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The use of transcutaneous bilirubinometers optimises safety, experience and efficiency, says Sara Grace. Together with her colleagues, she explains why.
COMMUNITY MIDWIFERY TEAMS PLAY A crucial role in identifying babies whose wellbeing might change or warrant early intervention during the first few days of life. An analysis of the National Reporting and Learning System (NRLS) data highlighted that the most commonly reported reasons for admission of a neonate to a neonatal unit or paediatric ward were poor feeding, weight loss and jaundice (NHS Improvement, 2017). Similarly, analysis of a database of admissions of neonates to English neonatal units between 2011 and 2013 showed that 20% of all admissions from the community were for management of jaundice (NHS Improvement, 2017). As jaundice is one of the most common conditions community midwives will face when assessing newborns, a good knowledge of risk factors for and early identification of potentially toxic levels of jaundice is essential. This means community midwives need to be adept in the use and evaluation of transcutaneous bilirubin measurements.
High bilirubin levels leftuntreated can lead to devastating brain injury, known as kernicterus. Though very rare in the UK, affecting fewer than one in every 100,000 babies (NHS Choices, 2015a), kernicterus is widely considered preventable in full-term babies. The consequences for families and affected children, and cost to the NHS, are considerable and could be greatly reduced by implementing and adhering to national guidance.
NICE (2016) provides guidance for healthcare professionals on 'at risk' babies, including signs and symptoms and thresholds for intervention. The clinical guidelines include advice for parents in the recognition that they play a key role in the identification of symptoms and escalation to healthcare professionals.
The gold standard measurement of bilirubin levels is total serum bilirubin (TSB) concentration obtained through blood sampling using invasive techniques (Bosschaart et al, 2012). However, this method poses particular considerations for use in the community. As results are not immediately available, blood samples must be sent for laboratory processing promptly to provide a timely response. When transporting samples, the blood cannot be exposed to sunlight, which may interfere with results. These challenges can often mean babies are...