Prolonged Jaundice protocol for Whipps Cross Hospital



Prolonged Jaundice protocol for Whipps Cross Hospital

Definitions: Jaundice at or beyond 14 days in a term infant

Jaundice at or beyond 21 days in a preterm infant

The majority of babies with prolonged jaundice are in the community and are well. The important diagnosis to be able to rule out is biliary atresia because the appropriate surgical management has better outcomes if done before the age of 6 weeks. Other important causes of prolonged jaundice to rule out are hypothyroidism, haemolysis (either immune-mediated eg. ABO incompatibility or non-immune mediated eg. G6PD deficiency) and hereditary spherocytosis. Urinary tract infections can be associated with prolonged jaundice too.

The initial management of prolonged jaundice in Waltham Forest is the responsibility of the community midwives. Please assess the baby at 14 days, check that the newborn blood spot screening has been done and personally examine the baby’s stool colour. If the baby is well and the stool not pale, please organise the baby to have the following tests with the phlebotomists at 21 days of age if still visibly jaundiced:

Total bilirubin

Conjugated (direct) bilirubin

Urine for culture (which must be a clean catch. No urine bags to be used please)

Full blood count

Please check the results and enter them on the Prolonged Jaundice sheet overleaf. You should discuss any babies you are concerned about with the neonatal SHO (bleep 644) or registrar (bleep 141). The neonatal doctor can request repeat or further tests if necessary and will arrange appropriate follow up for the baby.

Please do not send these babies to A and E.

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