Neonatal Jaundice
Issue date: May 2010Neonatal jaundiceNICE clinical guideline 98Developed by the National Collaborating Centre for Women’s and Children’s Health
NICE clinical guideline 98Neonatal jaundiceOrdering informationYou can download the following documents fromwww.nice.org.uk/guidance/CG98 The NICE guideline (this document) – all the recommendations. A quick reference guide – a summary of the recommendations forhealthcare professionals. ‘Understanding NICE guidance’ – a summary for patients and carers. The full guideline – all the recommendations, details of how they weredeveloped, and reviews of the evidence they were based on.For printed copies of the quick reference guide or ‘Understanding NICEguidance’, phone NICE publications on 0845 003 7783 or emailpublications@nice.org.uk and quote: N2143 (quick reference guide) N2144 (‘Understanding NICE guidance’).NICE clinical guidelines are recommendations about the treatment and care ofpeople with specific diseases and conditions in the NHS in England andWales.This guidance represents the view of NICE, which was arrived at after carefulconsideration of the evidence available. Healthcare professionals areexpected to take it fully into account when exercising their clinical judgement.However, the guidance does not override the individual responsibility ofhealthcare professionals to make decisions appropriate to the circumstancesof the individual patient, in consultation with the patient and/or guardian orcarer, and informed by the summary of product characteristics of any drugsthey are considering.Implementation of this guidance is the responsibility of local commissionersand/or providers. Commissioners and providers are reminded that it is theirresponsibility to implement the guidance, in their local context, in light of theirduties to avoid unlawful discrimination and to have regard to promotingequality of opportunity. Nothing in this guidance should be interpreted in a waythat would be inconsistent with compliance with those duties.National Institute for Health and Clinical ExcellenceMidCity Place71 High HolbornLondon WC1V 6NAwww.nice.org.uk National Institute for Health and Clinical Excellence, 2010. All rights reserved. This materialmay be freely reproduced for educational and not-for-profit purposes. No reproduction by orfor commercial organisations, or for commercial purposes, is allowed without the expresswritten permission of NICE.NICE clinical guideline 98 – Neonatal jaundice1
ContentsIntroduction . 3Patient-centred care. 5Key priorities for implementation . 7Guidance . 101.1Information for parents or carers . 111.2Care for all babies . 111.3Management and treatment of hyperbilirubinaemia . 141.4Measuring and monitoring bilirubin thresholds during phototherapy . 151.5Factors that influence the risk of kernicterus . 201.6Formal assessment for underlying disease . 201.7Care of babies with prolonged jaundice . 211.8Intravenous immunoglobulin . 211.9Exchange transfusion. 221.10Other therapies . 232Notes on the scope of the guidance . 243Implementation . 244Research recommendations. 255Other versions of this guideline . 286Related NICE guidance . 297Updating the guideline . 30Appendix A: The Guideline Development Group and acknowledgements . 31Appendix B: The Guideline Review Panel . 35Appendix C: The algorithms . 36Appendix D: The treatment threshold graphs . 37NICE clinical guideline 98 – Neonatal jaundice2
IntroductionJaundice is one of the most common conditions needing medical attention innewborn babies. Jaundice refers to the yellow colouration of the skin and thesclerae (whites of the eyes) caused by the accumulation of bilirubin in the skinand mucous membranes. Jaundice is caused by a raised level of bilirubin inthe body, a condition known as hyperbilirubinaemia.Approximately 60% of term and 80% of preterm babies develop jaundice inthe first week of life, and about 10% of breastfed babies are still jaundiced at1 month. For most babies, jaundice is not an indication of an underlyingdisease, and this early jaundice (termed ‘physiological jaundice’) is generallyharmless.Breastfed babies are more likely than bottle-fed babies to developphysiological jaundice within the first week of life. Prolonged jaundice – that is,jaundice persisting beyond the first 14 days – is also seen more commonly inthese babies. Prolonged jaundice is generally harmless, but can be anindication of serious liver disease.Jaundice has many