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Neonatal jaundice
Short Text
Introduction
This pathway covers neonatal jaundice, one of the most common conditions needing medical attention in newborn babies. It also includes the quality standard on specialist neonatal care.
Jaundice refers to yellow colouration of the skin and the sclerae and is caused by a raised level of bilirubin in the circulation, a condition known as hyperbilirubinaemia.
Approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breastfed babies are still jaundiced at 1 month of age. In most babies early jaundice is harmless. However a few babies will develop very high levels of bilirubin, which can be harmful if not treated.
Clinical recognition and assessment of jaundice can be difficult, particularly in babies with dark skin tones. Once jaundice is recognised, there is uncertainty about when to treat, and there is widespread variation in the use of phototherapy and exchange transfusion. This pathway provides guidance on the recognition, assessment and treatment of neonatal jaundice in babies from birth to 28 days.
Source guidance
The NICE guidance that was used to create the pathway.
Neonatal jaundice. NICE clinical guideline 98 (2010)
Quality standards
Specialist neonatal care quality standard
These quality statements are taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.
Quality statements
Care pathways and guidelines
This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.
Quality statement
In-utero and postnatal transfers for neonatal special, high-dependency, intensive and surgical care follow perinatal network guidelines and care pathways that are integrated with other maternity and newborn network guidelines and pathways.
Quality measure
Structure
(a) Evidence of perinatal network guidelines and care pathways for in-utero and postnatal transfers for neonatal special, high-dependency, intensive and surgical care.
(b) Evidence that perinatal network guidelines and care pathways for in-utero and postnatal transfers for neonatal special, high-dependency, intensive and surgical care, are integrated with other maternity and newborn network guidelines and pathways.
(c) Evidence of network arrangements to ensure that when a baby is admitted to specialist neonatal care, the mother and any multiple birth siblings can be accommodated in the same hospital during their respective admissions.
Process
(a) Proportion of babies born at less than 28 weeks of gestation who receive intensive care in a neonatal intensive care unit (NICU) within the network.
Numerator: the number of babies receiving intensive care in a NICU within the network.
Denominator: the number of babies born at less than 28 weeks of gestation within the network.
(b) Proportion of babies with antenatally diagnosed fetal malformations requiring early surgery who are delivered at a designated network surgical centre.
Numerator: the number of babies delivered at a designated network surgical centre.
Denominator: the number of babies born within the network with antenatally diagnosed fetal malformations requiring early surgery.
(c) Proportion of babies who are transferred back to their local neonatal unit within 24 hours of request for repatriation.
Numerator: the number of babies transferred within 24 hours of repatriation request.
Denominator: the number of babies transferred back to their local neonatal unit.
(d) Proportion of babies who require neonatal surgery who receive it at a designated network surgical centre.
Numerator: the number of babies undergoing surgery at a designated network surgical centre.
Denominator: the number of babies born within the network who require neonatal surgery.
(e) For singleton births: proportion of mothers who still require inpatient care when their baby is transferred to specialist neonatal care, who are transferred to the same hospital as their baby.
Numerator: the number of mothers transferred to the same hospital as their baby.
Denominator: the number of mothers who still require inpatient care when their baby is transferred to specialist neonatal care.
(f) For multiple births: proportion of babies transferred to specialist neonatal care whose mother and/or multiple birth siblings are transferred to the same hospital if still requiring inpatient care.
Numerator: the number of babies whose mother and/or multiple birth siblings are transferred to the same hospital.
Denominator: the number of babies from multiple births transferred to specialist neonatal care whose mother and/or multiple birth siblings still require inpatient care.
Description of what the quality statement means for each audience
Service providers ensure perinatal network guidelines and care pathways for transfers for neonatal special, high-dependency, intensive and surgical care are implemented and integrated with other maternity and neonatal guidelines and pathways. Ensure regular monitoring of operation and effectiveness.
Healthcare professionals ensure perinatal network guidelines and care pathways are followed when transferring babies for neonatal special, high-dependency, intensive and surgical care, and invoke a report or alert mechanism where this is not possible.
