Assessing for neonatal jaundice in the community: an integrative systematic review

BACKGROUND: Jaundice is a common condition in newborn babies, usually resolving within two weeks post-birth. A small number of babies develop hyperbilirubinaemia, which if untreated can lead to kernicterus. It is essential to recognise jaundice and assess the bilirubin level as quickly as possible so that timely treatment can be provided. However, currently, there is a lack of knowledge about the feasibility of assessing jaundice reliably in the community. AIM: This integrative review explores the experiences, barriers and facilitators to assessing for neonatal jaundice in community settings in high-income countries. METHODS: Five databases (MEDLINE, PsycINFO, CINAHL, Embase and Overton) and backward and forward chaining were undertaken. Findings were analysed and synthesised using a narrative-based approach. DISCUSSION: Searches identified 7076 hits, and after exclusions, nine studies were included. Jaundice assessment methods included visual assessment, Transcutaneous Bilirubinometer (TcB), and Total Serum Bilirubin (TSB). Six themes were developed: 1) Communication, 2) Knowledge and skills, 3) Time and resources, 4) Variation in post-discharge care, 5) Type of community setting and 6) Impact of community screening. TcB was reported to be more accurate than visual inspection, and less time consuming, invasive and costly than TSB. CONCLUSION: Available insights highlight the need for clear communication and care pathways, and training and education for healthcare professionals and parents. Further research is needed to determine the optimal TcB derived threshold values for hyperbilirubinaemia and accuracy among babies with dark skin tones.