Management of Jaundice in Babies Less than 28 Days of Age€¦ · This guideline was developed in line with the NICE Neonatal Jaundice guideline [1], ... Phototherapy for babies near

CAEC Registration Identifier 1790 Sheffield Children’s (NHS) Foundation Trust Management of Jaundice in Babies Less than 28 Days of Age

Author: Dr Sally Connolly and Dr Gareth Penman Review date: October 2019 © SC(NHS)FT 2016. Not for use outside the Trust. Page 1 of 16

Management of

Jaundice in Babies

Less than 28 Days of

Age

Reference: 1790v1

Written by: Dr Sally Connolly and Dr Gareth Penman

Peer reviewer: Dr Noreen West

Approved: November 2016

Review Due: October 2019

Purpose

This guideline was developed in line with the NICE Neonatal Jaundice guideline [1],

updated in May 2016. The focus is to reduce the incidence of severe jaundice and

bilirubin encephalopathy.

Intended Audience

It is expected that this guideline will be used by nursing and medical staff looking

after babies with jaundice at Sheffield Children’s Hospital.



Table of Contents Purpose 1

Intended Audience 1

1. Introduction 3

Purpose 3

Intended Audience 3

Background 3

2. Routes of referral 4

Referral from the community i.e. GP or midwife 4

Parents have brought the child to the emergency department 4

Current inpatients at SCH 4

3. Assessment of a neonate with jaundice 5

History 5

Clinical assessment 5

Measurement of serum bilirubin 6

Treatment of jaundice 6

4. Specific scenarios 8

Jaundice in the first 24 hours of life 8

Jaundice in Preterm infants 9

Prolonged Jaundice 9

Conjugated Jaundice 10

5. Management of jaundice needing, or potentially needing, an exchange

transfusion 10

Initial assessment 10

Care following the starting of phototherapy 12

Preparing for an exchange transfusion for hyperbilirubinaemia 13

Phototherapy for babies near or above the exchange transfusion line 14

Requesting packed red cells for exchange transfusion 14

Vascular access 15

Immunoglobulin 16

6. References 16

7. Bilirubin monitoring charts – see next page 16



1. Introduction

Purpose

This guideline was developed in line with the NICE Neonatal Jaundice guideline [1],

updated in May 2016. The focus is to reduce the incidence of severe jaundice and

bilirubin encephalopathy.

Intended Audience

It is expected that this guideline will be used by nursing and medical staff looking after

babies with jaundice at Sheffield Children’s Hospital.

Background

Neonatal jaundice affects approximately 60% of term and 80% of preterm infants.

Physiological jaundice is the most common cause of unconjugated

hyperbilirubinaemia in the newborn. Typically it peaks at around 100 µmol/L on day 3

of life and subsides over the following week. About 10% of breast fed babies are still

jaundiced at one month of age and breast milk jaundice can last up to twelve weeks.

In the vast majority of infants jaundice is harmless and self- limiting, requiring no

treatment. However, a few babies will develop very high levels of serum bilirubin which

unless treated promptly and appropriately can cause kernicterus (seven new cases

occur each year in the UK).

Key recommendations from the NICE guideline are:

Clinically examine all babies for jaundice at every opportunity

Visual inspection alone is inadequate for determination of serum bilirubin levels

and objective testing is required

Promote and support breast feeding

Provide appropriate follow up (ANNP Clinic /Community Midwife follow up)

Provide parents with information about neonatal jaundice that is tailored to their

needs and expressed concerns



2. Routes of referral

Neonates with jaundice can come to health professionals through a number of routes.

Whilst babies up to seven days can be admitted to the post-natal ward at the Jessop

Wing, SCH is able to assess and initiate treatment. Discussions regarding location of

care should not delay essential medical care.

Referral from the community i.e. GP or midwife

Neonates who have not yet come to the Sheffield Children’s Hospital and are less

than 7 days old can be referred to back to the post-natal ward at Jessop Wing.

