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National Collaborating Centre for Women's and Children's Health (UK). Neonatal Jaundice. London: RCOG Press; 2010 May. (NICE Clinical Guidelines, No. 98.)

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Neonatal Jaundice.

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Abbreviations, Glossary and References



American Academy of Pediatrics


auditory brainstem response


area under the ROC curve

B/A ratio

bilirubin/albumin ratio




A form of cost-effectiveness analysis where the treatment alternatives are considered to be equally effective. Where treatments are equally effective the least costly is the most cost-effective


citrate phosphate dextrose


direct antiglobulin test, also known as ‘Coombs' test


double-volume exchange transfusion


corrected end-tidal carbon monoxide concentration (the concentration at the end of an expired breath)


gestational age


Guideline Development Group


glucose-6-phosphate dehydrogenase. Lack of this enzyme (G6PD deficiency or G6PDD) is associated with a tendency to haemolytic disease. This can present in the newborn period, and can thus be associated with neonatal jaundice.


high-performance liquid chromatography


intravenous immunoglobulin


light-emitting diode


mean difference


neonatal intensive care unit


negative predictive value


odds ratio


positive predictive value


quality-adjusted life year


root mean square of successive differences


receiver operating characteristic


risk ratio


transcutaneous bilirubin


standard deviation


width of Poincaré plot images


Length of Poincaré plot images


single-volume exchange transfusion


trans-epidermal water loss


total serum bilirubin


umbilical cord blood bilirubin


ABO incompatibility

ABO incompatibility describes an antibody reaction that occurs when mother and baby have different blood groups, typically maternal blood group O, and baby blood group A or B. Some mothers have naturally occurring anti-A and anti-B antibodies present in the circulation, which can pass across the placenta and bind to antigenic sites on fetal red cell. Some mothers are sensitised by feto-maternal transfusion of ABO incompatible blood‥


A blood pH below 7.25.

Acute bilirubin encephalopathy

Acute bilirubin encephalopathy is the clinical manifestation of bilirubin toxicity. The clinical course is hypotonia followed by hypertonia, retrocollis (backward arching of the neck), or opisthotonos (backward arching of the back) or both.


Albumin is one of the proteins found in blood


Aminoglycosides are a group of antibiotics that are used to treat certain bacterial infections


Term used when a baby stops breathing for more than 20 seconds

Basal ganglia

The part of the brain affected by bilirubin neurotoxicity

Best available evidence

The strongest research evidence available to support a particular guideline recommendation.


Influences on a study that can lead to invalid conclusions about a treatment or intervention. Bias in research can make a treatment look better or worse than it really is. Bias can even make it look as if the treatment works when it actually doesn't. Bias can occur by chance or as a result of systematic errors in the design and execution of a study. Bias can occur at different stages in the research process, e.g. in the collection, analysis, interpretation, publication or review of research data. For examples see Selection bias, Performance bias, Information bias, Confounding, Publication bias.

Biliary atresia

The biliary tract has not formed properly and is not patent so that although the liver conjugates bilirubin it cannot be excreted and so backflows into the bloodstream giving rise to conjugated hyperbilirubinaemia. A serious congenital problem which require urgent surgery


Bilirubin is a product that results from the breakdown of haemoglobin

Bilirubinometer, transcutaneous

A device that used light reflectance to measure the yellow colour (bilirubin level) in the skin


Term used for the presence of bilirubin in the blood

Blinding or masking

The practice of keeping the investigators or subjects of a study ignorant of the group to which a subject has been assigned. For example, a clinical trial in which the participating patients or their doctors are unaware of whether they (the patients) are taking the experimental drug or a placebo (dummy treatment). The purpose of ‘blinding’ or ‘masking’ is to protect against bias. See also Double blind study, Single blind study, Triple blind study.


Term used for a slower than normal heart rate

Case–control study

A study that starts with the identification of a group of individuals sharing the same characteristics (e.g. people with a particular disease) and a suitable comparison (control) group (e.g. people without the disease). All subjects are then assessed with respect to things that happened to them in the past, e.g. things that might be related to getting the disease under investigation. Such studies are also called retrospective as they look back in time from the outcome to the possible causes.

Case report (or case study)

Detailed report on one patient (or case), usually covering the course of that person's disease and their response to treatment.

Case series

Description of several cases of a given disease, usually covering the course of the disease and the response to treatment. There is no comparison (control) group of patients.

Cephalo-Caudal progression

This refers to the phenomenon of jaundice progressing from the head (cephalo) down the trunk as bilirubin level rises, eventually reaching the legs. Caudal refers to tail so it literally means spread from head to tail.


Collection of blood that develops beneath the outer layer of periosteum of a neonate's skull. Clinically, it appears as a firm, tense mass at birth and resolves in a few weeks to months.

