Turkish Neonatal Society guideline to the approach, follow-up, and treatment of neonatal jaundice

Abstract

Jaundice is one of the most common problems in the newborn. It is generally accepted as a physiologic condition; most cases are benign and transient. However, in a small portion of jaundiced newborn infants, serum bilirubin concentrations increase to a level at which irreversible brain damage can occur. The timely diagnosis and management of severe hyperbilirubinemia is essential to prevent acute bilirubin encephalopathy and kernicterus. Kernicterus still occurs although it is almost always preventable. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy. Therefore, a system-based approach using the recommendations of this guideline should be implemented in all birthing facilities and continued in ambulatory care of the newborn infants.

Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia

“…Domain 3: the mean score for rigour of development was 31.9%±22.6%. NICE 19 scored the highest for this domain at 85.9% with the most extensive development process, while TPA 24 received the lowest at only 9.9%. Domain 4: the mean score for clarity of presentation was 91.7%±5.7%.…”

“…Twelve clinical practice guideline documents were published by national or regional organisations, including the American Academy of Pediatrics (AAP) Subcommittee on Hyperbilirubinemia, 13 Canadian Pediatric Society (CPS) Fetus and Newborn Committee, 14 Chinese Pediatric Society (ChPS) Chinese medical Association, 15 Israel Neonatal Society (INS), 16 Italian Society of Neonatology (ISN), 17 Malaysia Health Technology Assessment Section (MaHTAS), 18 NICE in the UK, 19 Norwegian Pediatric Association, 20 Queensland Clinical Guidelines (QCG) in Australia, 21 Spanish Association of Pediatrics (SAP), 22 Swiss Society of Neonatology (SSN) 23 and Turkish Pediatric Association (TPA). 24 Five of these guidelines are new and the others have been updated or reaffirmed. Four guidelines from the USA, 13 Canada, 14 Italy 17 and Switzerland 23 were targeted towards neonates born at >35 weeks of gestation, while the other guidelines covered all preterm and term babies.…”

“…Six organisations (QCG, 21 CPS, 14 SAP, 22 NICE, 19 INS 16 and MaHTAS 18 reported performing a systematic review and appraisal of the evidence and were explicit about the level of evidence that underpinned their recommendations. Three groups were funded by governmental institutions (QCG, 21 NICE 19 and MaHTAS), 18 one declared no financial support (TPA), 24 and the remainder did not disclose a funding source.…”

Haemolytic Disease of Newborn due to Minor Blood Group C IncompatibilityA Case Report

“…In Turkish Neonatology Association Jaundice Guide, it was stated that IVIG can be used in the presence of bilirubin levels close to the blood exchange limits in the neonates with haemolytic disease due to blood group incompatibilities including Rh, ABO and minor blood groups. (9) American Academy of Pediatrics also states the same to give IVIG in patients with hyperbilirubinaemia close to blood exchange limits at a dose of 0.5 to 1.0 gm/kg, to be repeated 12 hourly if required. However In a meta-analysis conducted in 2014 of 463 Rh and 350 ABO incompatibility cases, use of IVIG did not reduce chances of exchange transfusion.…”

Most Proper Timing of Transcutaneous Bilirubin Measurement After Phototherapy Treatment in the Newborn Period

“…It can reach levels that require phototherapy in about 10% of term newborns and 25% of preterm newborns (2). Although it is generally a temporary and benign condition, it can cause neurologic sequelae through bilirubin encephalopathy and irreversible severe brain damage in a small portion of the newborns (3).…”