possible causes, including blood group incompatibility(most commonly Rhesus or ABO incompatibility), other causes of haemolysis(breaking down of red blood cells), sepsis (infection), liver disease, bruisingand metabolic disorders. Deficiency of a particular enzyme, glucose-6phosphate-dehydrogenase, can cause severe neonatal jaundice. Glucose-6phosphate-dehydrogenase deficiency is more common in certain ethnicgroups and runs in families.Bilirubin is mainly produced from the breakdown of red blood cells. Red cellbreakdown produces unconjugated (or ‘indirect’) bilirubin, which circulatesmostly bound to albumin although some is ‘free’ and hence able to enter thebrain. Unconjugated bilirubin is metabolised in the liver to produce conjugated(or ‘direct’) bilirubin which then passes into the gut and is largely excreted instool. The terms direct and indirect refer to the way the laboratory testsNICE clinical guideline 98 – Neonatal jaundice3
measure the different forms. Some tests measure total bilirubin and do notdistinguish between the two forms.In young babies, unconjugated bilirubin can penetrate the membrane that liesbetween the brain and the blood (the blood–brain barrier). Unconjugatedbilirubin is potentially toxic to neural tissue (brain and spinal cord). Entry ofunconjugated bilirubin into the brain can cause both short-term and long-termneurological dysfunction (bilirubin encephalopathy). The term kernicterus isused to denote the clinical features of acute or chronic bilirubinencephalopathy, as well as the yellow staining in the brain associated with theformer. The risk of kernicterus is increased in babies with extremely highbilirubin levels. Kernicterus is also known to occur at lower levels of bilirubin interm babies who have risk factors, and in preterm babies.Clinical recognition and assessment of jaundice can be difficult. This isparticularly so in babies with darker skin tones. Once jaundice is recognised,there is uncertainty about when to treat, and there is widespread variation inthe use of phototherapy and exchange transfusion. There is a need for moreuniform, evidence-based practice and for consensus-based practice wheresuch evidence is lacking. This guideline provides guidance regarding therecognition, assessment and treatment of neonatal jaundice. The advice isbased on evidence where this is available and on consensus-based practicewhere it is not.The guideline will assume that prescribers will use a drug’s summary ofproduct characteristics to inform decisions made with individual patients.NICE clinical guideline 98 – Neonatal jaundice4
Patient-centred careThis guideline offers best practice advice on the care of babies with neonataljaundice.Treatment and care should take into account parents’ preferences. Parents ofbabies with neonatal jaundice should have the opportunity to make informeddecisions about their babies’ care and treatment, in partnership with theirhealthcare professionals. If parents do not have the capacity to makedecisions, healthcare professionals should follow the Department of Health’sadvice on consent (available from www.dh.gov.uk/consent) and the code ofpractice that accompanies the Mental Capacity Act (summary available fromwww.publicguardian.gov.uk/). In Wales, healthcare professionals shouldfollow advice on consent from the Welsh Assembly Government (availablefrom www.wales.nhs.uk/consent).Healthcare professionals should follow the guidelines in ‘Seeking consent:working with children’ (available from www.dh.gov.uk/consent).Good communication between healthcare professionals and parents isessential. It should be supported by evidence-based written informationtailored to the parent’s needs. Treatment and care, and the informationparents are given about it, should be culturally appropriate. It should also beaccessible to people with additional needs such as physical, sensory orlearning disabilities, and to people who do not speak or read English.Families and carers should also be given the information and support theyneed.NICE clinical guideline 98 – Neonatal jaundice5
