Impact of implementing nice guidance for neonatal jaundice in a busy postnatal ward

Abstract

Background NICE jaundice guidance was implemented in our postnatal ward in September 2010 using the Drager JM103 transcutaneous bilirubinometer (TcB). The results of a before and after intervention study are presented. Aims (1) To evaluate TcB for acceptability, staff workload and ease of use. (2) To evaluate the impact on laboratory bilirubin estimations, requirement for phototherapy and admissions for jaundice. Methodology Data was collected from hospital records and bilirubin log over an 18 week period (for 9 weeks pre and 9 weeks post introduction of guidance intervention). A staff satisfaction survey was conducted to evaluate the TcB. Results Of the 586 live babies in the pre NICE period, 32 required laboratory estimation of bilirubin and 12 received phototherapy. Of the 651 babies in the post NICE period, 53 needed transcutaneous bilirubin estimations, 6 required laboratory testing and 2 phototherapy. There were no admissions to the neonatal unit or Paediatric Admissions Unit for jaundice. All junior doctors/ANNPs and 80% of midwifes felt the TcB was safe, easy to use, reduced workload and resulted in earlier discharge. Conclusions and recommendations (1) TcB is well accepted by staff and reduces the need for laboratory bilirubin estimations by 5 fold. (2) NICE guidance reduced the need for phototherapy 6 fold. We postulate that this might be due to better support with breast feeding associated with earlier awareness of jaundice. There was no increase in admissions before or after discharge. Larger studies are recommended to evaluate the impact on kernicterus.