MFT selected to review effective monitoring for jaundice in Black, Asian and ethnic minority newborns

The NHS Race and Health Observatory has commissioned further work into neonatal screening assessments which effectively identify jaundice in Black, Asian and ethnic minority babies.

Manchester University NHS Foundation Trust (MFT) has now started a recommendations review on the benefits, limitations and implications of transcutaneous bilirubin (TCB) monitoring devices, used within the screening process to diagnose jaundice, a leading condition affecting newborns.

An estimated six out of every 10 babies develop the condition and babies with darker skin are especially at increased risk.

The 12-month review will investigate guidance, data on delays in diagnoses, latest evidence and research data across England, to set out a series of practical recommendations. To gather further insights, community health organisation, the Caribbean, African Health Network (CAHN) will lead on surveys and structured interviews to engage feedback with mothers, service-users and families from the wider community.

TCB monitors provide non-invasive, portable methods to measure levels of bilirubin, the compound responsible for jaundice. Studies show jaundice often goes undetected or is inadequately identified in infants via subjective, visual assessments carried out by maternity professionals.

Characterised by skin colouring with whites of eyes appearing yellow, early treatment is vital for newborns with elevated levels of the bilirubin substance in the blood. If left untreated, the risks of jaundice can cause seizures, learning disabilities, hearing problems and brain damage.

The study team led by Saint Mary’s Managed Clinical Service, part of MFT will work in collaboration with a range of leading healthcare professionals, researchers, policy makers and patients/experts by experience from the University of Central Lancashire, Imperial College London and CAHN.

Dr Ngozi Edi-Osagie, Consultant Neonatologist, Group Associate Medical Director at MFT and Principal Investigator for the study, said:

We are delighted to be partnering with the NHS Race and Health Observatory on this vital piece of work which will provide further insights into the effective and timely diagnosis of jaundice in newborn babies with darker skin in the community, which will lead to improved clinical outcomes.

The study follows last year’s Observatory commissioned report, led by Sheffield Hallam University, which identified a several limitations around current neonatal assessments and perinatal practices involving the Apgar score, cyanosis detection and jaundice. Subsequently, an Invitation to Tender for further research was issued.

Despite clinical guidance from the National Institute for Health and Care Excellence (NICE) on recommending TCB measurements where jaundice is suspected, the guidance also acknowledges “clinical recognition and assessment of jaundice can be difficult, particularly in babies with darker skin tones.”

Professor Habib Naqvi, chief executive of the NHS Race and Health Observatory, said:

The colour of someone’s skin or their ethnicity should not impact health outcomes, and yet we know, from data and evidence, how too many avoidable inequalities remain persistent for our communities.

“We have a duty to take immediate action on de-biasing current clinical guidelines, assessments and practices, and to prepare the next generation of healthcare professionals in ensuring fair health outcomes for all groups in society.

“That’s why we are pleased to commission this work, which seeks to ensure early, accurate diagnoses and treatments to help prevent serious and avoidable complications resulting from jaundice.”

Research will factor several key areas including:

• A landscape review of relevant, existing studies, products and assessments used in paediatric care
• Review of incidences of jaundice in Black, Asian and ethnic minority newborns and comparisons with other ethnicities, working within local communities
• An exploration on the usage and feasibility of TCB monitors in community settings and the impact on clinical practice
• Analysis of the accuracy of results for TCB monitors in diagnosing jaundice in neonates of different skin tones and comparison with subjective assessment.
• Identification of practical recommendations for clinical practice, for healthcare users and families
• Review of the impact of TCB monitoring on clinical practice including cost and implications for late diagnosis and treatment of jaundice