Page 17 - 16Neonatal Jaundice_compressed

Guidance summary

ID Recommendations See Chapter/Section
Phototherapy equipment

42 Ensure all phototherapy equipment is maintained and used according to 7.2.1
the manufacturers’ guidelines.
43 Use incubators or bassinets according to clinical need and availability. 7.2.4
44 Do not use white curtains routinely with phototherapy as they may impair 7.2.4
observation of the baby.
Factors that influence the risk of kernicterus
45 Identify babies with hyperbilirubinaemia as being at increased risk of 3.2
developing kernicterus if they have any of the following:
• a serum bilirubin level greater than 340 micromol/litre in babies with a
gestational age of 37 weeks or more
• a rapidly rising bilirubin level of greater than 8.5 micromol/litre per
hour
• clinical features of acute bilirubin encephalopathy.
Formal assessment for underlying disease

46 In addition to a full clinical examination by a suitably trained healthcare 6.1
professional, carry out all of the following tests in babies with significant
hyperbilirubinaemia as part of an assessment for underlying disease (see
threshold table (Section 1.3) and treatment threshold graphs (Section 1.6)):
• serum bilirubin (for baseline level to assess response to treatment)
• blood packed cell volume
• blood group (mother and baby)
• DAT (Coombs’ test). Interpret the result taking account of the strength of
reaction, and whether mother received prophylactic anti-D
immunoglobulin during pregnancy.
47 When assessing the baby for underlying disease consider whether the 6.1
following tests are clinically indicated:
• full blood count and examination of blood film
• blood glucose-6-phosphate dehydrogenase levels, taking account of
ethnic origin
• microbiological cultures of blood, urine and/or cerebrospinal fluid (if
infection is suspected).

Care of babies with prolonged jaundice
48 In babies with a gestational age of 37 weeks or more with jaundice lasting 6.2
more than 14 days, and in babies with a gestational age of less than
37 weeks with jaundice lasting more than 21 days:
• look for pale chalky stools and/or dark urine that stains the nappy
• measure the conjugated bilirubin
• carry out a full blood count
• carry out a blood group determination (mother and baby) and DAT
(Coombs’ test). Interpret the result taking account of the strength of
reaction, and whether mother received prophylactic anti-D
immunoglobulin during pregnancy.
• carry out a urine culture
• ensure that routine metabolic screening (including screening for
congenital hypothyroidism) has been performed.

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