However, if the referring professional has had difficulty in organizing admission to

Jessop Wing then it may be in the patient’s best interest to be brought to SCH for

review. Be aware it is a NICE standard that a bilirubin measurement is made within 6

hours of recognising a baby is jaundiced and within 2 hours if the baby is less than 24

hours old.

Babies can be referred to The Jessop by calling the Royal Hallamshire Switchboard

on 0114 271 1900

09.00 to 18.00 any day of the week bleep the advanced nurse practitioner on

#2978 to discuss being seen in the rapid access clinic

Outside of these hours bleep the SHO on-call #2749 to discuss admission to the

post-natal ward

Parents have brought the child to the emergency department

The patient should have a full medical assessment, including measurement of a

serum bilirubin, and any necessary medical treatment commenced. Patients can then

be referred to the Jessop Wing for ongoing care if felt to be beneficial. Benefits

include the ability for mum to stay with baby for breastfeeding support or other

aspects of maternity care. Transfer will result in a delay in treatment so should not be

considered for babies with jaundice requiring more than single phototherapy, unless

this has been discussed with the general paediatric consultant on-call.

Current inpatients at SCH

Neonates currently admitted at SCH with jaundice requiring phototherapy can be

managed effectively on their ward and should not be transferred for phototherapy.



3. Assessment of a neonate with jaundice

The following sections apply to all babies with jaundice. Additional information should

be looked at for the following patients

less than 24 hours old

< 38 weeks gestation

conjugated or prolonged jaundice

History

A full medical history should be undertaken. This should include risk factors for

jaundice, possible pathological causes of jaundice, and indicators of hydration.

Risk factors for jaundice requiring phototherapy

Gestational age less than 38 weeks

A previous sibling who

o developed neonatal jaundice requiring phototherapy

o required treatment for jaundice due to haemolytic disease

Family history of red cell enzyme defects

Mother intends to breast feed exclusively

Visible jaundice is present in the first 24 hours of life

Clinical assessment

All babies with jaundice require a full examination.

When inspecting for jaundice, examine the naked baby in bright/natural light

Examine the sclera, gums and blanched skin in babies with dark skin tones

Look for cephalohaematoma or excessive bruising as they increase the risk of

developing jaundice requiring phototherapy

Abnormal neurology in a jaundiced baby may indicate acute bilirubin

encephalopathy necessitating and exchange transfusion

All babies with visible jaundice must have a serum bilirubin level

checked at a minimum

Clinical jaundice becomes evident in a Caucasian baby with an SBR level of

85μmol/L; however, visual inspection alone is unreliable at estimating bilirubin levels.



Measurement of serum bilirubin

The serum bilirubin level should be measured in all infants with jaundice, and the gold

standard is a laboratory measured SBR. This is the method used at Sheffield

Children’s Hospital and requires 0.4ml of blood in a lithium heparin (orange topped)

container. We do not use transcutaneous bilirubinometers.

The following points must be remembered

Switch off or remove from the incubator any phototherapy lights before taking the

sample

The sample should be transported as soon as possible and not be left

exposed to light while awaiting transport as this can affect the result

All SBR levels must be plotted on a treatment threshold graph (see section 7)

o These are specific to gestational age and treatment levels are

significantly less at 37 weeks compared to 38 weeks gestation

o In the first 72 hours of life the time the sample was taken is essential

for accurate interpretation

Do not subtract conjugated bilirubin from the total SBR

For babies below the phototherapy treatment line

o If a first test is 50 below the line then a further repeat is not necessary

o This does not apply to babies less than 38 weeks gestation and

decisions will have to be made based on the babies overall

clinical condition

Additional investigations

Additional investigations may be required, depending on the patient. These are

discussed in section 4. See also the additional SCH guideline:

http://nww.sch.nhs.uk/judownload/0_1467113760_akbO0J/4-1-Neonatal-Jaundice-

Guidelines-For-The-Initial-Investigations-Of-299-2015-17.pdf

Treatment of jaundice

Treatment of neonatal jaundice must be tailored to individual patient needs, and

phototherapy should be initiated at the earliest opportunity. The following should be

remembered.