Key terms used in this guidelineConventional phototherapy Phototherapy given using a single lightsource (not fibreoptic) that is positioned above the babyDirect antiglobulin test (DAT) Also known as the direct Coombs’ test;this test is used to detect antibodies or complement proteins that arebound to the surface of red blood cellsFibreoptic phototherapy Phototherapy given using a single light sourcethat comprises a light generator, a fibreoptic cable through which the lightis carried and a flexible light pad, on which the baby is placed or that iswrapped around the babyMultiple phototherapy Phototherapy that is given using more than onelight source simultaneously; for example two or more conventional units,or a combination of conventional and fibreoptic unitsNear-term 35 to 36 weeks gestational agePreterm Less than 37 weeks gestational ageProlonged jaundice Jaundice lasting more than 14 days in term babiesand more than 21 days in preterm babiesSignificant hyperbilirubinaemia An elevation of the serum bilirubin to alevel requiring treatmentTerm 37 weeks or more gestational ageVisible jaundice Jaundice detected by visual inspectionNICE clinical guideline 98 – Neonatal jaundice6
Key priorities for implementationInformation Offer parents or carers information about neonatal jaundice that is tailoredto their needs and expressed concerns. This information should beprovided through verbal discussion backed up by written information. Careshould be taken to avoid causing unnecessary anxiety to parents or carers.Information should include: factors that influence the development of significant hyperbilirubinaemia how to check the baby for jaundice what to do if they suspect jaundice the importance of recognising jaundice in the first 24 hours and ofseeking urgent medical advice the importance of checking the baby’s nappies for dark urine or palechalky stools the fact that neonatal jaundice is common, and reassurance that it isusually transient and harmless reassurance that breastfeeding can usually continue.Care for all babies Identify babies as being more likely to develop significanthyperbilirubinaemia if they have any of the following factors: gestational age under 38 weeks a previous sibling with neonatal jaundice requiring phototherapy mother’s intention to breastfeed exclusively visible jaundice in the first 24 hours of life. In all babies: check whether there are factors associated with an increased likelihoodof developing significant hyperbilirubinaemia soon after birth examine the baby for jaundice at every opportunity especially in the first72 hours. When looking for jaundice (visual inspection): check the naked baby in bright and preferably natural lightNICE clinical guideline 98 – Neonatal jaundice7
examination of the sclerae, gums and blanched skin is useful across allskin tones.Additional care Ensure babies with factors associated with an increased likelihood ofdeveloping significant hyperbilirubinaemia receive an additional visualinspection by a healthcare professional during the first 48 hours of life.Measuring bilirubin in all babies with jaundice Do not rely on visual inspection alone to estimate the bilirubin level in ababy with jaundice.How to measure the bilirubin level When measuring the bilirubin level: use a transcutaneous bilirubinometer in babies with a gestational age of35 weeks or more and postnatal age of more than 24 hours if a transcutaneous bilirubinometer is not available, measure the serumbilirubin if a transcutaneous bilirubinometer measurement indicates a bilirubinlevel greater than 250 micromol/litre check the result by measuring theserum bilirubin always use serum bilirubin measurement to determine the bilirubin levelin babies with jaundice in the first 24 hours of life always use serum bilirubin measurement to determine the bilirubin levelin babies less than 35 weeks gestational age always use serum bilirubin measurement for babies at or above therelevant treatment threshold for their postnatal age, and for allsubsequent measurements do not use an icterometer.How to manage hyperbilirubinaemia Use the bilirubin level to determine the management of hyperbilirubinaemiain all babies (see threshold table 1 and treatment threshold graphs2).12The threshold table is on page 10 of this guideline.The treatment threshold graphs are in appendix D on page 37 of this guideline.NICE clinical guideline 98 – Neonatal jaundice8
Care of babies with prolonged jaundice Follow expert advice about care for babies with a conjugated bilirubin levelgreater than 25 micromol/litre because this may indicate serious liverdisease.NICE clinical guideline 98 – Neonatal jaundice9
