Page 176 - 16Neonatal Jaundice_compressed

Appendix A

Scope

1 Guideline title

Neonatal jaundice

1.1 Short title
Neonatal jaundice

2 Background

a) The National Institute for Health and Clinical Excellence (‘NICE’ or ‘the Institute’) has
commissioned the National Collaborating Centre for Women’s and Children’s Health to
develop a clinical guideline on the recognition and treatment of infants with neonatal
jaundice for use in the NHS in England and Wales. This follows referral of the topic by the
Department of Health (see appendix). The guideline will provide recommendations for good
practice that are based on the best available evidence of clinical and cost-effectiveness.
b) The Institute’s clinical guidelines support the implementation of National Service Frameworks
(NSFs) in aspects of care for which a Framework has been published. The statements in each
NSF reflect the evidence that was used at the time the Framework was prepared. The clinical
guidelines and technology appraisals published by NICE after an NSF has been issued will
have the effect of updating the Framework.
c) NICE clinical guidelines support the role of healthcare professionals in providing care in
partnership with patients, taking account of their individual needs and preferences, and
ensuring that patients (and their carers and families, if appropriate) can make informed
decisions about their care and treatment.

3 Clinical need for the guideline

a) Jaundice is one of the most common conditions requiring medical attention in newborn
babies. Approximately 60% of term and 80% of preterm babies develop jaundice in the 1st
week of life, and about 10% of breastfed babies are still jaundiced at 1 month of age. In most
infants with jaundice there is no underlying disease, and this early jaundice (termed
‘physiological jaundice’) is generally harmless.
b) Neonatal jaundice refers to the yellow colouration of the skin and the sclera of newborn
babies that result from accumulation of bilirubin in the skin and mucous membranes. This is
associated with a raised level of bilirubin in the body, a condition known as
hyperbilirubinaemia.
c) Bilirubin is a breakdown product of the red cells in the blood. Red cell breakdown produces
unconjugated (or ‘indirect’) bilirubin, which is partly bound to albumin. Normally this is
metabolised in the liver to produce conjugated (or ‘direct’) bilirubin, which then circulates
through the gut and is excreted in the urine and the stool.
d) Newborn babies have more circulating red cells and a shortened red cell lifespan, so the
bilirubin levels are higher than they are later in life. The breakdown and excretion of
bilirubin is also slower. Thus degrees of hyperbilirubinaemia occurring as a result of this
normal physiological mechanism are common in newborn babies and usually benign
(harmless) compared with adult levels.

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