http://nww.sch.nhs.uk/judownload/0_1467113760_akbO0J/4-1-Neonatal-Jaundice-Guidelines-For-The-Initial-Investigations-Of-299-2015-17.pdfhttp://nww.sch.nhs.uk/judownload/0_1467113760_akbO0J/4-1-Neonatal-Jaundice-Guidelines-For-The-Initial-Investigations-Of-299-2015-17.pdf



Ensure adequate hydration and feeding

There can be a conflict between the priorities of maintaining adequate hydration,

continuing breastfeeding, and ensuring adequate phototherapy. Babies with mild

jaundice on single phototherapy can be allowed to continue breast feeding, although the

amount of time spent feeding may need to be limited to 20-30 minutes every 2-3 hours.

Babies with a jaundice level near or above the exchange transfusion line should not be

taken out from under phototherapy lights for breastfeeding. Nasogastric feeding

maintains hydration as effectively as IV fluids [2], but intravenous fluids may be indicated

if additional fluids are required or the baby cannot be fed enterally.

Hyper-hydration is not necessary for all babies on phototherapy. However, dehydration

can worsen hyperbilirubinaemia, and babies on phototherapy do need to have their fluid

balance reviewed regularly in keeping with SCH guidelines for IV fluids.

Phototherapy

Do not use sunlight to treat jaundice. Fibre-optic phototherapy/ Bili-blanket is not to be

used as first line treatment for babies more than 37 weeks gestation, but can be used

as a first line for infants with a gestation less than 37 weeks. White, halogen

phototherapy is available on the infant nursing platforms, but is not sufficiently

effective for routine use.

Phototherapy can be single or multiple, with a choice being made based on the

clinical assessment of the child. Phototherapy lights are kept on NSU and the

available units are listed in Table 1. Additional lights are available by contacting the

Jessop Neonatal Unit (extension 68456 from an SCH phone). Phototherapy for

babies near the exchange transfusion line is discussed in the relevant section below.

Phototherapy type Light type Ideal distance from

patient Maximum irradiance

Indication

Draeger Babytherm integral

phototherapy Halogen

80cm

(fixed) 9W/m

2

All other phototherapy unavailable

Medele Bilibed Fluorescent N/A 49W/m2

Jaundice for which single phototherapy

adequate

Medele Lamp

(one available) Fluorescent 25cm 46.6W/m

2

Jaundice requiring multiple

phototherapy lights

GE Lullaby

(one available) LED 35cm

46 W/cm2/nm

(equivalent to Medele Lamp)

Jaundice requiring multiple

phototherapy lights

Table 1: List of phototherapy units available at SCH.



Monitoring on phototherapy

Once phototherapy is started the SBT should be repeated 4-6 hourly until it is

stable/falling

A level rising by more than 8.5μmols/hour is an indication for an exchange

transfusion

Once stable/falling this can be extended to 12 - 18 hourly

Stopping phototherapy

The bilirubin level must be more than 50 mol/L below the patients

phototherapy treatment threshold

The bilirubin level should be checked 12-18 hours after stopping phototherapy

as levels can rebound

Depending on the rate of any rise further testing may be needed

4. Specific scenarios

Jaundice in the first 24 hours of life

Physiological jaundice is unlikely to present in the first 24 hours, therefore other possible

causes must be considered. Also, treatment thresholds are much lower since these

babies are at high risk of bilirubin toxicity.

