Excerpt

Jaundice is one of the most common conditions requiring medical attention in newborn babies. Approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breastfed babies are still jaundiced at 1 month of age. In most babies with jaundice thevre is no underlying disease, and this early jaundice (termed ‘physiological jaundice’) is generally harmless. However, there are pathological causes of jaundice in the newborn, which, although rare, need to be detected. Such pathological jaundice may co-exist with physiological jaundice.

Neonatal jaundice refers to yellow colouration of the skin and the sclera (whites of the eyes) of newborn babies that results from accumulation of bilirubin in the skin and mucous membranes. This is associated with a raised level of bilirubin in the circulation, a condition known as hyperbilirubinaemia.

Contents

• Guideline Development Group and acknowledgements
• 1. Guidance summary
  • 1.1. Key terms
  • 1.2. Key priorities for implementation
  • 1.3. Threshold table
  • 1.4. Summary of all recommendations
  • 1.5. Research recommendations
  • 1.6. Treatment threshold graphs
  • 1.7. Investigation, phototherapy and exchange transfusion pathways
• 2. Introduction
  • 2.1. Neonatal jaundice
  • 2.2. Aim of the guideline
  • 2.3. Areas outside the remit of the guideline
  • 2.4. Who has developed the guideline
  • 2.5. Related NICE guidance
  • 2.6. Guideline methodology
• 3. Factors that influence hyperbilirubinaemia and kernicterus
  • Introduction
  • 3.1. Factors that influence hyperbilirubinaemia
  • 3.2. Risk factors for kernicterus and/or adverse sequelae
• 4. Early prediction of serious hyperbilirubinaemia
  • Introduction
  • 4.1. Tests that predict hyperbilirubinaemia
  • 4.2. Tests that do not predict hyperbilirubinaemia
• 5. Recognition
  • Introduction
  • 5.1. Visual/clinical examination
  • 5.2. Devices for measuring bilirubin
• 6. Formal assessment for the causes of neonatal hyperbilirubinaemia
  • Introduction
  • 6.1. Tests to detect underlying disease in all babies with hyperbilirubinaemia
  • 6.2. Formal assessment of babies with prolonged jaundice
• 7. Treatment
  • 7.1. How to manage hyperbilirubinaemia
  • 7.2. Phototherapy
  • 7.3. Exchange transfusion
  • 7.4. Other treatments
  • 7.5. Satisfaction with treatment
• 8. Information
  • Description of included studies
• Appendix A. Scope
• Appendix B. Declarations of interest
• Appendix C. Economic evaluation of alternative testing strategies in the detection of hyperbilirubinaemia
• Appendix D. Cost-effectiveness of intravenous immunoglobulin (IVIG)
• Appendix E. Implementation tools
• Appendix F. Registered stakeholder organisations
• Appendix G. Clinical questions
• Appendix H. Evidence tables
• Appendix I. Search strategies
• Appendix J. Excluded studies
• Abbreviations, Glossary and References

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.

This guideline has been fully funded by NICE. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient.

Implementation of this guidance is the responsibility of local commissioners and/or providers.