NICE recommendations for the formal assessment of babies with prolonged jaundice: too much for well infants?

REFERENCES 1. Hannam S, McDonnell M, Rennie JM. Investigation of prolonged neonatal jaundice. Acta Paediatr 2000;89:694–7. 2. National Institute for Health and Clinical Excellence. Neonatal Jaundice. Clinical Guideline 98, 2010. http://www.nice.org.uk/CG98 (accessed 1 September 2010). 3. Unal S, Koc E, Aktas A, et al. Prolonged jaundice in newborns: what is it actually due to? Gazi Med J 2003;14:147–51. 4. Tiker F, Tarcan A, Kilicdag H, et al. Early onset conjugated hyperbilirubinemia in newborn infants. Indian J Pediatr 2006;73:409–12. We recently performed a prospective study of the investigation of ‘well’ term neonates referred from community for assessment of PJ. History and physical examination was performed and demographic data obtained (table 1). Existing local guidelines were followed during the fi rst half of the audit (table 2, group 1) and following interim analysis a rationalised approach to investigation was introduced (table 2, group 2), derived from the British Society of Paediatric Gastroenterology, Hepatology and Nutrition guidelines for the investigation of hyperbilirubinaemia and recommendations from the UK Children’s Liver Disease Foundation.5 6 We opted not to include urine culture in our rationalised approach for two reasons – antenatal ultrasound screening was routine in our health board and likely to detect any structural renal malformations, and also the literature supporting routine urine testing is inconsistent.7 8 One hundred and ninety-seven of 12 986 live births (1.5%) were referred for assessment of PJ. No signifi cant pathology associated with PJ was detected. The number of repeat investigations (37 vs 7, p<0.0001) and return appointments (28 vs 7, p=0.0009) fell following the introduction of the rationalised investigation algorithm. Our data suggest that in screening of well, term neonates who are thriving, a streamlined approach may be safe and reduce unnecessary workload. It is diffi cult to justify further investigations in this cohort, which frequently generates repeat testing for little diagnostic gain. We acknowledge that our study was limited not only by its small numbers, but also by the low referral NICE recommendations for the formal assessment of babies with prolonged jaundice: too much for well infants?