Cerebral palsy

A permanent neurological disorders which affects movement

Chalky pale stools

This is a descriptive term for the pale stools that accompany obstructive jaundice, such as occurs in biliary atresia. Since bile is not excreted from the liver/bile duct into the intestine, the stools are paler than normal and appear chalky


See Study checklist.


Term used for a condition where bile cannot flow from the liver to the duodenum

Chronic bilirubin encephalopathy

Persistent brain dysfunction arising from hyperbilirubinaemia

Chronic sequelae

Persistent morbidity arising from acute events

Clinical effectiveness

The extent to which a specific treatment or intervention, when used under usual or everyday conditions, has a beneficial effect on the course or outcome of disease compared to no treatment or other routine care. (Clinical trials that assess effectiveness are sometimes called management trials). Clinical ‘effectiveness’ is not the same as efficacy.

Clinical impact

The effect that a guideline recommendation is likely to have on the treatment, or treatment outcomes, of the target population.

Clinical importance

The importance of a particular guideline recommendation to the clinical management of the target population.

Clinical question

This term is sometimes used in guideline development work to refer to the questions about treatment and care that are formulated in order to guide the search for research evidence. When a clinical question is formulated in a precise way, it is called a focused question.

Clinical trial

A research study conducted with patients which tests out a drug or other intervention to assess its effectiveness and safety. Each trial is designed to answer scientific questions and to find better ways to treat individuals with a specific disease. This general term encompasses controlled clinical trials and randomised controlled trials.


A healthcare professional providing patient care, e.g. doctor, nurse, physiotherapist.


A lipid lowering agent used for controlling high cholesterol and triacylglyceride level in the blood.

Cochrane Collaboration

An international organisation in which people find, appraise and review specific types of studies called randomised controlled trials. The Cochrane Database of Systematic Reviews contains regularly updated reviews on a variety of health issues and is available electronically as part of the Cochrane Library.

Cochrane Library

The Cochrane Library consists of a regularly updated collection of evidence-based medicine databases including the Cochrane Database of Systematic Reviews (reviews of randomised controlled trials prepared by the Cochrane Collaboration). The Cochrane Library is available on CD-ROM and the Internet.


A group of people sharing some common characteristic (e.g. patients with the same disease), followed up in a research study for a specified period of time.

Cohort study

An observational study that takes a group (cohort) of patients and follows their progress over time in order to measure outcomes such as disease or mortality rates and make comparisons according to the treatments or interventions that patients received. Thus within the study group, subgroups of patients are identified (from information collected about patients) and these groups are compared with respect to outcome, e.g. comparing mortality between one group that received a specific treatment and one group which did not (or between two groups that received different levels of treatment). Cohorts can be assembled in the present and followed into the future (a ‘concurrent’ or ‘prospective’ cohort study) or identified from past records and followed forward from that time up to the present (a ‘historical’ or ‘retrospective’ cohort study). Because patients are not randomly allocated to subgroups, these subgroups may be quite different in their characteristics and some adjustment must be made when analysing the results to ensure that the comparison between groups is as fair as possible.

Combined modality

Use of different treatments in combination (for example surgery, chemotherapy and radiotherapy used together for cancer patients).


Co-existence of a disease or diseases in the people being studied in addition to the health problem that is the subject of the study.

Confidence interval

A way of expressing certainty about the findings from a study or group of studies, using statistical techniques. A confidence interval describes a range of possible effects (of a treatment or intervention) that are consistent with the results of a study or group of studies. A wide confidence interval indicates a lack of certainty or precision about the true size of the clinical effect and is seen in studies with too few patients. Where confidence intervals are narrow they indicate more precise estimates of effects and a larger sample of patients studied. It is usual to interpret a ‘95%’ confidence interval as the range of effects within which we are 95% confident that the true effect lies.

Confounder or confounding factor

Something that influences a study and can contribute to misleading findings if it is not understood or appropriately dealt with. For example, if a group of people exercising regularly and a group of people who do not exercise have an important age difference then any difference found in outcomes about heart disease could well be due to one group being older than the other rather than due to the exercising. Age is the confounding factor here and the effect of exercising on heart disease cannot be assessed without adjusting for age differences in some way.

Conjugated bilirubin

A term used to describe the form of bilirubin which has been processed by the liver. This is otherwise described as direct bilirubin. Conjugated bilirubin is released into the bile by the liver and stored in the gallbladder, or transferred directly to the small intestines. Bilirubin is further broken down by bacteria in the intestines, and those breakdown products contribute to the colour of the faeces.

Conjugated hyperbilirubinaemia

A term used when large amounts of conjugated bilirubin appear in the bloodstream.