Commissioners and networks ensure all eligible patients within their health economy are covered by perinatal network guidelines and care pathways for transfer for special, high-dependency, intensive and surgical care.
Parents of babies transferred to neonatal special, high-dependency, intensive or surgical care can expect the transfer to be in line with network guidelines and care pathways. These guidelines and care pathways describe specific procedures about safely transferring babies to other hospitals.
Definitions
The Department of Health toolkit (2009) defines a network as 'linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a coordinated manner, unconstrained by existing professional and health board boundaries, to ensure equitable provision of high-quality, clinically effective services.'
Guidance on the content of guidelines and pathways can be found within the Department of Health toolkit (2009) under Principles 4 and 7.
Data source
Structure
Local and network data collection.
Process
Local and network data collection.
Annual needs assessments
This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.
Quality statement
Networks, commissioners and providers of specialist neonatal care undertake an annual needs assessment and ensure each network has adequate capacity.
Quality measure
Structure
Evidence of an annual needs assessment including production of an annual report covering, as a minimum, specialist neonatal activity for the network's population, monitoring of quality metrics and how concerns are being addressed.
Process
(a) Proportion of mothers whose babies required specialist neonatal care and who were booked to deliver in the network who received all their perinatal care within the network area (standard 95% as per Department of Health toolkit [2009]).
Numerator: the number of mothers receiving all their perinatal care within the network area.
Denominator: the number of mothers whose babies required specialist neonatal care and who were booked to deliver in the network area.
(b) Proportion of babies who receive specialist neonatal care in the network who are from outside the network area.
Numerator: the number of babies from outside the network area.
Denominator: the number of babies receiving specialist neonatal care in the network.
(c) Bed occupancy for each level of care (standard 80% as specified in the Department of Health toolkit [2009]).
Description of what the quality statement means for each audience
Service providers cooperate with networks and commissioners to carry out an annual specialist neonatal care needs assessment. If service provision levels are found to be inadequate, they ensure action is taken in conjunction with commissioners.
Healthcare professionals assist with specialist neonatal care needs assessments by providing accurate and validated data.
Commissioners and networks ensure that, in conjunction with service providers, an annual specialist neonatal care needs assessment is undertaken. In addition, they clearly define expected levels of service provision.
Parents of babies receiving specialist neonatal care can expect that the needs of their baby will be met by services provided in their area.
Definitions
Quality metrics are defined further in the Department of Health toolkit (2009) section 5.
Data source
Structure
Local and network data collection.
Process
(a): Local and network data collection.
(b): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on whether all babies who access neonatal services are treated following their own neonatal network clinical pathway.
(c): Local and network data collection.
Skilled and multidisciplinary staff
This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.
Quality statement
Specialist neonatal services have a sufficient, skilled and competent multidisciplinary workforce.
Quality measure
Structure
(a) Evidence of local arrangements to ensure specialist neonatal staff are compliant with competency levels as described by the Department of Health toolkit (2009).
(b) Evidence of local arrangements to provide a multidisciplinary service, trained and competent in the care of neonates, that has access to:
- specialist neonatal or paediatric dietitians
- specialist neonatal occupational therapists
- specialist neonatal physiotherapists
- specialist neonatal speech and language therapists
- specialist neonatal pharmacists.
Process
Proportion of completed specialist neonatal care shifts with the correct nursing and medical staffing levels as specified in the Department of Health toolkit (2009).
Numerator: the number of shifts with the correct nursing and medical staffing levels as specified in the Department of Health toolkit (2009).
Denominator: the number of completed specialist neonatal care shifts.
Description of what the quality statement means for each audience
Service providers ensure specialist neonatal services are staffed in accordance with the Department of Health toolkit (2009), and that training and competencies are regularly reviewed.
Healthcare professionals ensure they are skilled and competent for their roles and responsibilities by accessing appropriate training.
Commissioners ensure that specialist neonatal services assess and monitor the staffing levels, composition and competency of their workforce. In addition, they ensure that appropriate education programmes are commissioned.
Parents of babies receiving specialist neonatal care can expect care to be given by an appropriate number of fully trained healthcare professionals.
