This guideline covers diagnosing and treating jaundice, which is caused by increased levels of bilirubin in the blood, in newborn babies (neonates). It aims to help detect or prevent very high levels of bilirubin, which can be harmful if not treated.
In October 2023, we updated recommendations on looking for jaundice to highlight that skin pigmentation changes may be harder to see in darker skin and managing prolonged jaundice to advise that urine culture should only be considered if there is clinical suspicion of urinary tract infection. For more information, see the October 2023 surveillance report.
March 2023: There is variability between assays from different manufacturers in reported bilirubin measurement. Healthcare professionals should consult their local pathology laboratory when interpreting threshold tables.
This guideline includes recommendations on:
- providing information to parents or carers
- managing and treating hyperbilirubinaemia
- measuring and monitoring bilirubin thresholds before and during phototherapy
- assessing babies for underlying disease
- caring of babies with prolonged jaundice
- using intravenous immunoglobulin, exchange transfusion and other therapies
Who is it for?
- Healthcare professionals
- Parents of newborn babies and their families and carers
Is this guideline up to date?
April 2023: We have checked the evidence and plan to update the guideline. The update will focus on total serum bilirubin thresholds for starting phototherapy or exchange transfusion in term babies with neonatal hyperbilirubinaemia. For more information, see the surveillance decision.
Guideline development process
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.