GuidanceThe following guidance is based on the best available evidence. The fullguideline (www.nice.org.uk/guidance/CG98/Guidance) gives details of themethods and the evidence used to develop the guidance.Threshold table. Consensus-based bilirubin thresholds for managementof babies 38 weeks or more gestational age with hyperbilirubinaemiaAgeBilirubin measurement 49096 – 100 100 100 100 112 125 137 150 162 175 187 200––––– 112 125 137 150 162 175 187 200 212 225 237 250 262 275 287 300 100 125 150 175 200 212 225 237 250 262 275 287 300 312 325 337 350 100 150 200 250 300 350 400 450 450 450 450 450 450 450 450 450 450Considerphototherapyand repeatbilirubinmeasurementin 6 mentin6–12 hoursPerform anexchangetransfusionunless thebilirubinlevel fallsbelowthresholdwhile thetreatmentis beingpreparedNICE clinical guideline 98 – Neonatal jaundice10
1.1Information for parents or carers1.1.1Offer parents or carers information about neonatal jaundice that istailored to their needs and expressed concerns. This informationshould be provided through verbal discussion backed up by writteninformation. Care should be taken to avoid causing unnecessaryanxiety to parents or carers. Information should include: factors that influence the development of significanthyperbilirubinaemia how to check the baby for jaundice what to do if they suspect jaundice the importance of recognising jaundice in the first 24 hours andof seeking urgent medical advice the importance of checking the baby’s nappies for dark urine orpale chalky stools the fact that neonatal jaundice is common, and reassurance thatit is usually transient and harmless reassurance that breastfeeding can usually continue.1.2Care for all babies1.2.1Identify babies as being more likely to develop significanthyperbilirubinaemia if they have any of the following factors: gestational age under 38 weeks a previous sibling with neonatal jaundice requiring phototherapy mother’s intention to breastfeed exclusively visible jaundice in the first 24 hours of life.1.2.2Ensure that adequate support is offered to all women who intend tobreastfeed exclusively 3.3Refer to ‘Routine postnatal care of women and their babies’ (NICE clinical guideline 37) forinformation on breastfeeding support.NICE clinical guideline 98 – Neonatal jaundice11
1.2.3In all babies: check whether there are factors associated with an increasedlikelihood of developing significant hyperbilirubinaemia soonafter birth examine the baby for jaundice at every opportunity especially inthe first 72 hours.1.2.4Parents, carers and healthcare professionals should all look forjaundice (visual inspection).1.2.5When looking for jaundice (visual inspection): check the naked baby in bright and preferably natural light examination of the sclerae, gums and blanched skin is usefulacross all skin tones.1.2.6Do not rely on visual inspection alone to estimate the bilirubin levelin a baby with jaundice.1.2.7Do not measure bilirubin levels routinely in babies who are notvisibly jaundiced.1.2.8Do not use any of the following to predict significanthyperbilirubinaemia: umbilical cord blood bilirubin level end-tidal carbon monoxide (ETCOc) measurement umbilical cord blood direct antiglobulin test (DAT) (Coombs’test).Additional care1.2.9Ensure babies with factors associated with an increased likelihoodof developing significant hyperbilirubinaemia receive an additionalvisual inspection by a healthcare professional during the first48 hours of life.NICE clinical guideline 98 – Neonatal jaundice12
Urgent additional care for babies with visible jaundice in the first24 hours1.2.10Measure and record the serum bilirubin level urgently (within2 hours) in all babies with suspected or obvious jaundice in the first24 hours of life.1.2.11Continue to measure the serum bilirubin level every 6 hours for allbabies with suspected or obvious jaundice in the first 24 hours oflife until the level is both: below the treatment threshold stable and/or falling.1.2.12Arrange a referral to ensure that an urgent medical review isconducted (as soon as possible and within 6 hours) for babies withsuspected or obvious jaundice in the first 24 hours of life to excludepathological causes of jaundice.1.2.13Interpret bilirubin levels according to the baby’s postnatal age inhours and manage hyperbilirubinaemia according to the thresholdtable 4 and treatment threshold graphs 5.Care for babies more than 24 hours old1.2.14Measure and record the bilirubin level urgently (within 6 hours) inall babies more than 24 hours old with suspected or obviousjaundice.How to measure the bilirubin level1.2.15When measuring the bilirubin level: use a transcutaneous bilirubinometer in babies with a gestationalage of 35 weeks or more and postnatal age of more than24 hours45The threshold table is on page 10 of this guideline.The treatment threshold graphs are in appendix D on page 37 of this guideline.NICE clinical guideline 98 – Neonatal jaundice13