Definitions
Definition of a skilled and competent workforce can be found in Department of Health toolkit (2009) Principle 2.
The process measure 'proportion of completed shifts with the correct nursing and medical staffing levels' was considered by the Topic Expert Group (TEG) as an appropriate measure of staffing. It is noted that this is not a mandatory data collection requirement and that collection of this data is at the discretion of local units.
Data source
Structure
Local data collection.
Process
Local data collection.
Neonatal transfer services
This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.
Quality statement
Neonatal transfer services provide babies with safe and efficient transfers to and from specialist neonatal care.
Quality measure
Structure
Evidence of network arrangements to provide a 24-hour, 7 days a week neonatal transport service with a single telephone contact.
Process
(a) Proportion of transfer teams responding to time-critical emergencies that depart from the transport base within 1 hour from the start of the referring call.
Numerator: the number of transfer teams departing from the transport base within 1 hour from the start of the referring call.
Denominator: the number of emergency transfer requests deemed time-critical.
(b) Proportion of newborn babies who receive specialist neonatal care who have an admission temperature of less than 36°C.
Numerator: the number of newborn babies with an admission temperature of less than 36°C.
Denominator: the number of newborn babies receiving specialist neonatal care.
Description of what the quality statement means for each audience
Service providers ensure a safe and efficient service for babies transferred to and from specialist neonatal care.
Healthcare professionals ensure babies receive a safe and efficient transfer to and from specialist neonatal care.
Commissioners and networks ensure transfer services are contracted and monitored to provide appropriate levels of service provision.
Parents of babies who need to be transferred to or from specialist neonatal services can expect this to be done safely and efficiently.
Definitions
The Department of Health toolkit (2009) states 'a transfer service is concerned with organising and implementing the transfer of babies and/or mothers from within a defined geographical area (network). It encompasses both users and providers, and transfers may be ex-utero or in-utero.'
Further description of a high quality transfer service can be found in Principle 4 of the Department of Health toolkit (2009).
Data source
Structure
Network data collection.
Process
(a) and (b): Network data collection.
Encouraging parental involvement in care
This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.
Quality statement
Parents of babies receiving specialist neonatal care are encouraged and supported to be involved in planning and providing care for their baby, and regular communication with clinical staff occurs throughout the care pathway.
Quality measure
Structure
(a) Evidence of local arrangements to involve parents in decision-making processes.
(b) Evidence of local audit demonstrating active involvement of parents in providing care for their baby.
(c) Evidence of regular surveys on parent experience.
(d) Evidence of local arrangements to provide bereavement services.
(e) Evidence of local arrangements to provide palliative care.
Process
Parents' experience is monitored through satisfaction surveys and the evidence used to inform learning and change for improvement.
Description of what the quality statement means for each audience
Service providers ensure a policy is in place to maintain accurate records of communication with parents of babies receiving specialist neonatal care and that parents are involved in planning and providing care. Ensure plans are in place to seek regular parental views and experience.
Healthcare professionals communicate regularly with parents of babies receiving specialist neonatal care and ensure parents are involved in decision-making and their baby's care.
Commissioners ensure services use parental feedback on involvement in decision-making and planning and provision of care to inform service improvement of specialist neonatal care.
Parents of babies receiving specialist neonatal care can expect to be encouraged and supported to be actively involved in planning and providing care, joint decision-making and to be in regular contact with their healthcare team.
Definitions
Support provided will depend on the parents' needs and may include physical, psychological or social support.
Data source
Structure
(a), (b), (d) and (e): Local data collection.
(c): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme denominator survey Question 8: In the last 12 months has the unit carried out a parent satisfaction survey?
Process
A Picker Institute parent survey, developed in conjunction with Bliss, is in development and will contain questions specifically aimed at assessing parent involvement in care and decision-making.
Breastfeeding
This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.
Quality statement
Mothers of babies receiving specialist neonatal care are supported to start and continue breastfeeding, including being supported to express milk.
Quality measure
Structure
Evidence of a written local policy on breastfeeding and expressing milk for babies receiving specialist neonatal care.
Outcomes
(a) Proportion of babies born at less than 33 weeks of gestation who receive specialist neonatal care who are breastfed when discharged from hospital.
