Judgement, especially where different skin tones could inhibit visual assessment. Continued assessment of feeding behavior and general wellbeing of the baby continues to be crucial in all contacts with neonates in the first weeks of life.
Other sources of information that can be used for assessment of neonatal jaundice are dark urine and chalky stools. The practitioner must ask the parents about this as part of the assessment and at subsequent contacts. Prolonged jaundice is jaundice that persists for more than 14 days in term babies and 21 days in preterm babies, and requires expert clinical assessment. This will include measurements of total and conjugated bilirubin, urine screening, assessment for G6PD deficiency if appropriate, ensuring the Guthrie test has been performed to exclude congenital hypothyroidism, and investigations to determine other possible causes.
Key points for practice
The intention to breastfeed exclusively is one of several factors that can increase the likelihood of a baby developing neonatal jaundice. This has the potential to raise concern among community midwives and health visitors. It is important to maximize the opportunity for support and success in breastfeeding in the light of these guidelines. Promotion of breastfeeding and support is recommended even when treatment is required to reduce bilirubin levels. It is essential to acknowledge that all opportunities to monitor and assess the neonate for evidence of jaundice requires an experienced healthcare professional. Open discussion about neonatal jaundice should continue at all contacts with new parents, while avoiding raising anxiety.