1022 NICE guidelines for treatment of neonatal jaundice

While South Africa unquestionably has other more prevalent conditions to deal with than kernicterus, recent guidelines produced in the UK are helpful for the management of neonatal hyperbilirubinaemia. The latter problem affects some 60% of term neonates during the first week of life and 80% of those born preterm, and 10% of breastfed neonates are still jaundiced at one month of age. The UK reckons that 7 cases of kernicterus are encountered annually, and hopes that the guideline will reduce or eliminate the problem. Given that women and their babies are now fairly routinely discharged from maternity services 1 or 2 days after delivery, in light of the frequency of elevated bilirubin levels Britain’s National Institute for Health and Clinical Excellence (NICE), assisted by the National Collaborating Centre for Women’s and Children’s Health has produced a 500+ page report in which issues are raised, research is comprehensively reviewed, and guidelines are proposed. The message is that high risk situations such as gestation <38 weeks, previous child with jaundice requiring phototherapy, exclusive breastfeeding, and jaundice within the first 24 hours of life should be closely monitored. In such cases the neonate should be watched closely by parents, and visited by a health worker. The guideline is available on-line and also provides downloadable graphs that advise according to week of gestation as to when to start phototherapy, type of phototherapy to be used (blue light vs fibreoptic vs combined) and when to perform an exchange transfusion. There are also recommendations for use of intravenous immunoglobulin (500mg/kg over 4 hours as an adjunct to continuous multiple phototherapy) for immune-mediated Rh or ABO haemolytic disease. Therapies that are not recommended include albumin, barbiturates, charcoal, cholestyramine, clofibrate and metalloporphyrins. Some of these have been shown to be ineffective while others are mentioned as being in need of formal research (e.g. clofibrate). Research is also encouraged to gain more insight into the mechanism of ‘breast milk jaundice.’

Read more:
NICE neonatal jaundice guideline: http://guidance.nice.org.uk/CG98
Arch Dis Child Fetal Neonatal ed 2009; 94: F323-7
Pediatrics 2009; 123: 524-32