Introduction

This quality standard covers the recognition and management of neonatal jaundice in newborn babies (both term and preterm) from birth to 28 days in primary care (including community care) and secondary care. It does not cover babies with jaundice who need surgery to correct the underlying cause, or the management of conjugated hyperbilirubinaemia in babies. For more information see the topic overview.

Why this quality standard is needed

Jaundice refers to the yellow colouration of the skin and the whites of the eyes caused by a raised level of bilirubin (hyperbilirubinaemia). Jaundice is one of the most common conditions needing medical attention in newborn babies; approximately 60% of term (gestational age of 37 weeks or more) and 80% of preterm babies develop jaundice in the first week of life. For most babies, this early jaundice (or 'physiological jaundice'[1]) is not a sign of underlying disease and is generally harmless. Breastfed babies are more likely than formula-fed babies to develop physiological jaundice within the first week of life. Prolonged jaundice – that is, jaundice that lasts longer than the first 14 days of life – is also seen more commonly in these babies. Prolonged jaundice is generally harmless, but can be a sign of serious liver disease. Jaundice that develops in the first 24 hours of life can indicate underlying disease and needs urgent assessment.

Even if there is no underlying disease, unconjugated bilirubin, which is potentially toxic to neural tissue, can penetrate the blood–brain barrier. This can cause both short-term and long-term neurological dysfunction, known as bilirubin encephalopathy or kernicterus, which can have significant life-altering implications for babies and their families. The risk of kernicterus is increased in babies with particularly high bilirubin levels and for certain groups, such as preterm babies. However, kernicterus can be prevented if jaundice is identified early and treated effectively. Although neonatal jaundice is common, kernicterus is rare.

High levels of bilirubin can be controlled by placing the baby under a lamp emitting light in the blue spectrum, which is known as phototherapy. Light energy of the appropriate wavelength converts the bilirubin in the skin into a harmless form that can be excreted in the urine. Phototherapy has proved to be a safe and effective treatment for jaundice in newborn babies, reducing the need to perform an exchange transfusion of blood (the only other means of removing bilirubin from the body).

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014–15

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Improvement areas

Reducing deaths in babies and young children

1.6i Infant mortality*

1.6ii Neonatal mortality and stillbirths

4 Ensuring that people have a positive experience of care

Improvement areas

Improving women and their families' experience of maternity services

4.5 Women's experience of maternity services

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Improvement areas

Improving the safety of maternity services

5.5 Admission of full-term babies to neonatal care

Alignment across the health and social care system

*Indicator shared with Public Health Outcomes Framework (PHOF)

Table 2 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.1 Infant mortality

4.11 Emergency readmissions within 30 days of discharge from hospital

Coordinated services

The quality standard for neonatal jaundice specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole neonatal jaundice care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to babies with neonatal jaundice in all settings.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality neonatal jaundice service are listed in Related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating babies with neonatal jaundice in any setting should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of parents and carers

Quality standards recognise the important role parents and carers have in supporting babies with neonatal jaundice. Healthcare professionals should ensure that parents and carers are involved in the decision-making process about investigations, treatment and care.



[1] Neonatal jaundice. NICE clinical guideline 98 (2010).