if a transcutaneous bilirubinometer is not available, measure theserum bilirubin if a transcutaneous bilirubinometer measurement indicates abilirubin level greater than 250 micromol/litre check the result bymeasuring the serum bilirubin always use serum bilirubin measurement to determine thebilirubin level in babies with jaundice in the first 24 hours of life always use serum bilirubin measurement to determine thebilirubin level in babies less than 35 weeks gestational age always use serum bilirubin measurement for babies at or abovethe relevant treatment thresholds for their postnatal age, and forall subsequent measurements do not use an icterometer.1.3Management and treatment of hyperbilirubinaemiaInformation for parents or carers on treatment1.3.1Offer parents or carers information about treatment forhyperbilirubinaemia, including: anticipated duration of treatment reassurance that breastfeeding, nappy-changing and cuddlescan usually continue.1.3.2Encourage mothers of breastfed babies with jaundice to breastfeedfrequently, and to wake the baby for feeds if necessary.1.3.3Provide lactation/feeding support to breastfeeding mothers whosebaby is visibly jaundiced.How to manage hyperbilirubinaemia1.3.4Use the bilirubin level to determine the management ofhyperbilirubinaemia in all babies (see threshold table 6 andtreatment threshold graphs7).6The threshold table is on page 10 of this guideline.NICE clinical guideline 98 – Neonatal jaundice14
1.3.5Do not use the albumin/bilirubin ratio when making decisions aboutthe management of hyperbilirubinaemia.1.3.6Do not subtract conjugated bilirubin from total serum bilirubin whenmaking decisions about the management of hyperbilirubinaemia(see management thresholds in the threshold table8 and treatmentthreshold graphs9).1.4Measuring and monitoring bilirubin thresholds duringphototherapyStarting phototherapy1.4.1Use serum bilirubin measurement and the treatment thresholds inthe threshold table8 and treatment threshold graphs9 whenconsidering the use of phototherapy.1.4.2In babies with a gestational age of 38 weeks or more whosebilirubin is in the ‘repeat bilirubin measurement’ category in thethreshold table8 repeat the bilirubin measurement in 6–12 hours.1.4.3In babies with a gestational age of 38 weeks or more whosebilirubin is in the ‘consider phototherapy’ category in the thresholdtable8 repeat the bilirubin measurement in 6 hours regardless ofwhether or not phototherapy has subsequently been started.1.4.4Do not use phototherapy in babies whose bilirubin does not exceedthe phototherapy threshold levels in the threshold table8 andtreatment threshold graphs9.During phototherapy1.4.5During phototherapy: repeat serum bilirubin measurement 4–6 hours after initiatingphototherapy repeat serum bilirubin measurement every 6–12 hours when theserum bilirubin level is stable or falling.7The treatment threshold graphs are in appendix D on page 37 of this guideline.NICE clinical guideline 98 – Neonatal jaundice15
Stopping phototherapy1.4.6Stop phototherapy once serum bilirubin has fallen to a level at least50 micromol/litre below the phototherapy threshold (see thresholdtable 8 and treatment threshold graphs 9).1.4.7Check for rebound of significant hyperbilirubinaemia with a repeatserum bilirubin measurement 12–18 hours after stoppingphototherapy. Babies do not necessarily have to remain in hospitalfor this to be done.Type of phototherapy to use1.4.8Do not use sunlight as treatment for hyperbilirubinaemia.Single phototherapy treatment for term babies1.4.9Use conventional ‘blue light’ phototherapy as treatment forsignificant hyperbilirubinaemia in babies with a gestational age of37 weeks or more unless: the serum bilirubin levels are rising rapidly (more than8.5 micromol/litre per hour) the serum bilirubin is at a level that is within 50 micromol/litrebelow the threshold for which exchange transfusion is indicatedafter 72 hours (see the threshold table12 and treatment thresholdgraphs13).1.4.10Do not use fibreoptic phototherapy as first-line treatment forhyperbilirubinaemia for babies with a gestational age 37 weeks ormore.89The threshold table is on page 10 of this guideline.The treatment threshold graphs are in appendix D on page 37 of this guideline.NICE clinical guideline 98 – Neonatal jaundice16