A serum bilirubin (SBR) must be taken within two hours of identifying

suspected or obvious jaundice

Always refer to the appropriate gestation specific treatments charts noting

accurately the babies time of birth and the time the SBR sample was taken

The SBR should be repeated 6 hourly until the level is

o Below the treatment threshold

o Stable and/or falling

Exclude pathological causes as below

o Rhesus haemolytic disease

o ABO incompatibility

o Congenital spherocytosis

o Intra-uterine infection (e.g. CMV)

o G6PD or Pyruvate kinase deficiency

o Bacterial sepsis

o Bruising/haemorrhage

o Genetic defects of bilirubin metabolism e.g. Crigler-Najar syndrome



Investigations

o SBR

o FBC and film

o Review maternal Blood Group and antibody status results

o Infant Blood Group and Coombs

o To consider

Septic screen and IV antibiotics

G6PD or other red cell enzyme deficiency testing

Jaundice in Preterm infants

Hyperbilirubinaemia in preterm infants is more prevalent, more severe and its course

more protracted than in term neonates as a result of exaggerated neonatal red cell,

hepatic and gastrointestinal immaturity. Very sick preterm infants may be at increased

risk of developing kernicterus even at moderately low bilirubin level without showing

acute neurological signs.

Additional factors for increased risk include

Septicaemia

Hypothermia

Asphyxia

Acidosis

Severe bruising

Treatment threshold charts are based on gestational age with significantly lower

thresholds for babies below 38 weeks gestation. Using the correct threshold chart is

essential (see appendix).

Prolonged Jaundice

Prolonged jaundice is defined as persisting for greater than 2 weeks in a term

infant, or greater than 3 weeks in a preterm infant.

If prolonged jaundice is present then see separate guideline available on SCH

intranet.

http://nww.sch.nhs.uk/judownload/0_1467113632_yiv0jZ/1657-Prolonged-Jaundice-

Referral-Guideline.pdf

http://nww.sch.nhs.uk/judownload/0_1467113632_yiv0jZ/1657-Prolonged-Jaundice-Referral-Guideline.pdfhttp://nww.sch.nhs.uk/judownload/0_1467113632_yiv0jZ/1657-Prolonged-Jaundice-Referral-Guideline.pdf



Conjugated Jaundice

Defined as a level of conjugated jaundice above the local reference range, and

being >25% of total bilirubin.

If levels of conjugated jaundice are significant then see separate guideline

available on SCH intranet.

http://nww.sch.nhs.uk/judownload/0_1467113705_PygZ0r/1006v4_1215_Investiga

tion_of_Neonatal_Conjugated_Hyperbilirubinaemia.pdf

5. Management of jaundice needing, or potentially

needing, an exchange transfusion

The following are potential indications for undertaking an exchange transfusion

The finding of a total i.e. unconjugated and conjugated, bilirubin level above

the exchange transfusion line, or less than 10 points below

A bilirubin level rising faster than 8.5μmols/hour

Acute bilirubin encephalopathy

This is an urgent medical problem requiring prompt action. The patient should be

reviewed by the medical registrar, and a clear plan of care to address the problem

documented in the notes.

Initial assessment

Reassess patients overall condition

Important questions are:

Is the patient unwell?

The patients overall condition will affect their treatment and where they are cared for.

Most babies can be cared for on NSU, which is the ward of choice for the carrying out

of an exchange transfusion. However, their jaundice may be due to a condition

requiring medical intensive care.

http://nww.sch.nhs.uk/judownload/0_1467113705_PygZ0r/1006v4_1215_Investigation_of_Neonatal_Conjugated_Hyperbilirubinaemia.pdfhttp://nww.sch.nhs.uk/judownload/0_1467113705_PygZ0r/1006v4_1215_Investigation_of_Neonatal_Conjugated_Hyperbilirubinaemia.pdf



Is the patient encephalopathic?

Evidence of encephalopathy due to hyperbilirubinaemia is an indication for

immediate exchange transfusion. A neurological examination should be

documented describing

Tone

Spontaneous movements

Stretch and primitive reflexes

Seizures

If there is any uncertainty initiate the basic medical care outlined below (section 3),

and then discuss with the general paediatric consultant on-call the need for an

exchange transfusion.

Decide where the baby should be transferred to

Determining where the baby will be cared for should not delay the initiation of

treatment, which can be started in any department within the hospital. If transferring

the patient to a ward able to provide the required phototherapy is likely to take more

than half an hour, the phototherapy lights should be brought to the patient’s location.

