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Review of the NICE guidance on neonatal jaundice
  1. M Atkinson1,
  2. H Budge2
  1. 1Department of Paediatrics, Sandwell and West Birmingham NHS Trust, Lyndon, UK
  2. 2Department of Child Health, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr M Atkinson, Department of Paediatrics, Sandwell and West Birmingham NHS Trust, Lyndon B71 4HJ, UK; maria{at}doctors.org.uk

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Introduction

The new guidance from National Institute for Health and Clinical Excellence (NICE)1 on recognition and treatment of neonatal jaundice is discussed in this review. Maternity units across the UK have differing guidelines for the management of neonatal jaundice, which is confusing for doctors, nurses and parents. The difference is responsible for wide variation in practice throughout the UK.2 This guidance will standardise practice in both the hospital and community settings. Areas where practice may change as a result of this guideline have been highlighted.

Elements the guideline covers

  • Management of neonatal jaundice in babies from birth to 28 days.

  • Recognition, assessment and treatment of neonatal jaundice. These recommendations are combined in three care pathways: care for all babies (see Investigation Pathway), phototherapy and exchange transfusion.

  • Investigation of prolonged jaundice.

  • Suggestions for information for parents/carers.

  • Other useful documents:

    • a treatment threshold table and treatment threshold graphs;

    • a PowerPoint slide set with accompanying notes to help implement the guideline;

    • a costing template;

    • audit criteria with a data-collection sheet;

    • baseline assessment sheet to help organisations assess where current practice is in relation to the recommended guidance.

Elements the guideline does not cover

  • Jaundice that requires surgical treatment to correct the underlying cause.

  • Management of babies with conjugated hyperbilirubinaemia, although the importance of identifying this group is covered.

Key areas where your local practice may change as a result of this new guidance

  • Measuring bilirubin in any baby with visible jaundice rather than relying on visual assessment.

  • Introduction of bilirubin measurements using the transcutaneous route.

  • Examining the baby for jaundice ‘at every opportunity’ in the first 72 h and an additional inspection by a healthcare professional within 48 h for infants with risk factors for hyperbilirubinaemia.

  • The use of clear thresholds for phototherapy individualised by gestational age.

  • ‘Biliblankets’ are not recommended for term babies.

  • Sunlight is not recommended as …

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