Approximately 60% of term and 80% of preterm babies develop jaundice in the first week of life and about 10% of breast-fed babies are still jaundiced at 1 month of age.
This information refers to babies with prolonged jaundice and is not intended to cover babies that appear jaundiced in the first two weeks after birth.
Any baby who appears clinically jaundiced after 2 weeks (term babies) or 3 weeks (pre term babies) should be referred for Paediatric assessment. Report of jaundice from parent/carer should be taken seriously.
Important things to consider include:
• Method of feeding, amounts taken (if formula/EBM fed)
• Weight – has baby regained birth weight, and is it plotted in the Red Book?
• Colour of stools and urine
• Is there a family background of G6PD deficiency? Or is the baby’s ethnic background high risk for G6PD (Mediterranean, Asian)?
• Please include the Mum’s blood group if it is known to you.
• General behaviour – is the baby waking for feeds, is the tone normal for age?
• Temperature instability – is there a recent background of high (>38oC) or low (<36oC) temperatures? This is a sign of sepsis and needs urgent referral.
The following are considered ‘Red Flags’ for significant metabolic or liver disease.
• Pale stools (chalky) or dark urine that stains the nappy
• Faltering growth or failure to regain birth weight
If these are present, please highlight in the referral information so that we can appropriately prioritize.
• Poor feeding, difficulty waking baby for feeds, temperature instability (these are all signs of sepsis in babies and need urgent referral to Paediatrics)
Please refer babies with prolonged jaundice for Paediatric assessment. The parents should expect an appointment in our ‘Prolonged Jaundice’ clinic urgently (usually within 10 days). Please call the Paediatric Admin Office via switchboard if they have not received an appointment.
Parents should expect a clinic assessment of their baby which will include weighing the baby, a thorough examination and blood tests. These tests may be done by heel prick or by venepuncture. They may also be asked to collect a urine sample.
Blood test results are usually available within 24 hours for the basic screening and these will be communicated to them. If the blood tests show a raised conjugated bilirubin (>25mmol/L), they will be asked to return for a more extensive screening, and the baby may need to be discussed with the Paediatric Liver Team at Kings College Hospital.
Babies found to have biliary atresia need prompt surgery to improve their prognosis, so there is a window of opportunity for the diagnosis to be made.
• In babies with a gestational age of 37 weeks or more (ie: term babies) with jaundice lasting more than 14 days
• In babies with a gestational age of less than 37 weeks (ie: pre term babies) and jaundice lasting more than 21 days
• Pale chalky stools and/or dark urine that stains the nappy is a worrying sign – please highlight in the referral so we can prioritize these babies.
We accept referrals for our nurse-led Prolonged Jaundice Clinic via email – please send to khn-tr.paediatricsadministration@nhs.net. We aim to see these babies in the next available clinic.
If the baby’s current age is > 5 weeks, please call the PAU Phone via switchboard and we will arrange to see asap (usually same day on PAU).
Jaundice in newborn babies under 28 days (2010 updated 2016) NICE guideline CG98