Consensus statement

A statement of the advised course of action in relation to a particular clinical topic, based on the collective views of a body of experts.

Control group

A group of patients recruited into a study that receives no treatment, a treatment of known effect, or a placebo (dummy treatment) - in order to provide a comparison for a group receiving an experimental treatment, such as a new drug.

Controlled clinical trial (CCT)

A study testing a specific drug or other treatment involving two (or more) groups of patients with the same disease. One (the experimental group) receives the treatment that is being tested, and the other (the comparison or control group) receives an alternative treatment, a placebo (dummy treatment) or no treatment. The two groups are followed up to compare differences in outcomes to see how effective the experimental treatment was. A CCT where patients are randomly allocated to treatment and comparison groups is called a randomised controlled trial.

Conventional phototherapy

Phototherapy given using a single light source (not fibreoptic) that is positioned above the baby

Coombs' test

See Direct Antibody Test (DAT)

Cost benefit analysis

A type of economic evaluation where both costs and benefits of healthcare treatment are measured in the same monetary units. If benefits exceed costs, the evaluation would recommend providing the treatment.

Cost-minimisation analysis

A form of cost-effectiveness analysis where the treatment alternatives are considered to be equally effective. Where treatments are equally effective the least costly is the most cost-effective


Value for money. A specific healthcare treatment is said to be ‘cost-effective’ if it gives a greater health gain than could be achieved by using the resources in other ways.

Cost-effectiveness analysis

A type of economic evaluation comparing the costs and the effects on health of different treatments. Health effects are measured in ‘health-related units’, for example, the cost of preventing one additional heart attack.

Cross-sectional study

The observation of a defined set of people at a single point in time or time period – a snapshot. (This type of study contrasts with a longitudinal study which follows a set of people over a period of time.)

Data set

A list of required information relating to a specific disease.

Decision analysis

Decision analysis is the study of how people make decisions or how they should make decisions. There are several methods that decision analysts use to help people to make better decisions, including decision trees.

Decision tree

A decision tree is a method for helping people to make better decisions in situations of uncertainty. It illustrates the decision as a succession of possible actions and outcomes. It consists of the probabilities, costs and health consequences associated with each option. The overall effectiveness or overall cost-effectiveness of different actions can then be compared.

Declaration of interest

A process by which members of a working group or committee ‘declare’ any personal or professional involvement with a company (or related to a technology) that might affect their objectivity e.g. if their position or department is funded by a pharmaceutical company.

Diagnostic study

A study to assess the effectiveness of a test or measurement in terms of its ability to accurately detect or exclude a specific disease.

Direct Antiglobulin Test

Also known as the direct Coombs' test; this test is used to detect antibodies or complement proteins that are bound to the surface of red blood cells; a blood sample is taken and the RBCs are washed (removing the patient's own plasma) and then incubated with antihuman globulin (also known as ‘Coombs' reagent’). If this produces agglutination of RBCs, the direct Coombs' test is positive, a visual indication that antibodies (and/or complement proteins) are bound to the surface of red blood cells.

Direct bilirubin

See Conjugated bilirubin

Double blind study

A study in which neither the subject (patient) nor the observer (investigator/clinician) is aware of which treatment or intervention the subject is receiving. The purpose of blinding is to protect against bias.

Economic evaluation

A comparison of alternative courses of action in terms of both their costs and consequences. In health economic evaluations the consequences should include health outcomes.


See Clinical effectiveness.


The extent to which a specific treatment or intervention, under ideally controlled conditions (e.g. in a laboratory), has a beneficial effect on the course or outcome of disease compared to no treatment or other routine care.


Based directly on experience (observation or experiment) rather than on reasoning alone.

End-tidal carbon monoxide concentration

The concentration of carbon monoxide at the end of an expired breath.


Enteral refers to any form of administered treatment or food that involves the gastrointestinal tract:

  • by mouth (orally), many drugs as tablets, capsules, or drops
  • by gastric feeding tube, duodenal feeding tube, or gastrostomy

Entero-hepatic circulation of bilirubin

The uptake of bilirubin into the blood from bowel contents


Study of diseases within a population, covering the causes and means of prevention.

Evidence based

The process of systematically finding, appraising, and using research findings as the basis for clinical decisions.

Evidence based clinical practice

Evidence based clinical practice involves making decisions about the care of individual patients based on the best research evidence available rather than basing decisions on personal opinions or common practice (which may not always be evidence based). Evidence based clinical practice therefore involves integrating individual clinical expertise and patient preferences with the best available evidence from research.

Evidence table

A table summarising the results of a collection of studies which, taken together, represent the evidence supporting a particular recommendation or series of recommendations in a guideline.