Potential locations for undertaking and exchange transfusion

The neonatal surgical unit (NSU) has the necessary equipment and trained nursing

staff to undertake an exchange transfusion and should be the location of choice. If

they lack staff or beds then the bed manager should be contacted to provide

additional staff and/or help move patients out of NSU.

PICU/HDU is the next most appropriate location if it is not possible to make a physical

space on NSU, or the patient requires medical intensive care.

Patients can be transferred to the neonatal unit at Jessop for an exchange

transfusion, but this will potentially interrupt phototherapy treatment and delay the

exchange transfusion. Therefore, this should only be considered if there is a clear

reason why the procedure cannot be undertaken at SCH. If transfer is being

considered, this must be discussed with the general paediatric consultant on-call at

the earliest opportunity.

Initiate medical treatment and inform the relevant staff members that an

exchange transfusion may be required

The general paediatric team is primarily responsible for the care of patients outside of

PICU/HDU requiring an exchange transfusion, including setting up and carrying out

the procedure.



The initial medical treatment should be as follows

Start 3 phototherapy lights immediately!

o Request one additional phototherapy light from The Jessop Neonatal

Unit – phone extension 68456

o See “Phototherapy” sections on pages 6 and 14

Secure peripheral venous access and send the following blood tests if not

already done

o FBC and film

o Group and save from both baby and mum

o Repeat bilirubin (conjugated and unconjugated) if taken more than 2

hours before starting phototherapy

o LFT, UE, clotting studies

o CRP, blood cultures

o Consider any additional tests that may be required

Start the following treatments

o IV benzylpenicillin and gentamicin for suspected sepsis

o IV fluid as advised in IV fluid guidelines at a volume appropriate for age

with close monitoring for abnormalities

Accurate fluid balance recording is essential

Minimum 12 hourly UE in the acute phase

More frequently if abnormal UE or fluid balance

o If there is felt to be a hydration deficit this should be corrected

o If the DCT is positive give IV immunoglobulin

500mg/kg over four hours

See section “Immunoglobulin”

The following members of staff should be informed that an exchange transfusion may

be required

The acute general paediatric consultant on-call

Blood bank

o To inform them that blood specifically required for an exchange

transfusion may be required (volumes are discussed later in this

document)

Care following the starting of phototherapy

The patient’s condition should be reviewed and a repeat bilirubin sent one hour after

starting phototherapy. Liaise with the laboratory to request the sample be processed



urgently, and that the result be phoned through to the doctor or nursing team caring

for the patient.

If the bilirubin level is falling

This indicates treatment is working and should be continued. The bilirubin level

should be repeated 2-3 hourly to ensure it continues to fall

If the bilirubin is static

This indicates that the patient remains likely to need an exchange transfusion.

Start preparations for an exchange transfusion although it may not be

undertaken if the bilirubin starts to fall

Give a single bolus of human albumin solution

10mls/kg 4.5% human albumin solution over 30 minutes

5mls/kg 20% human albumin solution over 30 minutes

Repeat the bilirubin one hour after the most recent results was received

o If the level has still not reduced then an exchange transfusion is

required

If the bilirubin has increased or the patient’s neurology has deteriorated

The patient should be prepared for an exchange transfusion with an expectation that

it will be undertaken.

Preparing for an exchange transfusion for hyperbilirubinaemia

1. Inform the general paediatric consultant on-call and the nurse caring for the

patient

2. Contact blood bank and request packed red cells for exchange transfusion

a. Request a volume of 180mls/kg i.e. double volume plus an amount for

dead space in the giving set (see details in paragraph * below)

b. Will be less than five days old, CMV negative and irradiated (see

details in paragraph below +)

