Page 178 - 16Neonatal Jaundice_compressed

Appendix A: Scope

4 The guideline

a) The guideline development process is described in detail in two publications that are
available from the NICE website (see ‘Further information’). ‘The guideline development
process: an overview for stakeholders, the public and the NHS’ describes how organisations
can become involved in the development of a guideline. ‘The guidelines manual’ provides
advice on the technical aspects of guideline development.
b) This document is the scope. It defines exactly what this guideline will (and will not) examine,
and what the guideline developers will consider. The scope is based on the referral from the
Department of Health (see appendix).
c) The areas that will be addressed by the guideline are described in the following sections.
4.1 Population

4.1.1 Groups that will be covered
a) All newborn infants (both term and preterm) from birth to 28 days.
b) Special attention will be given to the recognition and management of neonatal jaundice in
babies with darker skin.
4.1.2 Groups that will not be covered
a) Babies with jaundice that lasts beyond the first 28 days.
b) Babies with jaundice that requires surgical treatment to correct the underlying cause.
c) Management of babies with conjugated hyperbilirubinaemia.
4.2 Healthcare setting

a) The guideline will cover management in primary (including community care) and secondary
care. Guidance regarding tertiary referral will also be included.

4.3 Clinical management
a) Identification of factors that increase the risk of kernicterus in a baby with jaundice
b) Recognition and management in primary care (includes community care).
• Role and timing of assessment in primary care.
• Estimation of hyperbilirubinaemia and its management.
• Management at home, in the community and after discharge.
• Indications for referral to secondary care
c) Recognition and management in secondary care.
• Assessment in secondary care.
• Investigations including:
– bilirubin – components and methods of estimation
– other relevant haematological and biochemical tests
– urine tests
– screening for metabolic disorders
– end tidal carbon monoxide concentration
• Timing of lab investigations including point of care testing. Indications for referral to
tertiary care.
d) Treatment of hyperbilirubinaemia.
• Interpretation of bilirubin levels and use of nomograms.
• Phototherapy (various modalities).
• Blood exchange transfusion.
• Other treatment modalities.
• Role of nutritional support and rehydration.
e) Outcomes that will be considered:
• major outcomes:
– mortality
– morbidity, seizures
– neurological complications (immediate, short-term and long-term)
– impact on resource use and costs
• other outcomes:

147