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Guidance summary

ID Recommendations See Chapter/Section
9 Do not use any of the following to predict significant hyperbilirubinaemia 4.2
• umbilical cord blood bilirubin level
• end-tidal carbon monoxide (ETCOc) measurement
• umbilical cord blood direct antiglobulin test (DAT) (Coombs’ test).

Additional care

10 Ensure babies with factors associated with an increased likelihood of 5.1
developing significant hyperbilirubinaemia receive an additional visual
inspection by a healthcare professional during the first 48 hours of life.

Urgent additional care for babies with visible jaundice in the first 24 hours

11 Measure and record the serum bilirubin level urgently (within 2 hours) in 4.1
all babies with suspected or obvious jaundice in the first 24 hours of life.
12 Continue to measure the serum bilirubin level every 6 hours for all babies 4.1
with suspected or obvious jaundice in the first 24 hours of life until the
level is both:
• below the treatment threshold
• stable and/or falling.
13 Arrange a referral to ensure that an urgent medical review is conducted (as 4.1
soon as possible and within 6 hours) for babies with suspected or obvious
jaundice in the first 24 hours of life to exclude pathological causes of
jaundice.

14 Interpret bilirubin levels according to the baby’s postnatal age in hours 4.1
and manage hyperbilirubinaemia according to the threshold table
(Section 1.3) and treatment threshold graphs (Section 1.6).
Care for babies more than 24 hours old

15 Measure and record the bilirubin level urgently (within 6 hours) in all 5.1
babies more than 24 hours old with suspected or obvious jaundice.

How to measure the bilirubin level

16 When measuring the bilirubin level: 5.2
• use a transcutaneous bilirubinometer in babies with a gestational age of
35 weeks or more and postnatal age of more than 24 hours
• if a transcutaneous bilirubinometer is not available, measure the serum
bilirubin
• if a transcutaneous bilirubinometer measurement indicates a bilirubin
level greater than 250 micromol/litre check the result by measuring the
serum bilirubin
• always use serum bilirubin measurement to determine the bilirubin
level in babies with jaundice in the first 24 hours of life
• always use serum bilirubin measurement to determine the bilirubin
level in babies less than 35 weeks gestational age
• always use serum bilirubin measurement for babies at or above the
relevant treatment threshold for their postnatal age, and for all
subsequent measurements
• do not use an icterometer.

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