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 of babies 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 Hospital episode statistics (HES) online or the Neonatal Critical Care Minimum Data Set.

What the quality statement means for service providers, healthcare professionals and commissioners

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.

What the quality statement means for patients and carers

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

  • Neonatal jaundice (NICE clinical guideline 98), recommendations 1.3.4 (key priority for implementation) 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 clinical guideline 98. These include treatment threshold graphs published on the NICE website. All tables or charts should take into account serum bilirubin level, gestational age and postnatal age.