1. anet Rennie, consultant and senior lecturer in neonatal medicine1, 2. Shona Burman-Roy, senior research fellow2, 3.

M Stephen Murphy, clinical co-director for childrens health2 Author Affiliations 1. Correspondence to: J Rennie janet.rennie@uclh.nhs.uk Neonatal jaundice is one of the most common conditions needing medical attention in newborn babies. About 60% of term and 80% of preterm babies develop jaundice in the first week of life, and about 10% of breast fed babies are still jaundiced at age 1 month.1 Neonatal jaundice is generally harmless, but high concentrations of unconjugated bilirubin may occasionally cause kernicterus (permanent brain damage). This is a rare condition (about seven new cases each year in the United Kingdom2) and sequelae include choreoathetoid cerebral palsy, deafness, and upgaze palsy. Jaundice can also be a sign of serious liver disease, such as biliary atresia, the prognosis for which is better if it is treated before age 6 weeks.3 Early recognition of jaundice is vital for treatment of any underlying condition and for the appropriate use of phototherapy, which can safely control bilirubin concentrations in most cases. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on how to diagnose and treat jaundice in newborns up to 28 days old.4

Recommendations
NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Groups experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Information for parents and carers

Offer parents or carers information about neonatal jaundice that is tailored to their needs and expressed concerns, taking care to avoid causing unnecessary anxiety; discuss verbally and back up the discussions with written information. [Based on low quality qualitative studies and on the experience and opinion of the Guideline Development Group (GDG)]
Pengamatan dari hiperbilirubinemia bila; 1. Ikterus terjadi pada 24 jam pertama 2. Peningkatan konsentrasi bilirubin 5 mg% atau lebih lengkap setiap 24 jam 3. Konsentrasi bilirubin serum sewaktu 10 mg % pada neonatus kurang bulan dan 12,5 mg% pada neonatus cukup bulan. penelitian di RSCM Jakarta menunjukkan bahwa dianggap

4. Ikterus yang diserti proses hemolisis (inkompatibilitas darah, defisiensi enzim G-6- PD dan sepsis) 5. Ikterus yang disertai keadaan sebagai berikut Berat lahir kurang dari 2000 gram Masa gestasi kurang dari 36 minggu Asfiksia, hipoksia, sindrom gangguan pernapasan Infeksi Trauma lahir pada kepala Hipoglikemia,hiperkarbia Hiperosmolalitas daras

Kernicterus ialah suatu kerusakan otak akibat perlengketan bilirubin indirek pada otak terutama pada korpus striatum,talamus,nukleus subtalamus hipokampus. Nukleus merah dan nukleus di dasar ventrikel IV. Gejalaklinis pada permulaannya tidak jelas tapi dapat disebutkan ialah mata yang berputar, letargi, kejang, tak mau menghisap, tonus otot meninggi, leher kaku dan akhirnya opitotonus, kejang, atestosis yang disertai ketegangan otot. Ketulian pada nada tinggi ditemukan, gangguan bicara dan retardasi mental. Pengamatan ikterus kadang-kadang agak sulit dengan cahaya matahari dan dengan menekan sedikit kulit yang akan diamati untuk menghilangkan warna karena pengaruh sirkulasi. Ikterus biasanya bermanifestasi pada kadar yang lebih putih dan lebih tinggi pada orang yang berkulit berwarna. Uttley (1974) menyebutkan bahwa ikterus baru terlihat bila kadar bilirubin mencapai 2 mg%. Brown (1973) menyebutkan bahwa ikterus baru terlihat bila kadar bilirubinnya lebih dari 6 mg%. Pengalaman juga membuktikan bahwa derajat intensitas ikterus tidak selalu sama dengan tingginya kadar bilirubin darah.