Exchange transfusion

This procedure involves slowly removing the baby's blood and replacing it with fresh donor blood.

Exclusion criteria

See Selection criteria.

Experimental study

A research study designed to test if a treatment or intervention has an effect on the course or outcome of a condition or disease - where the conditions of testing are to some extent under the control of the investigator. Controlled clinical trial and randomised controlled trial are examples of experimental studies.

Experimental treatment

A treatment or intervention (e.g. a new drug) being studied to see if it has an effect on the course or outcome of a condition or disease.

Fibreoptic phototherapy

Phototherapy given using a single light source that comprises a light generator, a fibre-optic cable through which the light is carried and a flexible light pad, on which the baby is placed or that is wrapped around the baby.

Forest plot

A graphical display of results from individual studies on a common scale, allowing visual comparison of results and examination of the degree of heterogeneity between studies.


The extent to which the results of a study hold true for a population of patients beyond those who participated in the research. See also External validity.

Gilbert syndrome

A genetic liver disorder in which the liver shows impaired processing of bilirubin

Glucose-6-phosphate dehydrogenase

Lack of this enzyme (G6PD deficiency) is associated with a tendency to haemolysis. This can present in the newborn period, and can thus be associated with neonatal jaundice.

Gold standard

A method, procedure or measurement that is widely accepted as being the best available.

Grey literature

Reports that are unpublished or have limited distribution, and are not included in bibliographic retrieval systems.


A systematically developed tool which describes aspects of a patient's condition and the care to be given. A good guideline makes recommendations about treatment and care, based on the best research available, rather than opinion. It is used to assist clinician and patient decision-making about appropriate health care for specific clinical conditions.

Guideline recommendation

Course of action advised by the guideline development group on the basis of their assessment of the supporting evidence.


The coloured pigment inside red blood cells that carries oxygen round the body.


The breakdown of red blood cells.

Haemolytic disease of the newborn

Abnormal breakup of red blood cells in the fetus or newborn. This is usually due to maternal antibodies which pass into the fetus and trigger haemolysis of the baby's red cells (also known as Isoimmune haemolytic disease)

Health economics

A branch of economics which studies decisions about the use and distribution of healthcare resources.

Health technology

Health technologies include medicines, medical devices such as artificial hip joints, diagnostic techniques, surgical procedures, health promotion activities (e.g. the role of diet versus medicines in disease management) and other therapeutic interventions.

Health Technology Appraisal

A health technology appraisal, as undertaken by NICE, is the process of determining the clinical and cost-effectiveness of a health technology. NICE health technology appraisals are designed to provide patients, health professionals and managers with an authoritative source of advice on new and existing health technologies.


Or lack of homogeneity. The term is used in meta-analyses and systematic reviews when the results or estimates of effects of treatment from separate studies seem to be very different – in terms of the size of treatment effects or even to the extent that some indicate beneficial and others suggest adverse treatment effects. Such results may occur as a result of differences between studies in terms of the patient populations, outcome measures, definition of variables or duration of follow-up.

Hierarchy of evidence

An established hierarchy of study types, based on the degree of certainty that can be attributed to the conclusions that can be drawn from a well conducted study. Well-conducted randomised controlled trials (RCTs) are at the top of this hierarchy. (Several large statistically significant RCTs which are in agreement represent stronger evidence than say one small RCT.) Well-conducted studies of patients' views and experiences would appear at a lower level in the hierarchy of evidence.


This means that the results of studies included in a systematic review or meta analysis are similar and there is no evidence of heterogeneity. Results are usually regarded as homogeneous when differences between studies could reasonably be expected to occur by chance. See also Consistency.


Raised levels of bilirubin in the blood.

Hyperbilirubinaemia, significant

An elevation of serum bilirubin to a level requiring treatment (see key terms 1.1


Raised level of glucose in the bloodstream.


A high serum potassium concentration


An electrolyte disturbance in which the sodium concentration in the plasma is too high


Overactive or over-responsive reflexes.

Hypertonicity (hypertonia)

High muscle tension, when used to describe clinical examination findings.


Lowered levels of glucose in the bloodstream.


Lowered levels of is sodium concentration in the bloodstream


A tool for estimating the level of jaundice. It consists of strips of perspex with varying degrees of yellow colour shown in bands. These are placed against the baby's skin and the colour closest to the baby's skin colour is used to indicates the severity of the jaundice.

Indirect bilirubin

See Unconjugated bilirubin

In depth interview

A qualitative research technique. It is a face to face conversation between a researcher and a respondent with the purpose of exploring issues or topics in detail. Does not use pre-set questions, but is shaped by a defined set of topics or issues.