Numerator: the number of babies breastfed when discharged from hospital.
Denominator: the number of babies born at less than 33 weeks of gestation receiving specialist neonatal care and discharged from hospital.
(b) Proportion of babies born at less than 33 weeks of gestation who remain in hospital and still receive their mother's breast milk at 6 weeks.
Numerator: the number of babies receiving their mother's breast milk at 6 weeks.
Denominator: the number of babies born at less than 33 weeks of gestation, receiving specialist neonatal care and remaining in hospital at 6 weeks.
Description of what the quality statement means for each audience
Service providers ensure implementation of a local policy on breastfeeding and expressing milk for babies in specialist neonatal care.
Healthcare professionals ensure all mothers of babies receiving specialist neonatal care are supported to start and continue breastfeeding, including support to express milk.
Commissioners ensure services audit their compliance against agreed standards on supporting mothers to start and continue breastfeeding, including support to express milk.
Mothers of babies receiving specialist neonatal care can expect to be offered support to start and continue to breastfeed, including support to express milk.
Data source
Structure
Local data collection.
Outcomes
(a): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme produce figures on feeding status at discharge for babies born at less than 33 weeks of gestation.
(b): Local data collection.
Coordinated transition to community care
This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.
Quality statement
Babies receiving specialist neonatal care have their health and social care plans coordinated to help ensure a safe and effective transition from hospital to community care.
Quality measure
Structure
(a) Evidence of provision of a neonatal outreach service.
(b) Evidence of multiagency discharge planning with input from community neonatal outreach services.
Process
Proportion of babies discharged from specialist neonatal care who receive an outreach service follow-up.
Numerator: the number of babies receiving outreach service follow-up.
Denominator: the number of babies discharged from specialist neonatal care requiring an outreach service follow-up.
Description of what the quality statement means for each audience
Service providers ensure that agreements are in place for coordinating the care plans of babies receiving specialist neonatal care between relevant agencies.
Health and social care professionals ensure the care plans of babies receiving specialist neonatal care are coordinated with all relevant agencies.
Commissioners and networks ensure services are commissioned according to agreed levels of care across the specialist neonatal care pathway to enable safe and effective transition from hospital to community care.
Parents of babies discharged from specialist neonatal care can expect to receive support from health or social care professionals working in the community if their baby requires it. They can also expect that their baby's care plan will be coordinated between relevant teams to help ensure a safe and effective transition from hospital to home.
Data source
Structure
(a) and (b): Local and network data collection.
Process
Local and network data collection.
Data, audit and research
This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.
Quality statement
Providers of specialist neonatal services maintain accurate and complete data, and actively participate in national clinical audits and applicable research programmes.
Quality measure
Structure
(a) Evidence of a documented data validation process to ensure data completeness and accuracy.
(b) Evidence of participation in national clinical audits and benchmarking.
(c) Evidence of participation in applicable research studies.
Process
(a) Complete and accurate data collected for the National Neonatal Audit Programme.
(b) Complete and accurate data collected for the British Association of Perinatal Medicine (BAPM) dataset.
(c) Proportion of babies receiving specialist neonatal care whose parents are invited to participate in applicable research studies.
Numerator: the number of babies whose parents are invited to participate in applicable research studies.
Denominator: the number of babies receiving specialist neonatal care.
Description of what the quality statement means for each audience
Service providers ensure accuracy and completeness of specialist neonatal data collection systems and participate in national clinical audits and applicable research programmes.
Healthcare professionals ensure accurate record keeping and data collection.
Commissioners ensure service providers participate in agreed national clinical audits and applicable research programmes.
Parents of babies receiving specialist neonatal care can expect complete and accurate information to be kept about their baby's care and for it to be used to improve care. They can also expect to be invited to participate in applicable research programmes.
Data source
Structure
(a): Local and network data collection.
(b): Participation in the Royal College of Paediatrics and Child Health National Neonatal Audit Programme.
Process
(a): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme provides quarterly data completeness and accuracy reports to participating sites.
(b): Data completeness and accuracy figures of BAPM dataset submissions.
