Quality standard
Quality statement 3: Management of hyperbilirubinaemia: treatment thresholds
Quality statement 3: Management of hyperbilirubinaemia: treatment thresholds
Quality statement
Babies with hyperbilirubinaemia are started on treatment in accordance with standardised threshold tables or charts.
Rationale
Once jaundice in babies is recognised, it is important to know when and how to treat it. Phototherapy is an effective treatment for significant hyperbilirubinaemia and can reduce the need for exchange transfusion (a procedure involving a complete changeover of blood), which is necessary only in the most severe cases. The consistent use of treatment thresholds, alongside NICE guidance, will help to ensure a balance between the thresholds being low enough to prevent complications (such as kernicterus) but not so low that phototherapy is used unnecessarily.
Quality measures
Structure
Evidence of local arrangements to ensure the use of standardised treatment threshold tables or charts when starting treatment for babies with hyperbilirubinaemia.
Data source: Local data collection.
Process
Proportion of babies identified with hyperbilirubinaemia who are started on treatment in accordance with standardised threshold tables or charts.
Numerator – the number in the denominator who are started on treatment in accordance with standardised threshold tables or charts.
Denominator – the number of babies identified with hyperbilirubinaemia.
Data source: Local data collection.
Outcome
Incidence of kernicterus.
Data source: Local data collection. The ICD‑10 code for Kernicterus is P57. Data available via NHS Digital's Hospital Episode Statistics or the NHS Digital's Neonatal Critical Care Minimum Data Set.
What the quality statement means for different audiences
Service providers ensure that healthcare professionals have access to, and are competent to use, standardised threshold tables or charts when deciding whether to start (or not start) treatment for babies with hyperbilirubinaemia.
Healthcare professionals ensure that they use standardised threshold tables or charts when deciding whether to start (or not start) treatment for babies with hyperbilirubinaemia.
Commissioners ensure that they commission services in which healthcare professionals have access to, and are competent to use, standardised threshold tables or charts when deciding whether to start (or not start) treatment for babies with hyperbilirubinaemia.
Babies with high levels of bilirubin receive treatment according to tables or charts that tell the healthcare team whether to start (or not start) treatment. The information used when making decisions about when to start treatment includes how high the baby's bilirubin level is, the age of the baby when the bilirubin was measured, and the baby's maturity at the time of birth (that is, how many weeks of pregnancy they were born after).
Source guidance
Jaundice in newborn babies under 28 days. NICE guideline CG98 (2010, updated 2016), recommendations 1.3.4 and 1.2.13
Definitions of terms used in this quality statement
Standardised threshold tables or charts
These are tables or charts that help healthcare professionals to implement treatment thresholds for phototherapy and exchange transfusion in accordance with NICE's guideline on jaundice in newborn babies. These include treatment threshold graphs for NICE's guideline on jaundice in newborn babies. All tables or charts should take into account serum bilirubin level, gestational age and postnatal age.
Note that there is variability between assays from different manufacturers in reported bilirubin measurement. Healthcare professionals should consult their local pathology laboratory when interpreting threshold tables or charts.