Information bias

Pertinent to all types of study and can be caused by inadequate questionnaires (e.g. difficult or biased questions), observer or interviewer errors (e.g. lack of blinding), response errors (e.g. lack of blinding if patients are aware of the treatment they receive) and measurement error (e.g. a faulty machine).


Healthcare action intended to benefit the patient, e.g. drug treatment, surgical procedure, psychological therapy, etc.

Interventional procedure

A procedure used for diagnosis or treatment that involves making a cut or hole in the patient's body, entry into a body cavity or using electromagnetic radiation (including X-rays or lasers). The National Institute for Clinical Excellence (NICE) has the task of producing guidance about whether specific interventional procedures are safe enough and work well enough for routine use.


The giving of liquid substances intermittently or continuously, directly into a vein.


The situation which occurs when fetal erythrocytes of a different blood group to the mother leak into her circulation during pregnancy, and are recognised as foreign by the maternal immune system. Isoimmunisation is the most common cause of severe early onset jaundice. See ABO incompatability, Rhesus.


The yellow colouration of the sclera caused by the accumulation of bilirubin in the skin and mucous membranes

Jaundice, visible

Jaundice detected by visual inspection

Jaundice, prolonged

Jaundice lasting more than 14 days in term babies and more than 21 days in preterm babies (see 1.1)


A term from pathology which means ‘yellow staining of the basal nuclei of the brain’. This term is often used to refer to the acute and chronic brain effects of severe hyperbilirubinaemia. There are other causes of yellow staining of the brain other than jaundice. However, the term ioften refers to the clinical syndrome and sequelae of bilirubin encephalopathy

LED (light emitting diode) phototherapy

A phototherapy unit that comprises light-emitting diodes rather than fluorescent or halogen tubes that is positioned above the baby‥

Level of evidence

A code (e.g. 1++, 1+) linked to an individual study, indicating where it fits into the hierarchy of evidence and how well it has adhered to recognised research principles.

Literature review

A process of collecting, reading and assessing the quality of published (and unpublished) articles on a given topic.

Longitudinal study

A study of the same group of people at more than one point in time. (This type of study contrasts with a cross sectional study which observes a defined set of people at a single point in time.)


See Blinding.


Results from a collection of independent studies (investigating the same treatment) are pooled, using statistical techniques to synthesise their findings into a single estimate of a treatment effect. Where studies are not compatible e.g. because of differences in the study populations or in the outcomes measured, it may be inappropriate or even misleading to statistically pool results in this way. See also Systematic review & Heterogeneity.


The overall approach of a research project, e.g. the study will be a randomised controlled trial, of 200 people, over one year.

Methodological quality

The extent to which a study has conformed to recognised good practice in the design and execution of its research methods.

Multicentre study

A study where subjects were selected from different locations or populations, e.g. a co-operative study between different hospitals; an international collaboration involving patients from more than one country.

Multiple phototherapy

Phototherapy that is given using more than one light source simultaneously; for example two or more conventional units, or a combination of conventional and fibreoptic units.


35 to 36 weeks gestational age (see key terms 1.1)

Necrotising enterocolitis

A gastrointestinal condition that mostly affects preterm babies. It involves infection and inflammation which causes destruction of all or part of the bowel (intestine)


Related to the first 28 days of life


Neurotoxicity occurs when the exposure to natural or artificial toxic substances, called neurotoxins, damages nerve tissue and alters its normal activity

Nominal group technique

A decision making method for use among groups of many sizes, who want to make their decision quickly, as by a vote, but want everyone's opinions taken into account

Number Needed to Treat (NNT)

This measures the impact of a treatment or intervention. It states how many patients need to be treated with the treatment in question in order to prevent an event which would otherwise occur. E.g. if the NNT=4, then 4 patients would have to be treated to prevent one bad outcome. The closer the NNT is to 1, the better the treatment is. Analogous to the NNT is the Number Needed to Harm (NNH), which is the number of patients that would need to receive a treatment to cause one additional adverse event e.g. if the NNH=4, then 4 patients would have to be treated for one bad outcome to occur.

Objective measure

A measurement that follows a standardised procedure which is less open to subjective interpretation by potentially biased observers and study participants.


A research technique used to help understand complex situations. It involves watching, listening to and recording behaviours, actions, activities and interactions. The settings are usually natural, but they can be laboratory settings, as in psychological research.

Observational study

In research about diseases or treatments, this refers to a study in which nature is allowed to take its course. Changes or differences in one characteristic (e.g. whether or not people received a specific treatment or intervention) are studied in relation to changes or differences in other(s) (e.g. whether or not they died), without the intervention of the investigator. There is a greater risk of selection bias than in experimental studies.