(c): Local and network data collection.
Health outcomes
This quality statement is taken from the specialist neonatal care quality standard. The quality standard defines clinical best practice in specialist neonatal care and should be read in full.
Quality statement
Babies receiving specialist neonatal care have their health outcomes monitored.
Quality measure
Structure
Evidence of processes to enable collection of health outcome data within the network for babies who receive specialist neonatal care.
Process
(a) Proportion of babies born at less than 30 weeks of gestation who received specialist neonatal care who have a 2-year outcome form completed.
Numerator: the number of babies with a completed 2-year outcome form.
Denominator: the number of babies born at less than 30 weeks of gestation receiving specialist neonatal care.
(b) Proportion of babies born at 30 weeks of gestation or more who received specialist neonatal care who have a 2-year outcome form completed.
Numerator: the number of babies with a completed 2-year outcome form.
Denominator: the number of babies born at 30 weeks of gestation or more receiving specialist neonatal care.
(c) Proportion of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g who receive specialist neonatal care and undergo retinopathy screening prior to discharge from hospital.
Numerator: the number of babies undergoing retinopathy screening prior to discharge from hospital.
Denominator: the number of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g, receiving specialist neonatal care and discharged from hospital.
(d) Proportion of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g who receive specialist neonatal care who require laser surgery.
Numerator: the number of babies requiring laser surgery.
Denominator: the number of babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g receiving specialist neonatal care.
e) Proportion of babies who received specialist neonatal care who have had a culture-positive infection of blood or cerebrospinal fluid prior to discharge from hospital.
Numerator: the number of babies who have had a culture-positive infection of blood or cerebrospinal fluid prior to discharge from hospital.
Denominator: the number of babies receiving specialist neonatal care.
f) Proportion of babies who have had neonatal encephalopathy.
Numerator and denominator under development for the National Neonatal Audit Programme.
Outcomes
(a) Proportion of babies born at less than 30 weeks of gestation who receive specialist neonatal care who have no functional impairment at 2 years when corrected for gestational age.
Numerator: the number of babies with no functional impairment at 2 years when corrected for gestational age.
Denominator: the number of babies born at less than 30 weeks of gestation receiving specialist neonatal care.
(b) Proportion of babies born at 30 weeks of gestation or more who receive specialist neonatal care who have no functional impairment at 2 years when corrected for gestational age.
Numerator: the number of babies with no functional impairment at 2 years when corrected for gestational age.
Denominator: the number of babies born at 30 weeks of gestation or more receiving specialist neonatal care.
(c) 2-year survival rates within and compared with other networks.
Description of what the quality statement means for each audience
Service providers ensure the health outcomes of all babies receiving specialist neonatal care are monitored.
Healthcare professionals ensure accurate and complete baseline data collection through pregnancy, childbirth and the perinatal period.
Commissioners and networks ensure specialist neonatal care health outcomes are monitored and used to inform service improvement.
Parents of babies receiving specialist neonatal care can expect their baby's health will continue to be assessed after discharge from hospital.
Data source
Structure
The Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on whether health outcomes are collected.
Process
(a) and (b): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on whether 2-year outcomes are collected.
(c): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme collects data on retinopathy screening prior to discharge from hospital for babies born at less than 32 weeks of gestation and/or with a birth weight less than 1501 g.
(d): Local and network data collection.
(e): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme will collect data on babies who have had a culture-positive infection of blood or cerebrospinal fluid prior to discharge.
(f): The Royal College of Paediatrics and Child Health National Neonatal Audit Programme will collect data on neonatal encephalopathy.
Outcomes
(a), (b) and (c): Network data collection.
For further information see the Royal College of Paediatrics and Child Health National Neonatal Audit Programme.
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Implementation
Commissioning
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Pathway information
Information for the public
NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.
NICE has also written a neonatal jaundice parent information factsheet.
Patient-centred care
Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If someone does not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent, the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards. In Wales, healthcare professionals should follow advice on consent from the Welsh Government.
If the person is under 16, healthcare professionals should follow the guidelines in Seeking consent: working with children. If a young person is moving between paediatric and adult services their care should be planned and managed according to the best practice guidance described in the Department of Health's Transition: getting it right for young people.
