A. Clinical Visual Assessment of Severity of Jaundices
Surveillance
for neonatal jaundice involves the use of regular visual assessment of skin
colour to identify babies in need of treatment on jaundice. All babies should
have ongoing assessment in the first 4 days of life, especially those at risk
of developing hyper-bilirubinaemia during the neonatal period at least every
8-12 hours. Always assess jaundice in a well lit room or in daylight at a
window by blanching the baby’s skin with a figher and observe the underlying
skin colour.
for neonatal jaundice involves the use of regular visual assessment of skin
colour to identify babies in need of treatment on jaundice. All babies should
have ongoing assessment in the first 4 days of life, especially those at risk
of developing hyper-bilirubinaemia during the neonatal period at least every
8-12 hours. Always assess jaundice in a well lit room or in daylight at a
window by blanching the baby’s skin with a figher and observe the underlying
skin colour.
Clinical features indicating an increasing severity of jaundice
are if the underlying skin colour changes from a lemon yellow to deeper orange
yellow and observation that jaundice start on the head, and extend towards the
feet. This dominates the visual assessment and is useful in deciding whether or
not a baby needs to have the serum bilirubin rate (SBR) measure.
Limitation to Visual Assessment
There
are limits to the accuracy of visual estimation especially in dark skinned
babies and if there is any doubt clinically. Visual assessments are also
inaccurate on a baby once under phototherapy as this will tend to blanch the
skin.
are limits to the accuracy of visual estimation especially in dark skinned
babies and if there is any doubt clinically. Visual assessments are also
inaccurate on a baby once under phototherapy as this will tend to blanch the
skin.
B. Transcutaneous Bilirubin Measurement (TCB)
Bilirubin
level can be measured transcutaneously by a transcutaneous bilirubinometer.
Available devices differ in accuracy; safe use of this device requires
knowledge of the accuracy of particular device being used. A transcutaneous
bilirubinometer may be particularly useful in health care setting where total
serum bilirubin (TSB) level result are expected to take longer than 6 hour
before becoming available. Transcutaneous bilirubin level are inaccurate on a
baby who has already commenced phototherapy and therefore accurate when
performed on the skin that has not been exposed to phototherapy (Zecca, Barone and
De Luca, 2009).
level can be measured transcutaneously by a transcutaneous bilirubinometer.
Available devices differ in accuracy; safe use of this device requires
knowledge of the accuracy of particular device being used. A transcutaneous
bilirubinometer may be particularly useful in health care setting where total
serum bilirubin (TSB) level result are expected to take longer than 6 hour
before becoming available. Transcutaneous bilirubin level are inaccurate on a
baby who has already commenced phototherapy and therefore accurate when
performed on the skin that has not been exposed to phototherapy (Zecca, Barone and
De Luca, 2009).
C. Total Serum Bilirubin (TSB)
The
TSB remains the gold standard measurement for treatment decision regarding
jaundice. TSB level measurement should be requested based on clinical
observation and the following factors:
TSB remains the gold standard measurement for treatment decision regarding
jaundice. TSB level measurement should be requested based on clinical
observation and the following factors:
i.
Visible jaundice in the first 24 hours
Visible jaundice in the first 24 hours
ii.
Jaundiced whose mother has rhesus or other red blood cells antibodies
Jaundiced whose mother has rhesus or other red blood cells antibodies
iii.
Term baby with estimated serum bilirubin level greater than 250μmol/l
Term baby with estimated serum bilirubin level greater than 250μmol/l
iv.
Preterm baby with estimate serum bilirubin level greater than 150μmol/l
Preterm baby with estimate serum bilirubin level greater than 150μmol/l
v.
Prolonged jaundice greater than 2 weeks in term babies and greater than
3 weeks in preterm babies.
Prolonged jaundice greater than 2 weeks in term babies and greater than
3 weeks in preterm babies.
