The NICE guideline recommends the measurement of transcutaneous bilirubin(TcB) as a less invasive procedure than blood sampling, and the recommended site for this is the sternum. This site will reduce distress for the baby and the potential for eye injury, or for forehead wrinkling to affect the readings. A bilirubinometer is required to measure the level of bilirubin. This is recommended in near-term and term babies over 24 hours old, but serum bilirubin should be taken if under 24 hours old where visible jaundice is present and for babies at less than 35 weeks. Any baby under 24 hours old with visible jaundice requires an urgent assessment of their risk of significant hyperbilirubinaemia, preferably within two hours. To take a TcB measurement first and then a serum bilirubin involves unnecessary delay. To summarise:
- visible or suspected jaundice in first 24 hours-serum bilirubin within two hours.
- over 24 hours in near-term and term infants-TcB measurement
- less than 35 week gestational age infant-serum bilirubin
- do not rely on TcB levels above 250 micromol/l.
The guideline recommends that either a TcB or serum bilirubin measurement should be used to assess the level of jaundice in babies who are visibly jaundice. The TcB or serum bilirubin level should be plotted against the threshold table (see figure 1), which is also available in the quick reference guideline and provides clear routes for further action. It is imperative that practitioners record and plot their findings accurately against the threshold data.
It is good practice to give information to all parents about neonatal jaundice. Asking parents if they think their baby is jaundiced provides an opportunity to include them in the decision-making process and keep them informed of what is happening. This approach acknowledges that parents may be able to make a more accurate judgement, especially where different skin tones could inhibit visual assessment.
The NICE guideline recommends the measurement of transcutaneous bilirubin(TcB) as a less invasive procedure than blood sampling, and the recommended site for this is the sternum. This site will reduce distress for the baby and the potential for eye injury, or for forehead wrinkling to affect the readings. A bilirubinometer is required to measure the level of bilirubin. This is recommended in near-term and term babies over 24 hours old, but serum bilirubin should be taken if under 24 hours old where visible jaundice is present and for babies at less than 35 weeks. Any baby under 24 hours old with visible jaundice requires an urgent assessment of their risk of significant hyperbilirubinaemia, preferably within two hours. To take a TcB measurement first and then a serum bilirubin involves unnecessary delay. To summarise: - visible or suspected jaundice in first 24 hours-serum bilirubin within two hours.- over 24 hours in near-term and term infants-TcB measurement - less than 35 week gestational age infant-serum bilirubin- do not rely on TcB levels above 250 micromol/l.The guideline recommends that either a TcB or serum bilirubin measurement should be used to assess the level of jaundice in babies who are visibly jaundice. The TcB or serum bilirubin level should be plotted against the threshold table (see figure 1), which is also available in the quick reference guideline and provides clear routes for further action. It is imperative that practitioners record and plot their findings accurately against the threshold data.It is good practice to give information to all parents about neonatal jaundice. Asking parents if they think their baby is jaundiced provides an opportunity to include them in the decision-making process and keep them informed of what is happening. This approach acknowledges that parents may be able to make a more accurate judgement, especially where different skin tones could inhibit visual assessment.
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The NICE guideline recommends the measurement of transcutaneous bilirubin(TcB) as a less invasive procedure than blood sampling, and the recommended site for this is the sternum. This site will reduce distress for the baby and the potential for eye injury, or for forehead wrinkling to affect the readings. A bilirubinometer is required to measure the level of bilirubin. This is recommended in near-term and term babies over 24 hours old, but serum bilirubin should be taken if under 24 hours old where visible jaundice is present and for babies at less than 35 weeks. Any baby under 24 hours old with visible jaundice requires an urgent assessment of their risk of significant hyperbilirubinaemia, preferably within two hours. To take a TcB measurement first and then a serum bilirubin involves unnecessary delay. To summarise:
- visible or suspected jaundice in first 24 hours-serum bilirubin within two hours.
- over 24 hours in near-term and term infants-TcB measurement
- less than 35 week gestational age infant-serum bilirubin
- do not rely on TcB levels above 250 micromol/l.
The guideline recommends that either a TcB or serum bilirubin measurement should be used to assess the level of jaundice in babies who are visibly jaundice. The TcB or serum bilirubin level should be plotted against the threshold table (see figure 1), which is also available in the quick reference guideline and provides clear routes for further action. It is imperative that practitioners record and plot their findings accurately against the threshold data.
It is good practice to give information to all parents about neonatal jaundice. Asking parents if they think their baby is jaundiced provides an opportunity to include them in the decision-making process and keep them informed of what is happening. This approach acknowledges that parents may be able to make a more accurate judgement, especially where different skin tones could inhibit visual assessment.
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