Neonatal jaundice.pdf

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National Collaborating Centre for
Women’s and Children’s Health
Neonatal jaundice
Clinical Guideline
May 2010
Funded to produce guidelines for the NHS by NICE
Neonatal jaundice
National Collaborating Centre for Women’s
and Children’s Health
Commissioned by the National Institute for
Health and Clinical Excellence
May 2010
Published by the Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s Park, London
NW1 4RG
www.rcog.org.uk
Registered charity no. 213280
First published 2010
© 2010 Royal College of Obstetricians and Gynaecologists
No part of this publication may be reproduced, stored or transmitted in any form or by any means, without
the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with
the terms of licences issued by the Copyright Licensing Agency in the UK [www.cla.co.uk]. Enquiries
concerning reproduction outside the terms stated here should be sent to the publisher at the UK address
printed on this page.
The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a
specific statement, that such names are exempt from the relevant laws and regulations and therefore for
general use.
While every effort has been made to ensure the accuracy of the information contained within this
publication, the publisher can give no guarantee for information about drug dosage and application thereof
contained in this book. In every individual case the respective user must check current indications and
accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the
manufacturers of specific products and the relevant authorities in the country in which they are practising.
This guideline has been fully funded by NICE. Healthcare professionals are expected to take it fully into
account when exercising their clinical judgement. However, the guidance does not override the individual
responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual
patient.
Implementation of this guidance is the responsibility of local commissioners and/or providers
NCC-WCH Editor: Andrew Welsh
Original design: FiSH Books, London
Typesetting: Andrew Welsh
Contents
Guideline Development Group and acknowledgements
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
2
2.1
2.2
2.3
2.4
2.5
2.6
3
3.1
3.2
4
4.1
4.2
5
5.1
5.2
6
6.1
6.2
7
7.1
7.2
7.3
7.4
7.5
8
Guidance summary
Key terms
Key priorities for implementation
Threshold table
Summary of all recommendations
Research recommendations
Treatment threshold graphs
Investigation, phototherapy and exchange transfusion pathways
Introduction
Neonatal jaundice
Aim of the guideline
Areas outside the remit of the guideline
Who has developed the guideline
Related NICE guidance
Guideline methodology
Factors that influence hyperbilirubinaemia and kernicterus
Factors that influence hyperbilirubinaemia
Risk factors for kernicterus and/or adverse sequelae
Early prediction of serious hyperbilirubinaemia
Tests that predict hyperbilirubinaemia
Tests that do not predict hyperbilirubinaemia
Recognition
Visual/clinical examination
Devices for measuring bilirubin
Formal assessment for the causes of neonatal hyperbilirubinaemia
Tests to detect underlying disease in all babies with hyperbilirubinaemia
Formal assessment of babies with prolonged jaundice
Treatment
How to manage hyperbilirubinaemia
Phototherapy
Exchange transfusion
Other treatments
Satisfaction with treatment
Information
iv
1
1
1
3
4
11
13
13
33
33
35
35
35
35
36
41
41
47
53
54
63
70
71
75
87
88
98
100
100
105
127
131
140
142
145
149
165
169
172
175
177
319
462
495
Appendix A Scope
Appendix B Declarations of interest
Appendix D Cost-effectiveness of intravenous immunoglobulin (IVIG)
Appendix E Implementation tools
Appendix F Registered stakeholder organisations
Appendix G Clinical questions
Appendix H Evidence tables
Appendix I Search strategies
Appendix J Excluded studies
Abbreviations, Glossary and References
Appendix C Economic evaluation of alternative testing strategies in the detection of hyperbilirubinaemia 152
iii

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