Assessment and investigation of neonatal jaundice

Formal assessment for underlying disease (1)

• NICE suggest that clinicians should carry out all of the following tests in babies with significant hyperbilirubinaemia as part of an assessment for underlying disease (see threshold table and treatment threshold graphs ): Follow expert advice about care for babies with a conjugated bilirubin level greater than 25 micromol/litre because this may indicate serious liver disease
  • In addition to a full clinical examination by a suitably trained healthcare professional, carry out all of the following tests in babies with significant hyperbilirubinaemia as part of an assessment for underlying disease (see threshold table and the treatment threshold graphs):
    • serum bilirubin (for baseline level to assess response to treatment)
      
      
    • blood packed cell volume blood group (mother and baby)
      
      
    • DAT (Coombs' test). Interpret the result taking account of the strength of reaction, and whether mother received prophylactic anti-D immunoglobulin during pregnancy
      
      
  • When assessing the baby for underlying disease, consider whether the following tests are clinically indicated:
    
    
    • full blood count and examination of blood film
    • blood glucose-6-phosphate dehydrogenase levels, taking account of ethnic origin
    • microbiological cultures of blood, urine and/or cerebrospinal fluid (if infection is suspected)
  • Care of babies with prolonged jaundice
    • in babies with a gestational age of 37 weeks or more with jaundice lasting more than 14 days, and in babies with a gestational age of less than 37 weeks and jaundice lasting more than 21 days:
      • look for pale chalky stools and/or dark urine that stains the nappy
      • measure the conjugated bilirubin
      • carry out a full blood count
      • carry out a blood group determination (mother and baby) and DAT (Coombs' test). Interpret the result taking account of the strength of reaction, and whether mother received prophylactic anti-D immunoglobulin during pregnancy
      • carry out a urine culture
      • ensure that routine metabolic screening (including screening for congenital hypothyroidism) has been performed
        
        

This process of investigation can be considered in terms on whether the jaundice is early, prolonged or conjugated.

Notes:

• How to measure the bilirubin level Use serum bilirubin measurement for babies: In babies who have a gestational age of 35 weeks or more and who are over 24 hours old:
  • in the first 24 hours of life or
  • who have a gestational age of less than 35 weeks
  • use a transcutaneous bilirubinometer to measure the bilirubin level
  • if a transcutaneous bilirubinometer is not available, measure the serum bilirubin
  • if a transcutaneous bilirubinometer measurement indicates a bilirubin level greater than 250 micromol/litre, measure the serum bilirubin to check the result
  • use serum bilirubin measurement if bilirubin levels are at or above the relevant treatment thresholds for their age, and for all subsequent measurements

Reference:

• NICE (May 2016). Jaundice in newborn babies under 28 days - update.