Single phototherapy treatment in preterm babies1.4.11Use either fibreoptic phototherapy or conventional ‘blue light’phototherapy as treatment for significant hyperbilirubinaemia inbabies less than 37 weeks unless: the serum bilirubin levels are rising rapidly (more than8.5 micromol/litre per hour) the serum bilirubin is at a level that is within 50 micromol/litrebelow the threshold for which exchange transfusion is indicatedafter 72 hours (see threshold table 10 and treatment thresholdgraphs 11).Continuous multiple phototherapy treatment for term and pretermbabies1.4.12Initiate continuous multiple phototherapy to treat all babies if any ofthe following apply: the serum bilirubin level is rising rapidly (more than8.5 micromol/litre per hour) the serum bilirubin is at a level within 50 micromol/litre below thethreshold for which exchange transfusion is indicated after 72hours (see threshold table15 and treatment threshold graphs16). the bilirubin level fails to respond to single phototherapy (that is,the level of serum bilirubin continues to rise, or does not fall,within 6 hours of starting single phototherapy).1.4.13If the serum bilirubin level falls during continuous multiplephototherapy to a level 50 micromol/litre below the threshold forwhich exchange transfusion is indicated step down to singlephototherapy.1011The threshold table is on page 10 of this guideline.The treatment threshold graphs are in appendix D on page 37 of this guideline.NICE clinical guideline 98 – Neonatal jaundice17
Information for parents or carers on phototherapy1.4.14Offer parents or carers verbal and written information onphototherapy including all of the following: why phototherapy is being considered why phototherapy may be needed to treat significanthyperbilirubinaemia the possible adverse effects of phototherapy the need for eye protection and routine eye care reassurance that short breaks for feeding, nappy changing andcuddles will be encouraged what might happen if phototherapy fails rebound jaundice potential long-term adverse effects of phototherapy potential impact on breastfeeding and how to minimise this.General care of the baby during phototherapy1.4.15During phototherapy: place the baby in a supine position unless other clinicalconditions prevent this ensure treatment is applied to the maximum area of skin monitor the baby’s temperature and ensure the baby is kept inan environment that will minimise energy expenditure(thermoneutral environment) monitor hydration by daily weighing of the baby and assessingwet nappies support parents and carers and encourage them to interact withthe baby.1.4.16Give the baby eye protection and routine eye care duringphototherapy.NICE clinical guideline 98 – Neonatal jaundice18
1.4.17Use tinted headboxes as an alternative to eye protection in babieswith a gestational age of 37 weeks or more undergoingconventional ‘blue light’ phototherapy.Monitoring the baby during phototherapy1.4.18During conventional ‘blue light’ phototherapy: using clinical judgement, encourage short breaks (of up to30 minutes) for breastfeeding, nappy changing and cuddles continue lactation/feeding support do not give additional fluids or feeds routinely.Maternal expressed milk is the additional feed of choice if available,and when additional feeds are indicated.1.4.19During multiple phototherapy: do not interrupt phototherapy for feeding but continueadministering intravenous/enteral feeds continue lactation/feeding support so that breastfeeding can startagain when treatment stopsMaternal expressed milk is the additional feed of choice if available,and when additional feeds are indicated.Phototherapy equipment1.4.20Ensure all phototherapy equipment is maintained and usedaccording to the manufacturers’ guidelines.1.4.21Use incubators or bassinets according to clinical need andavailability.1.4.22Do not use white curtains routinely with phototherapy as they mayimpair observation of the baby.NICE clinical guideline 98 – Neonatal jaundice19
