Jaundice in newborn babies under 28 days

Why this is important

Breastfeeding has been shown to be a factor in significant hyperbilirubinaemia. The reasons for this association have not yet been fully elucidated.

This question should be answered by studying infants in the first 28 days of life receiving different feeding types (breast milk, formula feeds or mixed feeds). Infants who do not develop significant hyperbilirubinaemia should be compared with infants with significant hyperbilirubinaemia. The outcomes chosen should include maternal factors, neonatal factors and blood analyses.

Why this is important

There is good evidence that a risk assessment that combines the result of a timed transcutaneous bilirubin level with risk factors for significant hyperbilirubinaemia is effective at preventing later significant hyperbilirubinaemia.

This question should be answered by studying the effects of timed pre‑discharge transcutaneous bilirubin levels and timed pre‑discharge transcutaneous bilirubin levels combined with risk assessment. The study population should consist of babies in the first 28 days of life, with subgroups including near‑term babies and babies with dark skin tones. The interventions should be compared with standard care (discharge without timed transcutaneous bilirubin level), and the outcomes chosen should include significant hyperbilirubinaemia, cost‑effectiveness and parental anxiety.

Why this is important

The accuracy of transcutaneous bilirubinometers (Minolta JM‑103 and BiliChek) has been adequately demonstrated in term babies below treatment levels (bilirubin less than 250 micromol/litre). New research is needed to evaluate the accuracy of different transcutaneous bilirubinometers in comparison to serum bilirubin levels in all babies.

This question should be answered by comparing bilirubin levels taken using different transcutaneous bilirubinometers with bilirubin levels assessed using serum (blood) tests. The study population should comprise babies in the first 28 days of life, with subgroups including preterm babies, babies with dark skin tones, babies with high levels of bilirubin and babies after phototherapy. The outcomes chosen should include diagnostic accuracy (sensitivity, specificity, positive predictive value, negative predictive value), parental anxiety, staff and parental satisfaction with test and cost effectiveness.

Why this is important

The effectiveness and tolerability of intermittent phototherapy has been adequately demonstrated in term babies at low treatment levels (bilirubin less than 250 micromol/litre). New research is needed to evaluate the effectiveness and tolerability of different frequencies of interruptions of different durations.

The study population should comprise babies in the first 28 days of life in phototherapy. Interruptions of 45 or 60 minutes would be made either on demand, every hour or every 2 hours, and compared with interruptions of up to 30 minutes every 3 hours. The outcomes chosen should include effectiveness in terms of the mean decrease in bilirubin levels and the mean duration of phototherapy. Extra outcomes could include adverse effects, parental bonding and parental anxiety, staff and parental satisfaction with treatment and cost effectiveness.

Why this is important

There is good evidence that prospective surveys in the UK and data from a national kernicterus register in the US can help to identify root causes of kernicterus and acute bilirubin encephalopathy.

The study population should comprise all children with a peak bilirubin level greater than 450 micromol/litre, which is the threshold for an exchange transfusion recommended by NICE. The intervention would be maternal, prenatal, perinatal and neonatal factors. The outcomes chosen should be shortcomings in clinical and service provision to prevent recurring themes in kernicterus cases.

Why this is important

There is a gap in the evidence about parental and healthcare professional experience and acceptability of phototherapy. The committee agreed that the need for this research should be supported, especially given the greater awareness of the crucial importance of close and early skin contact between babies and their carers. The study should be a qualitative study of newborn babies (term and preterm) with a diagnosis of jaundice but who are otherwise well. Outcomes should include both parental and staff experience, including access for bonding and breastfeeding.