-High bilirubin levels-great than 340 micromole per litre (micromole/l) in term babies
-Rapidly rising bilirubin levels-at more than 8.5 micromole per hour.
these babies require specialist monitoring and care.Community practitioners have a key role in assessment and recognition of hyperbilirubinaemia, particular with the current practice of early postnatal discharge.Other non-physiological causes of hyperbilirubinaemia, such as rhesus or ABO incompatibility and haemolysis, need to be identified and are detailed I the full guideline.
Evidence base
The guidelines were developed by researching published literature, which was evaluated rigorously. Where evidence was not available, consensus was reached within the guideline development group.
Traditionally, many practitioners feel confident in assessing the degree of jaundice visually and others may advocate the use of sunlight exposure to reduce jaundice, but neither of these is supported by evidence. Cephalohaematoma, significant bruising and vacuum delivery have previously been considered risk factors, but again there is no significant evidence to support this.
Practice must be informed by available evidence to protect neonates and improve practice, though this may challenge existing opinion. The NMC professional code of conduct has clear standards for accountability and working with evidence upon which to base practice, reminding us of our duty as nurses and midwives.