Jaundice persisting beyond day 14 of infant’s life is common occurring in 2-15% of all neonates and 15-40% of those who are breastfed. In most occasions it is normal but it is important to exclude serious conditions such as Biliary Atresia and G6DP that can benefit from prompt diagnosis and management.
The initial referral will be made to medical / ANNP holding bleep 6123
community.childrensnursingteam@borders.scot.nhs.uk
OPCL (outpatient clinic letter) \pjaun Instructions on how to complete this attached.
Printed copies are sent to child health secretary, who will upload them to EMIS, task the HV and send a copy to parents. paediatric.secretaries@borders.scot.nhs.uk
Term babies who remain visibly jaundiced beyond 14 days and preterm babies beyond 21 days require further assessment.
The baby is referred to bleep 6123 by the community team.
At the time of referral, the baby is admitted to a slot in the ACU Prolonged Jaundice Clinic to allow generation of a letter and printing of labels.
The referral information becomes the start of the outpatient clinic letter (OPCL) and this is done by the person taking the call. The letter is prewritten (\pjaun) but does involve options and deleting the parts not relevant.
CCNs abbreviated referral form is completed and emailed to CCN team, the ANNP mailbox and the consultant of the week.
CCN team should see term babies by D21 and preterm by D28
History and information from the referral should be clarified and clinical assessment, including weight (if not done recently), carried out. The information is added to the OPCL by the CCN.
In the absence of any other concerns, investigations are limited to:
Total and conjugated bilirubin
The blood should be taken from a capillary sample, using the baby’s heel and be collected into lithium heparin (orange or small green) tube, labelled and returned to the BGH lab.
Guidance on good technique for capillary blood sampling is attached to this guideline
Sucrose can be used for pain
The ANNP / Dr carrying 6123 should be made aware of this to allow them to chase results and complete OPCL.
Parents should be informed they will be phoned if the results are abnormal and given the information leaflet within this document.
NB Breast milk jaundice can take up to 12 weeks to resolve, it is not a reason to stop breast feeding
Total bilirubin significant if > 300
Conjugated bilirubin significant if > 30 or 20% of total bilirubin
Information to clarify on referral:
Age of infant in days
Breast or formula fed
Urine and stool colour and frequency
Regained birth weight by D14
Gestation < or > 37 weeks
Are they unwell (e.g. large vomits, poor feeding, lethargy, breathlessness)
Is the mother Rh –ve or known to have antibodies
Was the newborn blood spot screening done?
Risk of G6PD
Referral Letter for Prolonged Jaundice
Please click on the link above to download a copy of referral letter
A capillary sample is a blood sample collected by puncturing the skin and collecting the blood from the tiny blood vessels which are near the skin surface.
It can be used when small volume samples are required, and can help preserve peripheral veins.
Both Serum Bilirubin and Full blood counts can be taken this way.
Good technique is important to avoid sample problems and the requirement of a repeat specimen.
Consideration for the baby:
To help with the pain EBM / formula can be given prior to the procedure or it can be carried out while the baby is feeding or use of pacifier to encourage sucking.
Non sterile gloves
Cotton wool
Blood tubes: orange lithium heparin, red EDTA
Blood lancet for puncturing skin (Tender foot)
Clean disposable tray for equipment
Sharps box
A good flowing specimen will aid processing of sample, any haemolysis will impact on the result and the laboratory may not be able to process it at all.
| Hepatic, bile duct abnormality |
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| Metabolic disorders |
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| Infection |
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| Toxins / injury |
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Biliary atresia: a guide - Children's Liver Disease Foundation
Jaundice is described as a yellowing of the skin, and sometimes of the whites of the eyes. It occurs in 90% of newborn infants. Prolonged jaundice is the term for jaundice which is still present after 2 weeks in term babies (>37 wks) and 3 weeks in preterm babies
Jaundice is caused by a buildup of bilirubin, a dark yellow substance. This is a natural waste product of the normal breakdown of red blood cells. Before birth, the mother’s liver removes the product, but after birth the baby’s liver must get rid of it on its own.
However, the liver is still immature in newborns, so it is less efficient at clearing waste products. These can build up in the skin and appear as jaundice.
Jaundice usually appears after 2-3 days and gradually disappears on its own by 14 days. However, jaundice can often last longer, especially in the breastfed or preterm baby.
Prolonged jaundice is usually related to breast milk feeding and is harmless. In this case, jaundice will disappear in the coming weeks, and you should continue breastfeeding your baby.
Very rarely prolonged jaundice can be a sign of liver, thyroid, metabolic or blood problem. This is very uncommon but must be investigated so that treatment can be given if required.
If your baby develops dark urine, pale stools or is not thriving seek advice from health visitor or GP
Term babies who remain jaundice at 15 days and preterm babies who remain jaundice at 22 days will be referred to the children’s dept at the BGH to be reviewed by a member of the neonatal team within the following week.
If prior to this appointment there are any clinical concerns an urgent referral for review should be made via HV/GP/NHS 24.
NHS Borders clinical guidelines