Odds ratio

Odds are a way of representing probability, especially familiar for betting. In recent years odds ratios have become widely used in reports of clinical studies. They provide an estimate (usually with a confidence interval) for the effect of a treatment. Odds are used to convey the idea of ‘risk’ and an odds ratio of 1 between two treatment groups would imply that the risks of an adverse outcome were the same in each group. For rare events the odds ratio and the relative risk (which uses actual risks and not odds) will be very similar. See also Relative risk, Risk ratio.


The end result of care and treatment and/or rehabilitation. In other words, the change in health, functional ability, symptoms or situation of a person, which can be used to measure the effectiveness of care/treatment/rehabilitation. Researchers should decide what outcomes to measure before a study begins; outcomes are then assessed at the end of the study.


Refers to a route of treatment administration that involves giving drugs into body cavities, usually the blood (by intravenous infusions).

Patent ductus arteriosus

A condition in which the connection ( the ductus) between pulmonary artery and aorta, which is open normally before birth, fails to close after birth

Peer review

Review of a study, service or recommendations by those with similar interests and expertise to the people who produced the study findings or recommendations. Peer reviewers can include professional and/or patient/carer representatives.


This is treatment which consists of exposure to specific wavelengths of light using light-emitting diodes, fluorescent lamps, dichroic lamps or very bright, full-spectrum light,

Physiological jaundice

Term used to describe common, generally harmless, jaundice seen in babies in the first 2 weeks of life

Pilot study

A small scale ‘test’ of the research instrument. For example, testing out (piloting) a new questionnaire with people who are similar to the population of the study, in order to highlight any problems or areas of concern, which can then be addressed before the full scale study begins.


Placebos are dummy or inactive treatments received by participants allocated to the control group in a clinical trial which are indistinguishable from the active treatments being given in the experimental group. They are used so that participants are ignorant of their treatment allocation in order to be able to quantify the effect of the experimental treatment over and above any placebo effect due to receiving care or attention.

Placebo effect

A beneficial (or adverse) effect produced by a placebo and not due to any property of the placebo itself.


See Statistical power.


Less than 37 weeks gestational age (see key terms 1.1)

Primary care

Healthcare delivered to patients outside hospitals. Primary care covers a range of services provided by GPs, nurses and other healthcare professionals, dentists, pharmacists and opticians.

Primary Care Trust

A Primary Care Trust is an NHS organisation responsible for improving the health of local people, developing services provided by local GPs and their teams (called Primary Care) and making sure that other appropriate health services are in place to meet local people's needs.

Prognostic factor

Patient or disease characteristics, e.g. age or co-morbidity, which influence the course of the disease under study. In a randomised trial to compare two treatments, chance imbalances in variables (prognostic factors) that influence patient outcome are possible, especially if the size of the study is fairly small. In terms of analysis these prognostic factors become confounding factors. See also Prognostic marker.

Prognostic marker

A prognostic factor used to assign patients to categories for a specified purpose – e.g. for treatment, or as part of a clinical trial, according to the likely progression of the disease. For example, the purpose of randomisation in a clinical trial is to produce similar treatment groups with respect to important prognostic factors. This can often be achieved more efficiently if randomisation takes place within subgroups defined by the most important prognostic factors. Thus if age was very much related to patient outcome then separate randomisation schemes would be used for different age groups. This process is known as stratified random allocation.

Prospective study

A study in which people are entered into the research and then followed up over a period of time with future events recorded as they happen. This contrasts with studies that are retrospective.


A plan or set of steps which defines appropriate action. A research protocol sets out, in advance of carrying out the study, what question is to be answered and how information will be collected and analysed. Guideline implementation protocols set out how guideline recommendations will be used in practice by the NHS, both at national and local levels.


Refers to neurological and motor develoment

Publication bias

Studies with statistically significant results are more likely to get published than those with non-significant results. Meta-analyses that are exclusively based on published literature may therefore produce biased results. This type of bias can be assessed by a funnel plot.

P value

If a study is done to compare two treatments then the P value is the probability of obtaining the results of that study, or something more extreme, if there really was no difference between treatments. (The assumption that there really is no difference between treatments is called the ‘null hypothesis’.) Suppose the P value was P = 0.03. What this means is that if there really was no difference between treatments then there would only be a 3% chance of getting the kind of results obtained. Since this chance seems quite low we should question the validity of the assumption that there really is no difference between treatments. We would conclude that there probably is a difference between treatments. By convention, where the value of P is below 0.05 (i.e. less than 5%) the result is seen as statistically significant. Where the value of P is 0.001 or less, the result is seen as highly significant. P values just tell us whether an effect can be regarded as statistically significant or not. In no way does the P value relate to how big the effect might be, for this we need the confidence interval.

