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Appendix G

Clinical questions

I. Recognition

Q1. What are the factors associated with an increased risk of hyperbilirubinaemia?

Which factors affect the relationship between neonatal hyperbilirubinaemia and kernicterus or
other adverse outcomes (neurodevelopmental, auditory)?

Q2. What is the best method of recognising hyperbilirubinaemia?
What is the accuracy of various tests (clinical history and examination, urine/stool examination,
icterometer and transcutaneous bilirubin levels ) in recognising neonatal jaundice or
hyperbilirubinaemia?

II. Diagnosis

Q3. What should be included in a formal assessment of a baby with neonatal
hyperbilirubinaemia?

i) What are the elements of a formal assessment in a baby with neonatal hyperbilirubinaemia?
a) Clinical examination
b) Total and split bilirubin
c) Blood tests – blood grouping, G6PD levels, haematocrit,
d) Urine tests
e) Biochemical tests (bilirubin/albumin ratio, other relevant tests)
ii) What is the clinical and cost-effectiveness of the tests carried out during formal assessment?
Q4. How useful are the following tests in predicting neonatal hyperbilirubinaemia?

What is the accuracy of the following tests in predicting neonatal hyperbilirubinaemia?
i) Umbilical cord blood bilirubin levels
ii) Timed serum bilirubin levels
iii) Transcutaneous bilirubin levels
iv) End tidal CO levels Nomograms
v) Risk assessment
vi) Coombs’ test

What is the effectiveness (clinical & cost) of various tests in predicting hyperbilirubinaemia and
preventing morbidity/mortality?

III. Management

Q5. Phototherapy
i) How effective is phototherapy?
ii) What is the best modality of giving phototherapy (clinical and cost-effectiveness)?
a) Conventional phototherapy (single, double or multiple phototherapy)
b) Sunlight
c) Fibreoptic phototherapy (biliblankets, bilibeds and other products)

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