Page 73 - 16Neonatal Jaundice_compressed

Neonatal jaundice

GDG translation from evidence
Factors significantly associated with hyperbilirubinaemia are gestational age < 38 weeks,
visible jaundice within 24 hours of birth and history of a previous sibling with neonatal
jaundice. The GDG refined the latter to family history of neonatal jaundice requiring treatment
with phototherapy because neonatal jaundice is so common.
This evidence is consistent with the NICE guideline on ‘Postnatal care’, which recommends that
‘babies who develop jaundice within the first 24 hours after birth should be evaluated as an
emergency action’ (www.nice.org.uk/CG37).
The GDG has used the term ‘intention to breastfeed exclusively’ in a practical sense because
most babies are discharged home before breastfeeding has been fully established. At this time
the only risk factor that can be identified is the intention to breastfeed exclusively as opposed to
‘breastfeeding exclusively’. Early postnatal discharge also limits the opportunity to assess
lactation, and to provide adequate breastfeeding support and advice.
The GDG acknowledges the strong evidence that the intention exclusively to breastfeed is a risk
factor for hyperbilirubinaemia while also recognising the benefits of breastfeeding to both
mother and child. This was discussed at length as the GDG did not want to give the message
that breast milk feeding should be replaced by formula milk if a baby is being treated for
jaundice. The GDG has recommended that adequate lactation/feeding support be provided,
including support for expressing breast milk if the baby requires treatment. The GDG feels that
this support would be augmented if more were known about factors underlying the association
between breastfeeding and jaundice, and to this end has made a research recommendation on
this topic.

It is commonly believed that bruising, cephalohaematoma and vacuum delivery all contribute
towards development of hyperbilirubinaemia, but the evidence was inconclusive.

Recommendations – 3.1 Factors that influence hyperbilirubinaemia
Identify babies as being more likely to develop significant hyperbilirubinaemia if they have
any of the following factors:
• gestational age under 38 weeks
• a previous sibling with neonatal jaundice requiring phototherapy
• mother’s intention to breastfeed exclusively
• visible jaundice in the first 24 hours of life.
Ensure that adequate support is offered to all women who intend to breastfeed exclusively.
*

* Refer to ‘Routine postnatal care of women and their babies’ (NICE clinical guideline 37) for information on breastfeeding support.

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