Qualitative research

Qualitative research is used to explore and understand people's beliefs, experiences, attitudes, behaviour and interactions. It generates non-numerical data, e.g. a patient's description of their pain rather than a measure of pain. In health care, qualitative techniques have been commonly used in research documenting the experience of chronic illness and in studies about the functioning of organisations. Qualitative research techniques such as focus groups and in depth interviews have been used in one-off projects commissioned by guideline development groups to find out more about the views and experiences of patients and carers.

Quality-adjusted life years

A measure of health outcome which looks at both length of life and quality of life. QALYS are calculated by estimating the years of life remaining for a patient following a particular care pathway and weighting each year with a quality of life score (on a zero to one scale). One QALY is equal to one year of life in perfect health, or two years at 50% health, and so on.

Quantitative research

Research that generates numerical data or data that can be converted into numbers, for example clinical trials or the national Census which counts people and households.

Quasi experimental study

A study designed to test if a treatment or intervention has an effect on the course or outcome of disease. It differs from a controlled clinical trial and a randomised controlled trial in that: a) the assignment of patients to treatment and comparison groups is not done randomly, or patients are not given equal probabilities of selection, or b) the investigator does not have full control over the allocation and/or timing of the intervention, but nonetheless conducts the study as if it were an experiment, allocating subjects to treatment and comparison groups.

Random allocation/Randomisation

A method that uses the play of chance to assign participants to comparison groups in a research study, for example, by using a random numbers table or a computer-generated random sequence. Random allocation implies that each individual (or each unit in the case of cluster randomisation) being entered into a study has the same chance of receiving each of the possible interventions.

Randomised controlled trial

A study to test a specific drug or other treatment in which people are randomly assigned to two (or more) groups: one (the experimental group) receiving the treatment that is being tested, and the other (the comparison or control group) receiving an alternative treatment, a placebo (dummy treatment) or no treatment. The two groups are followed up to compare differences in outcomes to see how effective the experimental treatment was. (Through randomisation, the groups should be similar in all aspects apart from the treatment they receive during the study.)

Receiver operating characteristic curve

A curve can be used to evaluate the goodness of fit for a binary classifier. It is a plot of the true positive rate (rate of events that are correctly predicted as events) against the false positive rate (rate of nonevents predicted to be events) for the different possible cutpoints

Retrospective study

A retrospective study deals with the present/past and does not involve studying future events. This contrasts with studies that are prospective.


Summary of the main points and trends in the research literature on a specified topic. A review is considered non-systematic unless an extensive literature search has been carried out to ensure that all aspects of the topic are covered and an objective appraisal made of the quality of the studies.


A blood group system which comprises the Rhesus antigens


Vitamin B2

Risk ratio

Ratio of the risk of an undesirable event or outcome occurring in a group of patients receiving experimental treatment compared with a comparison (control) group. The term relative risk is sometimes used as a synonym of risk ratio.

Royal Colleges

In the UK medical/nursing world the term royal colleges, as for example in ‘The Royal College of….’, refers to organisations which usually combine an educational standards and examination role with the promotion of professional standards.

Safety netting

The provision of support for patients in whom the clinician has some uncertainty as to whether the patient has a self-limiting illness and is concerned that their condition may deteriorate. Safety netting may take a number of forms, such as dialogue with the patient or carer about symptoms and signs to watch for, advice about when to seek further medical attention, review after a set period, and liaising with other healthcare services


The whites of the eyes (singular sclera)


A part of the study's target population from which the subjects of the study will be recruited. If subjects are drawn in an unbiased way from a particular population, the results can be generalised from the sample to the population as a whole.


Refers to the way participants are selected for inclusion in a study.

Sampling frame

A list or register of names which is used to recruit participants to a study.

Secondary care

Care provided in hospitals.

Selection bias

Selection bias has occurred if, the characteristics of the sample differ from those of the wider population from which the sample has been drawn or there are systematic differences between comparison groups of patients in a study in terms of prognosis or responsiveness to treatment.

Selection criteria

Explicit standards used by guideline development groups to decide which studies should be included and excluded from consideration as potential sources of evidence.

Semi-structured interview

Structured interviews involve asking people pre-set questions. A semi-structured interview allows more flexibility than a structured interview. The interviewer asks a number of open-ended questions, following up areas of interest in response to the information given by the respondent.


In diagnostic testing, it refers to the chance of having a positive test result given that you have the disease. 100% sensitivity means that all those with the disease will test positive, but this is not the same the other way around. A patient could have a positive test result but not have the disease – this is called a ‘false positive’. The sensitivity of a test is also related to its ‘negative predictive value’ (true negatives) – a test with a sensitivity of 100% means that all those who get a negative test result do not have the disease. To fully judge the accuracy of a test, its Specificity must also be considered.

