HSIB report highlights risk of harm when relying on visual signs of jaundice

High bilirubin levels can cause significant harm including brain damage. It is therefore important that jaundice is diagnosed and treated in a timely way, however, sometimes the visual signs of jaundice are not obvious, particularly for premature or newborn babies with brown or black skin.

Detection of Jaundice in Newborn Babies, the latest investigation report from the Healthcare Safety Investigation Branch (HSIB), uses an example ‘reference event’ that involved the delayed diagnosis of jaundice in Baby Elliana, a baby girl of black African ethnicity who was born prematurely. The investigation’s main findings were:

• The assessment of visual signs of jaundice in newborn babies is subjective and more challenging with babies who have black or brown skin.
• Some neonatal units have introduced safety measures to mitigate the risk of reliance on visual signs of jaundice.
• National guidance does not recommend routinely measuring bilirubin levels in babies who are not visibly jaundiced.
• National guidance for jaundice in newborn babies maybe more applicable to term babies than those born prematurely.
• National guidance does not contain information on how to address the challenges of detecting jaundice in newborn babies with black or brown skin.
• Levels of bilirubin can vary according to the gestational age of a baby. Laboratory staff do not calculate the gestational age of a baby and therefore whether their bilirubin level is within the expected range.
• Laboratory practice varies in terms of whether specific reference ranges for bilirubin in newborn babies are set; whether there is a defined threshold for communicating results to neonatal units; and whether the telephone alert limit reflects the thresholds in national guidance.
• Neonatal staff may be unaware that laboratories analyse blood samples to see if they indicate jaundice. These staff will not know to look for a comment about this on blood test reports.

The report concludes with three recommendations regarding: updating guidance; promoting the adoption of a threshold at which a bilirubin test may be cascaded or reported; and neonatal specific reference ranges for total bilirubin and thresholds for direct communication of these results to clinicians.

To read the report visit: www.hsib.org.uk/investigations-and-reports/detection-of-jaundice-in-newborn-babies