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NICE standards cover jaundice in newborns

Quality standards on the management of jaundice in newborn babies have been issued by NICE.

Neonatal jaundice, characterised by yellow colouration of the skin and the whites of the eyes, is caused by a raised level of bilirubin.

An estimated 430,000 babies develop jaundice in the first week of life - about 60% of all-term and 80% of pre-term babies.

It is one of the most common conditions requiring medical attention among newborns and for most there is no underlying disease or harm, especially if it develops after the first 24 hours of life.

But if jaundice presents in the first 24 hours of life it can be an indicator of underlying disease and will require urgent assessment. If not treated early and effectively, jaundice can result in a rare but serious neurological condition called kernicterus, which is associated with long-term issues such as hearing loss, cerebral palsy, visual and dental problems.

Light treatment (phototherapy), which involves placing the baby under a lamp emitting light in the blue spectrum, converts the bilirubin in the skin into a harmless form that can be excreted in the urine.

This effective treatment reduces the need to perform an exchange transfusion of blood, which is the only other method of removing bilirubin from the body.

NICE said that early diagnosis is essential to ensure that babies with jaundice caused by underlying disease get appropriate treatment and avoid complications.

It said that measuring levels of bilirubin in babies with suspected or obvious visible jaundice is better at assessing the degree of jaundice and determining whether further investigations and treatment are required than visual inspection.

Knowing how and when to treat jaundice in babies is crucial when it has been identified, NICE adds.

Yvonne Benjamin, a member of the committee which developed the standard, said: “The NICE quality standard on neonatal jaundice supports practising midwives in the provision of current, clear, and concise information to parents of newborn babies.”

Ms Benjamin, a community midwife at University Hospitals Leicester Trust, added: “For community based midwives in particular, the quality standard provides support through the use of specialised equipment and standardised charts in the early recognition, treatment and management of care for babies with jaundice.”

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  • Many babies would not be getting jaundice in the first place if plenty of time was spent with them getting a feeding routine in place to flush the bilirubin through. Most of the time midwives are short staffed and having to deal with more complicated matters and the basics such as breastfeeding gets left. You can tell because on the days they managed to have a breastfeeding clinic and outside help come in there are many babies that don't get jaundice and the days there isn't anyone the baby's aren't feeding enough. Women are suffering as they want to feed their baby breast milk but the reality is no-one to help when it most counts.

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