Page 104 - 16Neonatal Jaundice_compressed

Recognition

The authors concluded that although prolonged jaundice is common in breastfed babies, serious
pathology is rare and the combination of prolonged jaundice with persistently pale stools and/or
dark urine is very uncommon. Hence, referral of babies with this combination of signs should
be considered necessary and all such babies should be investigated immediately. [EL III]

Evidence summary
No diagnostic study on the accuracy of urine or stool examination to detect liver disease in
jaundiced babies was found. A community programme of EL III reported that although
prolonged jaundice is common in breastfed babies, these babies rarely have serious liver
pathology or pale stools/dark urine. No baby was diagnosed with liver disease during the study
period and hence the sensitivity of the stool colour chart could not be evaluated, but it showed
a high specificity.
GDG translation from evidence

There is no evidence to show that the examination of stool colour is helpful in the recognition
of jaundice in babies. Babies’ stools undergo a sequence of colour changes as part of normal
postnatal adaptation. GDG experience is that the majority of breastfed babies with prolonged
jaundice pass stools and urine of normal colour. (See Section 6.2 for prolonged jaundice.)

Recommendations – 5.1 Visual/clinical examination
In all babies:
• check whether there are factors associated with an increased likelihood of developing
significant hyperbilirubinaemia soon after birth
• examine the baby for jaundice at every opportunity especially in the first 72 hours.
Parents, carers and healthcare professionals should all look for jaundice (visual inspection).
When looking for jaundice (visual inspection):
• check the naked baby in bright and preferably natural light
• examination of the sclerae, gums and blanched skin is useful across all skin tones.
Ensure babies with factors associated with an increased likelihood of developing significant
hyperbilirubinaemia receive an additional visual inspection by a healthcare professional
during the first 48 hours of life.
Do not rely on visual inspection alone to estimate the bilirubin level in a baby with jaundice.

Measure and record the bilirubin level urgently (within 6 hours) in all babies more than
24 hours old with suspected or obvious jaundice.

5.2 Devices for measuring bilirubin

5.2.1 Icterometers

Description of included studies

Five studies 57;63-66 have been included – four in term babies 57;63;64;66 including two in dark-
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skinned babies, 63;64 and one in preterm babies. The studies were carried out between 1974
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and 1998 in the USA (two studies 57;65 ), Rhodesia, Tanzania and Turkey. The Ingram 63;66 and
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the Gosset 64;65 icterometers were used in two studies each while the fifth study did not report
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the type of icterometer evaluated.
Review findings
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The first study, conducted in a community setting in the USA, has already been described in
detail in Section 5.1.1 on visual examination. The sample population in the study was multi-
ethnic and comprised 164 neonates discharged from hospital. During home visits by the nurses,
clinical examination and icterometer recordings were done at the time of blood sampling for

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