1.5Factors that influence the risk of kernicterus1.5.1Identify babies with hyperbilirubinaemia as being at increased riskof developing kernicterus if they have any of the following: a serum bilirubin level greater than 340 micromol/litre in babieswith a gestational age of 37 weeks or more a rapidly rising bilirubin level of greater than 8.5 micromol/litreper hour clinical features of acute bilirubin encephalopathy.1.6Formal assessment for underlying disease1.6.1In addition to a full clinical examination by a suitably trainedhealthcare professional, carry out all of the following tests in babieswith significant hyperbilirubinaemia as part of an assessment forunderlying disease (see threshold table 12 and treatment thresholdgraphs 13): serum bilirubin (for baseline level to assess response totreatment) blood packed cell volume blood group (mother and baby) DAT (Coombs’ test). Interpret the result taking account of thestrength of reaction, and whether mother received prophylacticanti-D immunoglobulin during pregnancy.1.6.2When assessing the baby for underlying disease, consider whetherthe following tests are clinically indicated: full blood count and examination of blood film blood glucose-6-phosphate dehydrogenase levels, takingaccount of ethnic origin microbiological cultures of blood, urine and/or cerebrospinal fluid(if infection is suspected).1213The threshold table is on page 10 of this guideline.The treatment threshold graphs are in appendix D on page 37 of this guideline.NICE clinical guideline 98 – Neonatal jaundice20
1.7Care of babies with prolonged jaundice1.7.1In babies with a gestational age of 37 weeks or more with jaundicelasting more than 14 days, and in babies with a gestational age of
NICE clinical guideline 98 – Neonatal jaundice 3 Introduction Jaundice is one of the most common conditions needing medical attention in newborn babies. Jaundice refers to the yellow colouration of the skin and the sclerae (whites of the eyes) caused by the accumulation of bilirubin in the skin and mucous membranes.File Size: 1MBPage Count: 54
jaundice must have their level of conjugated bilirubin measured. Preterm infants on long-term parenteral nutrition may develop conjugated jaundice which generally improves with the introduction of enteral feed and weaning of intravenous nutrition. Keywords: Neonatal jaundice, kernicterus, conjugated jaundice, phototherapy, exchange transfusion
The National Institute of Health and Clinical Excellence (NICE) has published a clinical guideline on neonatal jaundice which provides guidance on the recognition, assessment and treatment of neonatal jaundice in babies from birth to 28 days. Neonatal Jaundice Clinical Guideline guidance.nice.org.uk cg98 For more information go to nice.org.uk/cg98
the neonatal jaundice treatment to build a nursing protocol. Method: Comprehensive literature review, during period 2011-2016, conducted through literature searches in PubMed with the keywords "neonatal jaundice guidelines", "neonatal jaundice phototherapy"; in Cuiden, with the keywords "neonatal
NICE clinical guideline 98 – Neonatal jaundice 3 Introduction Jaundice is one of the most common conditions needing medical attention in newborn babies. Jaundice refers to the yellow colouration of the skin and the sclerae (whites of the eyes) caused by the accumulation of bilirubin in the skin and mucous membranes.
What is Jaundice Neonatal jaundice Definition Neonatal jaundice is the term used when a newborn has an excessive amount of bilirubin in the blood. Bilirubin is a yellowish-red pigment that is formed and released into the bloodstream when red blood cells are broken down. Jaundice comes from the French word jaune, which means
JAUNDICE Hepatocellular Jaundice: Due to Damage to liver cells Obstructive Jaundice: results from obstruction of the common bile duct. Obstruction can be a tumor or bile stones may block the duct preventing passage bilirubininto the intestine. Neonatal jaundice:Majority of newborn infants show a rise in bilirubin in the
KEY WORDS: bilirubin, hyperbilirubinemia, jaundice, neonatal intensive care, newborn, phototherapy, premature infant P hototherapy is the use of visible light for the treatment of hyperbilirubinemia, or jaundice, in the newborn.1 It is perhaps the most com-mon nonroutine therapy applied in the newborn
32.33 standards, ANSI A300:Performance parameters established by industry consensus as a rule for the measure of quantity, weight, extent, value, or quality. 32.34 supplemental support system: Asystem designed to provide additional support or limit movement of a tree or tree part. 32.35 swage:A crimp-type holding device for wire rope. 32.36 swage stop: Adevice used to seal the end of cable. 32 .