Updates to this pathway
25 January 2013 Minor maintenance updates
25 October 2011 Minor maintenance updates
Supporting information
How to measure the bilirubin level
When measuring the bilirubin level:
- use a transcutaneous bilirubinometer in babies with a gestational age of 35 weeks or more and postnatal age of more than 24 hours
- if a transcutaneous bilirubinometer is not available, measure the serum bilirubin
- if a transcutaneous bilirubinometer measurement indicates a bilirubin level greater than 250 micromol/litre check the result by measuring the serum bilirubin
- always use serum bilirubin measurement to determine the bilirubin level in babies:
- with jaundice in the first 24 hours of life
- less than 35 weeks gestational age
- always use serum bilirubin measurement for babies at or above the relevant treatment thresholds for their postnatal age, and for all subsequent measurements
- do not use an icterometer.
Do not measure bilirubin levels routinely in babies who are not visibly jaundiced.
Do not rely on visual inspection alone to estimate the bilirubin level in a baby with jaundice.
Glossary
Phototherapy given using a single light source (not fibreoptic) that is positioned above the baby
Also known as the direct Coombs' test; this test is used to detect antibodies or complement proteins that are bound to the surface of red blood cells
Phototherapy given using a single light source that comprises a light generator, a fibreoptic cable through which the light is carried and a flexible light pad, on which the baby is placed or that is wrapped around the baby
Phototherapy that is given using more than one light source simultaneously; for example two or more conventional units, or a combination of conventional and fibreoptic units
Less than 37 weeks gestational age
Jaundice lasting more than 14 days in term babies and more than 21 days in preterm babies
An elevation of the serum bilirubin to a level requiring treatment
37 weeks or more gestational age
Jaundice detected by visual inspection
Starting single phototherapy
Starting single phototherapy
Starting single phototherapy
In term babies use conventional phototherapy ('blue light'); in preterm babies use fibreoptic phototherapy or conventional 'blue light' phototherapy.
Using clinical judgement encourage short breaks for breastfeeding, nappy changing and cuddles.
Continue lactation/feeding support.
Do not give additional fluids or feeds routinely.
Monitor hydration by daily weighing of the baby and assessing wet nappies.
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeWhen to check bilirubin level
When to check bilirubin level
When to check bilirubin level
Check serum bilirubin level:
- 4–6 hours after starting phototherapy
- every 6–12 hours if bilirubin level is stable or falling.
How to measure the bilirubin level
When measuring the bilirubin level:
- use a transcutaneous bilirubinometer in babies with a gestational age of 35 weeks or more and postnatal age of more than 24 hours
- if a transcutaneous bilirubinometer is not available, measure the serum bilirubin
- if a transcutaneous bilirubinometer measurement indicates a bilirubin level greater than 250 micromol/litre check the result by measuring the serum bilirubin
- always use serum bilirubin measurement to determine the bilirubin level in babies:
- with jaundice in the first 24 hours of life
- less than 35 weeks gestational age
- always use serum bilirubin measurement for babies at or above the relevant treatment thresholds for their postnatal age, and for all subsequent measurements
- do not use an icterometer.
Do not measure bilirubin levels routinely in babies who are not visibly jaundiced.
Do not rely on visual inspection alone to estimate the bilirubin level in a baby with jaundice.
Implementation tools
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-multipleSource guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeStable or falling bilirubin level
Is serum bilirubin level stable or falling?
Start multiple phototherapy
View the 'Neonatal jaundice multiple phototherapy' pathThreshold for phototherapy
Is serum bilirubin level at least 50 micromol/litre below threshold for phototherapy?
Determine treatment
View the 'How to manage hyperbilirubinaemia and treatment thresholds' nodeStop
Stop phototherapy and check serum bilirubin for rebound after 12–18 hours
Paths in this pathway
- Neonatal jaundice exchange transfusion
- Neonatal jaundice phototherapy
- Neonatal jaundice single phototherapy
- Neonatal jaundice multiple phototherapy
Pathway created: May 2011 Last updated: January 2013
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