threshold for their postnatal age, and for all subsequent measurements How to measure the bilirubin level - 2
Use the bilirubin level to determine the management of hyperbilirubinaemia in all babies. Refer to the guideline for the: threshold table treatment threshold graphs investigation pathway phototherapy and exchange transfusion pathways How to manage hyperbilirubinaemia
Follow expert advice about care for babies with a conjugated bilirubin level greater than 25 micromol/litre because this may indicate serious liver disease. Care of babies with prolonged jaundice
Costs and savings Significant annually recurring costs per 100,000 population Testing£2,555 Significant non-recurrent costs per 100,000 population Purchase of TCBs£10,200 Estimated savings Per case of kernicterus avoided£5.5 million Reduced use of exchange transfusionUnquantified
Discussion Where does our current practice differ from the recommendations made by NICE about the recognition and assessment of neonatal jaundice? When and how often do we currently measure serum bilirubin? What changes do we need to make to enable us to measure serum bilirubin as outlined in the NICE guideline? How does our current practice compare to the treatment thresholds recommended by NICE?
Find out more Visit for: the guideline the quick reference guide Understanding NICE guidance costing report and template audit support a parent information factsheet treatment threshold graphs