Jaundice is one of the most common conditions requiring medical attention in newborn babies. In Singapore, approximately 60 per cent of full-term babies and 85 per cent of premature babies develop jaundice during the first week of life. In most newborn babies, the jaundice is mild and harmless. However in some babies, the jaundice levels may rapidly increase to high levels and make them at risk for permanent brain damage due to a condition called ‘kernicterus’.
The practice guidelines for neonatal jaundice was launched and developed by ‘The Singapore Workgroup Committee on Neonatal Jaundice, College of Paediatrics and Child Health’ with the help from expert representatives from three public hospitals (KK Women’s and Children’s Hospital, Singapore General Hospital and National University Hospital), a paediatrician in private practice as well as family medicine doctors from the polyclinics of the three healthcare clusters (SingHealth Polyclinics, National Healthcare Group Polyclinics, National University Polyclinics).
The set of guidelines, developed over a one-year-period, details the risk factors for severe neonatal jaundice, potential effects of use of herbs on jaundice, risk factors for bilirubin neurotoxicity that causes brain damage, safe level of bilirubin, and management strategies including screening for jaundice using Transcutaneous Bilirubin (TcB). In addition, the set of guidelines also outlines referral and admission processes, initial evaluation of prolonged jaundice and referral workflows to other specialists.
The introduction of TcB measurement, a painless, non-invasive screening technique to identify the level of jaundice in the baby’s skin without the need for a blood test, is one significant recommendation detailed in the guidelines. A recent large-scale study involving about 1,000 babies, conducted in KKH and SingHealth Polyclinics validated the accuracy and benefits of TcB measurements amongst Singapore babies. Adoption of the TcB screening technology across all polyclinics and hospitals in Singapore for babies above 35 weeks of gestation and above two kilogrammes at birth, will reduce the number of babies requiring invasive blood tests. Adjunct Professor Victor Samuel Rajadurai, Senior Consultant, Department of Neonatology, KKH, and Chairman, The Singapore Workgroup Committee on Neonatal Jaundice, College of Paediatrics and Child Health, explains, “From today, the set of neonatal jaundice guidelines will enable all clinicians to standardise screening for neonatal jaundice as well as the management and care for babies across the hospitals and polyclinics in Singapore. Importantly, potentially all newborn babies in Singapore are expected to benefit from non-invasive and pain-free screening that could replace up to 60 per cent of blood tests which were previously taken from the heel of the newborn. This also helps to alleviate the stress and anxiety of babies and their caregivers.”
Dr Ratnaporn Siriamornsarp, a Family Physician at SingHealth Polyclinics – Tampines, and a member of the task force, shared about additional benefits of the clinical guidelines. She said, “Prior to the introduction of this clinical guidelines for management of neonatal jaundice, clinicians were screening and managing jaundice in newborns based on various best practices. Now, we can look forward to providing enhanced care to newborns in a unified manner, knowing that all the clinicians will have access to the same set of guidelines, enabling a seamless transition of care. In addition, we are now able to convey to parents or caregivers that the clinical decisions are based on evidence-based inputs from various neonatal and paediatric experts in Singapore.”
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