3. Explain the treatment to the parents documenting the discussion and obtain

written consent

4. Locate the exchange transfusion box kept on NSU in the treatment room the

contents of which includes

a. Umbilical arterial and venous catheters with transparent drape

b. Location of the blood warmer

c. Set up guides and all other necessary equipment



5. Ensure adequate venous and arterial access

a. Umbilical access is ideal

b. Peripheral access may well be adequate but will require both arterial

and venous cannulas

c. If access not secured within 1 hour then the matter should be

escalated to the general paediatric consultant on-call and the section

on vascular access below reviewed

6. Allocate staff to undertake the procedure

a. Depending on method one or two doctors to withdraw/give blood

b. One nurse to document blood volumes

7. Refer to the Yorkshire and Humber Neonatal ODN (South) Clinical Guideline

“Exchange transfusion” which describes the process for carrying out an

exchange transfusion which can be accessed via the SCH intranet

a. http://nww.sth.nhs.uk/STHcontDocs/STH_CGP/Neonatology/Exchange

Transfusion.pdf

Phototherapy for babies near or above the exchange transfusion

line

These babies require maximal phototherapy. Babies should be nursed on the Medela

Bilibed with the GE Lullaby and Medela phototherapy lamps above them at

appropriate distances (see earlier phototherapy section). Biliblankets and the Draeger

Babytherm halogen bulb are weak in terms of irradiance and their use would interfere

with the more efficient phototherapy lamps.

An additional phototherapy lights from the Jessop Neonatal Unit should be requested

and used as soon as it has arrived.

Lights should be positioned to maximize the infants exposure. During procedures,

including whilst securing vascular access and undertaking the exchange transfusion,

lights should be re-positioned – this may mean moving the lights to the operating

theatres. Clear drapes are available with the exchange transfusion on NSU.

Requesting packed red cells for exchange transfusion

The volume of blood required for an exchange transfusion is

180mls/kg, plus an amount to allow for dead-space in the blood

giving sets.

* The circulating blood volume of a term neonate is 70-90mls/kg. For

hyperbilirubinaemia the usual volume for an exchange transfusion is double the

circulating volume i.e. 180mls/kg – this will remove 90% of the patients red cells and

http://nww.sth.nhs.uk/STHcontDocs/STH_CGP/Neonatology/ExchangeTransfusion.pdfhttp://nww.sth.nhs.uk/STHcontDocs/STH_CGP/Neonatology/ExchangeTransfusion.pdf



reduce available bilirubin by 50%. A single volume exchange is considered

insufficiently effective for hyperbilirubinaemia, although it may be indicated in certain

circumstances. 1 unit of blood contains approximately 250 – 300mls of blood.

Blood should be CMV negative, less than five days old, and

irradiated

+ Packed red cells for exchange transfusion have specific requirements.

Blood for neonates should always be CMV negative because of its potential to affect

neurological outcome.

The procedure will replace 90% of the patients own red cells. Red cells greater than 5

days old should not be used.

Ideally the blood should be irradiated to reduce graft versus host disease. However, if

it is known that the patient did not receive an intrauterine transfusion, non-irradiated

blood can be used. Irradiation takes 10-15 minutes after which the blood must be

used within 24 hours.

Vascular access

An exchange transfusion requires adequate vascular access. On neonatal units

venous and arterial umbilical access is preferred, but peripheral access can be used if

that is not possible. For babies admitted to Sheffield Children’s Hospital umbilical

access may not be feasible, and whilst other types of central vascular access are

available they are a significant undertaking. The following approach is suggested.

The initial responsibility lies with the general medical team to attempt peripheral or

umbilical access. Umbilical catheters are kept in the exchange transfusion equipment

box which, kept in the treatment room on NSU. Links to the Jessop Wing guidelines

for umbilical catheters are below. If umbilical access is not possible then peripheral

arterial and venous access can be used [3,4].

If the general medical team is unable to secure adequate access, within an hour of

the first attempts, the general paediatric consultant on-call should liaise with the on-

call consultant for the following teams to determine the most appropriate approach.

