The National Institute for Health and Care Excellence (NICE) has issued standards to improve the recognition and management of jaundice in newborn (from birth to 28 days) babies.

Caused by a raised level of bilirubinⁱ and characterised by yellow colouration of the skin and the whites of the eyes, neonatal jaundice is one of the most common conditions needing medical attention in newborn babies. It is estimated that more than 430,000 babies - around 60% of all term and 80% of all pre-term babies - develop jaundice in the first week of life.

For most newborn babies jaundice does not mean there is any underlying disease and is generally harmless, particularly when it develops after the first 24 hours of life. However, jaundice in the first 24 hours of life can be a sign of underlying disease and needs urgent assessment. If jaundice is not identified early and treated effectively it can result in kernicterus, a rare but serious neurological condition which is associated with long term problems such as cerebral palsy, hearing loss and visual and dental problems.

Phototherapy (light treatment) is an effective treatment for jaundice in newborn babies. It involves placing the baby under a lamp emitting light in the blue spectrum. This converts the bilirubin in the skin into a harmless form that can be excreted in the urine. Phototherapy has reduced the need to perform an exchange transfusion of blood (the only other means of removing bilirubin from the body).

In summary:

• To ensure that babies receive appropriate treatment for jaundice caused by underlying disease in order to prevent complications and achieve the best clinical outcomes, its early identification is essential. Parents or carers of newborn babies should have a discussion with healthcare professionals and be given written information about neonatal jaundice within 24 hours of the birth, including what to look for and who to contact if they are concerned.
• Measuring bilirubin levels in babies with suspected or obvious visible jaundice is better than visual inspection at assessing the degree of jaundice and determining whether the baby needs further investigations or treatment. Therefore the standard states that babies who are more than 24-hours old and suspected to have developed jaundice have their bilirubin level measured within 6 hours of jaundice being suspected. This will ensure that babies with rapidly rising bilirubin levels are identified promptly for treatment.
• Once jaundice in babies is recognised, it is important to know when and how to treat it. The standard states that 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.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: "The majority of babies develop jaundice in their first week of life, causing them no ill effects. In a very small proportion of babies, however, it is associated with underlying disease and has the potential to be serious. It's important, therefore, that the severity of the jaundice is properly assessed so that treatment, if it's needed, can be provided in a timely way. This new standard, by driving up the quality of care provided to newborn babies with jaundice and their parents or carers, will help to ensure that this happens."

Yvonne Benjamin, Community Midwife, University Hospitals Leicester NHS Trust and member of the committee which developed the standard, said: "The NICE quality standard on neonatal jaundice supports practising midwives in the provision of current, clear, and concise information to parents of new-born babies. For community based midwives in particular, the quality standard provides support through the use of specialised equipment, and standardised charts in the early recognition, treatment, and management of care for babies with jaundice."

Dr Janet Rennie, Consultant and Senior Lecturer in Neonatal Medicine, University College London Hospitals and member of the committee which developed the standard, said: "I am delighted that NICE is releasing a quality standard reinforcing the key messages of the guideline on neonatal jaundice published in 2010. Implementation has been patchy. The quality standard places further emphasis on the importance of measuring the bilirubin level rather than relying on visual inspection for the assessment of jaundice, and interpreting the result according to the baby's postnatal age in hours. Following the guideline will target treatment to those babies who need it and should prevent the rare but tragic occurrence of brain damage due to high levels of bilirubin (kernicterus)."

Ends

For more information, please call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813, or email pressoffice@nice.org.uk

Notes to Editors

References

i. Bilirubin is produced by the liver and other cells in the body as they break down the red blood cells.

About the neonatal jaundice quality standard

1. The NICE quality standard for neonatal jaundice disorders is available on the NICE website.

2. The NICE quality standard for neonatal jaundice is based on the following NICE accredited guidelines:

• Neonatal jaundice. NICE clinical guideline 98 (2010).
• Postnatal care. NICE clinical guideline 37 (2006).

Related NICE quality standards

Published

• Postnatal care. NICE quality standard 37 (2013).
• Specialist neonatal care. NICE quality standard 4 (2010).

Future quality standards

• Antibiotics for neonatal infection
• Blood transfusion in neonatology
• Premature birth

About NICE quality standards

NICE quality standards aim to help commissioners, health care professionals, social care and public health practitioners and service providers improve the quality of care that they deliver.

NICE quality standards are prioritised statements designed to drive measurable quality improvements within a particular area of health or care. There is an average of 6-8 statements in each quality standard.

Quality standards are derived from high quality evidence-based guidance, such as NICE guidance or guidance from NICE accredited sources, and are produced collaboratively with health care professionals, social care and public health practitioners, along with their partner organisations, patients, carers and service users.

NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health care professionals and social care and public health practitioners can use quality standards to help deliver high quality care and treatment.

NICE quality standards are not requirements or targets, but the health and social care system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

Quality standard topics are formally referred to NICE by NHS England (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for areas such as social care and public health.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what we do, visit our website: www.nice.org.uk and follow us on Twitter: @NICEcomms.