Neonatal jaundice: summary of NICE guidance

Abstract

Neonatal jaundice is one of the most common conditions needing medical attention in newborn babies. About 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breast fed babies are still jaundiced at age 1 month.1 Neonatal jaundice is generally harmless, but high concentrations of unconjugated bilirubin may occasionally cause kernicterus (permanent brain damage). This is a rare condition (about seven new cases each year in the United Kingdom2) and sequelae include choreoathetoid cerebral palsy, deafness, and upgaze palsy. Jaundice can also be a sign of serious liver disease, such as biliary atresia, the prognosis for which is better if it is treated before age 6 weeks.3 Early recognition of jaundice is vital for treatment of any underlying condition and for the appropriate use of phototherapy, which can safely control bilirubin concentrations in most cases. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on how to diagnose and treat jaundice in newborns up to 28 days old.4 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Information for parents and carers Offer parents or carers information about neonatal jaundice that is tailored to their needs and expressed concerns, taking care to avoid causing unnecessary anxiety; discuss verbally and back up the discussions with written information. [ Based on low quality qualitative studies and on the experience and opinion of the Guideline Development Group (GDG) ] The information might include the following: