There are training implications for those healthcare professionals who will use TcB monitors. Accuracy in interpreting and acting upon findings is paramount in the prevention of hyperbilirubinaemia and subsequent morbidity. Accessibility of the recommended tools needs careful consideration within teams to ensure no delay in identifying neonatal jaundice, particularly across a wide geographical area. The guideline recommends serum bilirubin if TcB monitors are not available. Careful consideration of this invasive procedure versus the overall cost savings in using TcB monitoring needs to be undertaken by healthcare commissioners.
The investigation pathway (see Figure 2) clearly shows the steps for healthcare professionals to take in the first 72 hours after birth. The full algorithm, with subsequent care pathways for when jaundice is identified, is available in the guidelines.1-5 The historical practice of many midwives, health visitors and other healthcare professionals in making their own judgements about 'breastfeeding jaundice' and degree of jaundice is unsafe - continued vigilance and gold standard breastfeeding support should be observed.
Using the NICE clinical guideline
The quick reference guidance is comprehensive in outiining the key steps, while the full guidance will give the team greater insight into the rationale and evidence behind the guidelines. There is also guidance written for patients and carers,8 and this can be used to support healthcare professionals working with parents and families of neonates.
The guidance is available online1 in full or quick reference format.