Intensive care consultants are able to site central venous and arterial access

but workload on PICU may limit availability

Anaesthetic consultants are able to provide a general anaesthetic, but whilst

they are able to site central venous and arterial lines they cannot do that whilst

managing an anaesthetised patient

Surgeons are able to site central venous access but not arterial central access



As any delay in starting the exchange transfusion will increase the risk of kernicterus,

and the aim should be for adequate access to be secured within one hour of starting

these discussions, although this may be affected by other clinical demands.

Immunoglobulin

The Department of Health includes haemolytic disease of the newborn (HDN) as a

red indication for intravenous immunoglobulin (IVIg) [5], although the evidence for its

effectiveness is not clear [6,7]. It is specifically used to avert an exchange transfusion

and should not be used routinely for babies with jaundice and suspected HDN.

For babies with a jaundice level near or above the exchange transfusion line the

finding of a positive DCT is sufficient evidence of HDN (a red indication) to allow an

IVIg panel member to authorize the release of IVIg urgently at any time. The request

should be discussed with the pharmacist. An IVIg form must be completed prior to the

IVIg form being dispensed.

Additional information is available in the trusts Intravenous Gamma Globulin

guideline:

http://nww.sch.nhs.uk/judownload/0_1467112261_m35Mt8/5-3-Intravenous-Gamma-

Globulin-954-2015-17.pdf

6. References

1. National Collaborating Centre for Women's and Children's Health (UK) (May 2010) Neonatal Jaundice. Available at http://www.ncbi.nlm.nih.gov/books/NBK65119/ (Accessed 6th June 2016)

2. Boo NY, Ishak S. Prediction of severe hyperbilirubinaemia using the Bilicheck transcutaneous bilirubinometer. Journal of paediatrics and child health 2007;43(4):297-302

3. Fok TF, So LY, Leung KW, et al. Use of peripheral vessels for exchange transfusion. Archives of disease in childhood 1990;65(7 Spec No):676-8

4. Chen HN, Lee ML, Tsao LY. Exchange transfusion using peripheral vessels is safe and effective in newborn infants. Pediatrics 2008;122(4):e905-10

5. Department of Health (July 2011) Clinical Guidelines for Immunoglobulin Use: update to second edition. Available at https://http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216671/dh_131107.pdf (Accessed 6th June 2016)

6. Alcock GS, Liley H. Immunoglobulin infusion for isoimmune haemolytic jaundice in neonates. The Cochrane database of systematic reviews 2002(3):CD003313

7. Louis D, More K, Oberoi S, et al. Intravenous immunoglobulin in isoimmune haemolytic disease of newborn: an updated systematic review and meta-analysis. Archives of disease in childhood Fetal and neonatal edition 2014;99(4):F325-31

7. Bilirubin monitoring charts – see next page –

must be printed onto eDMS preformatted paper SCH132000

http://nww.sch.nhs.uk/judownload/0_1467112261_m35Mt8/5-3-Intravenous-Gamma-Globulin-954-2015-17.pdfhttp://nww.sch.nhs.uk/judownload/0_1467112261_m35Mt8/5-3-Intravenous-Gamma-Globulin-954-2015-17.pdfhttp://www.ncbi.nlm.nih.gov/books/NBK65119/http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216671/dh_131107.pdfhttp://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216671/dh_131107.pdf

46703

*SCH132000* SCH132000

Neonatal Bilirubin Treatment Threshold

Chart

Treatment threshold graph for babies with neonatal jaundiceBaby's name Date of birth

Hospital number Time of birth Direct Antiglobulin Test !

Click below and choose gestation

Shade for phototherapy Baby's blood group Mother's blood group >=38 !!!!weeks!gestation

Phototherapy

Exchange transfusion

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icromol/litre)!

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Shade for phototherapy Baby's blood group Mother's blood group 37 !!!!weeks!gestation

Phototherapy


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Documents

Management of Jaundice in Babies Less than 28 Days of Age€¦ · This guideline was developed in line with the NICE Neonatal Jaundice guideline [1], ... Phototherapy for babies near