Detection of jaundice in newborn babies
HSIB Legacy
Published
Missed diagnosis
Neonatal
Jaundice is a common condition in newborn babies, with 1 in 20 requiring treatment. This national investigation explores safety issues associated with delayed diagnosis of jaundice in newborn babies.
2 recommendations
2 observations
2 of 2 responded
Safety Recommendations (2)
National Institute for Health and Care Excellence
R/2023/208
HSIB recommends that the National Institute for Health and Care Excellence reviews the available evidence and updates its guidance if appropriate, regarding: the reliability of visual signs to detect jaundice in newborn babies, particularly in babies with black and brown skin risk factors for jaundice identified by this investigation, including prematurity.
NICE completed an exceptional review of its jaundice guideline (CG98) and updated it to acknowledge visual detection difficulties in darker skin tones and to offer more flexibility regarding urine culture.
The National Institute for Health and Care Excellence (NICE) will review its guideline on jaundice in newborn babies under 28 days [CG98] to see if an update to its current recommendations is required. Actions planned to deliver safety recommendation: Undertake an exceptional review of the NICE guideline on jaundice in newborn babies under 28 days [CG98], by July 2023. Update CG98 if the exceptional surveillance review indicates this is required, by TBC. Response received on 18 April 2023. Update on actions taken: Exceptional review published. We will amend: Recommendation 1.2.5 to include text to acknowledge that jaundice may be harder to detect visually in darker skin tones. Recommendation 1.7.1 to be more flexible around urine culture. Guidance updated and available at https://www.nice.org.uk/guidance/cg98/resources/2023-exceptional-surveillance-of-jaundice-in-newborns-under-28-days-nice-guideline-cg98-13197079837/chapter/Surveillance-decision?tab=evidence Updated response received on 2 November 2023.
Royal College of Pathologists
R/2023/209
HSIB recommends that the Royal College of Pathologists works with stakeholders to understand current practice and make any appropriate recommendations to promote the adoption of an icteric threshold at which a bilirubin test may be cascaded or reported.
The Royal College of Pathologists decided against recommending an icteric threshold for bilirubin tests, citing significant variation and lack of standardisation across analytical platforms that could confuse clinicians.
This proposal was discussed at the Biochemistry Specialty Advisory Committee (SAC) of the Royal College of Pathologists (RCPath) in February 2023. Whilst the recommendation was considered, it was felt that this [the adoption of an icteric threshold at which a bilirubin test may be cascaded or reported] was something that could not be recommended or promoted at present as icteric index measurement is not a uniform procedure and is manufacturer dependent. There is significant variation across analytical platforms and manufacturers, with no standardisation and thus interpretation of such results might be confusing for the requesting clinician. Response received on 22 March 2024.
Safety Observations (2)
It may be beneficial for regulators of pathology services to consider the findings of the investigation and amend their guidance if necessary.
It may be beneficial to develop a national standardised Early Warning System track and trigger observation chart for use in neonatal unit settings.