Sensorineural deafness

A type of hearing loss in which the root cause lies in the vestibulocochlear nerve (Cranial nerve VIII), the inner ear, or central processing centers of the brain.


A fluid component of clotted blood that lacks clotting factors and other elements which plasma includes. It retains antibodies, electrolytes and soluble proteins. In this guideline, when referring to bilirubin measurements on blood made on spun-down blood samples, sderum is also used to refer to plasma.

Single blind study

A study in which either the subject (patient/participant) or the observer (clinician/investigator) is not aware of which treatment or intervention the subject is receiving.

Single phototherapy

Phototherapy given using a single light source.


In diagnostic testing, it refers to the chance of having a negative test result given that you do not have the disease. 100% specificity means that all those without the disease will test negative, but this is not the same the other way around. A patient could have a negative test result yet still have the disease – this is called a ‘false negative’. The specificity of a test is also related to its ‘positive predictive value’ (true positives) – a test with a specificity of 100% means that all those who get a positive test result definitely have the disease. To fully judge the accuracy of a test, its Sensitivity must also be considered.

Split bilirubin

Laboratory test measuring conjugated and unconjugated bilirubin.

Standard deviation

A measure of the spread, scatter or variability of a set of measurements. Usually used with the mean (average) to describe numerical data.

Statistical power

The ability of a study to demonstrate an association or causal relationship between two variables, given that an association exists. For example, 80% power in a clinical trial means that the study has a 80% chance of ending up with a P value of less than 5% in a statistical test (i.e. a statistically significant treatment effect) if there really was an important difference (e.g. 10% versus 5% mortality) between treatments. If the statistical power of a study is low, the study results will be questionable (the study might have been too small to detect any differences). By convention, 80% is an acceptable level of power. See also P value.


The breastbone. For the purposes of the guideline we are specifically referring to the section of the skin and chest wall overlying the breastbone.


Term used for faeces or poo.

Structured interview

A research technique where the interviewer controls the interview by adhering strictly to a questionnaire or interview schedule with pre-set questions.

Study checklist

A list of questions addressing the key aspects of the research methodology that must be in place if a study is to be accepted as valid. A different checklist is required for each study type. These checklists are used to ensure a degree of consistency in the way that studies are evaluated.

Study population

People who have been identified as the subjects of a study.

Study quality

See Methodological quality.

Study type

The kind of design used for a study. Randomised controlled trial, case–control study, cohort study are all examples of study types.


A person who takes part in an experiment or research study.


A study in which information is systematically collected from people (usually from a sample within a defined population).


Methodical, according to plan; not random.

Systematic error

Refers to the various errors or biases inherent in a study. See also Bias.

Systematic review

A review in which evidence from scientific studies has been identified, appraised and synthesised in a methodical way according to predetermined criteria. May or may not include a meta-analysis.


Involving the whole body.


Rapid heart-rate.


Rapid breathing.

Target population

The people to whom guideline recommendations are intended to apply. Recommendations may be less valid if applied to a population with different characteristics from the participants in the research study – e.g. in terms of age, disease state, social background.


37 weeks or more of pregnancy. For the purposes of this guideline babies of 27 weeks are considered differently to those of 38 weeks.

Tertiary centre

A major medical centre providing complex treatments which receives referrals from both primary and secondary care. Sometimes called a tertiary referral centre. See also Primary care and Secondary care.

Thermo-neutral environment

Surroundings of an ambient temperature which minimizes the baby's energy expenditure on keeping warm or cool


Passing, entering, or made by penetration through the skin


Passes across the epidermal layer (skin) to the surrounding atmosphere via diffusion and evaporation processes.

Triple blind study

A study in which the statistical analysis is carried out without knowing which treatment patients received, in addition to the patients and investigators/clinicians being unaware which treatment patients were getting.

Unconjugated bilirubin

This is the term used to describe bilirubin which has not been processed by the liver. Normally unconjugated bilirubin is taken up by the liver where an enzyme produces conjugated bilirubin. It is then transported by the biliary system to the intestine and excreted.

Unconjugated hyperbilirubinaemia arises if the liver cannot handle the amount of unconjugated bilirubin presented to it. This can occur as a result of excessive red blood cell breakdown – (haemolysis) and/or because of immaturity of the liver enzymes involved in conjugation.

Univariate analysis

Analysis of data on a single variable at a time

Urinary tract infection

A bacterial infection that affects any part of the urinary tract.


Assessment of how well a tool or instrument measures what it is intended to measure. See also External validity, Internal validity.


A measurement that can vary within a study, e.g. the age of participants. Variability is present when differences can be seen between different people or within the same person over time, with respect to any characteristic or feature which can be assessed or measured.

Vasodilator effects

Refers to widening of blood vessels


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