DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20163993

Three-year experience with prolonged neonatal jaundice screening in a district general hospital

Prasad Adavappa Parvathamma, Emily P. Brockbank, Youssef Abourahma

Abstract


Background: Investigations for prolonged jaundice vary in complexity, especially in well neonates. The aim was to ascertain the causes of prolonged jaundice in well neonates and to analyse the extent and consistency of investigations performed.

Methods: We performed a retrospective review of nurse-led prolonged jaundice screening in our children’s assessment unit from 2013 to 2016. The proforma included clinical assessment and recommended investigations. Data from electronic records and laboratory findings were compiled for analysis.

Results: A total of 116 infants aged 14-73 days were referred for screening, with 100% utilization of the screening proforma. All patients had unconjugated hyperbilirubinaemia with normal urine and stool colour. Of the 113 with a full blood count performed, 74 (65.5%) were normal, with neutropenia in 32 (28.3%) and 1 blood film showing spherocytosis with haemolysis. Urine culture was performed in 106 infants, yielding 2 pure-growth cultures in infants subsequently treated for urinary tract infection (UTI) (1%). Seventy-four infants had one or more additional tests. The causes of prolonged jaundice identified were breast-milk jaundice (97), feeding difficulties (7), UTI (2) and hereditary spherocytosis (1).

Conclusions: The most common cause of prolonged jaundice identified was breast-milk jaundice. The eldest referred infant was 73 days old, demonstrating a need for increased community awareness of guidelines to facilitate prompt referral. Additional investigations yielded little diagnostic value and we propose that in well neonates, following clinical evaluation, investigations may safely be reduced to full blood count and split bilirubin.

Keywords


Neonatal jaundice, Prolonged jaundice

Full Text:

PDF

References


Rodie ME, Harry C, Taylor R. Rationalized assessment of prolonged jaundice is safe and cost-effective. Scott Med J. 2012;57(3):144-7.

Crofts DJ, Michel VJ, Rigby AS. Assessment of stool colour in community management of prolonged jaundice in infancy. Acta Paediatr. 1999;88(9):969-74.

Starship Clinical Guideline. Jaundice- management of prolonged. Available at https: //www.starship.org.nz /for-health-professionals /starship-clinicalguidelines/j/ jaundice-investigation-of-prolonged/. Accessed on 05 August 2016.

Alonso EM, Whitington PF, Whitington SH. Enterohepatic circulation of nonconjugated bilirubin in rats fed with human milk. J Pediatr. 1991;118(3):425-30.

Preer GL, Philipp BL. Understanding and managing breast milk jaundice. Arch Dis Child Fetal Neonatal Ed. 2011;96(6):461-6.

McKiernan PJ. Neonatal cholestasis. Semin Neonatol. 2002;7(2):153-65.

NICE. Care of baby with prolonged jaundice. Available at http:// pathways.nice.org.u k/pathways/ neonatal-jaundice/neonatal-jaundice-overview #content=view-node%3Anodes-care-of-baby-with-prolonged-jaundice. Accessed on 02 July 2016.

Guideline for the evaluation of cholestatic jaundice in infants: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Available at http:// journals.lww.com /jpgn /pages /articleviewer.aspx?year=9000&issue=00000&article=97441&type=abstract. Accessed on 12 July 2016.

Ives NK. Neonatal jaundice. Current Paedia. 1997;7:67-72.

Gilmour SM. Prolonged neonatal jaundice: when to worry and what to do. Paediatr Child Health. 2004;9(10):700-4.

Steadman S, Ahmed I, Mcgarry K. Is screening for urine infection in well infants with prolonged jaundice required? local review and meta-analysis of existing data. Arch Dis Child. 2016;101(7):614-9.

Satwik V, Booth D. An audit of urine culture results in well infants attending a prolonged jaundice clinic. Arch Dis Child. 2009;94(11):914.

Unal S, Aktas A, Ergenekon E. Prolonged jaundice in newborns: what is it actually due to? Gazi Med J. 2000;14:147-51.

Tiker F, Tarcan A, Kilicdag H. Early onset conjugated hyperbilirubinaemia in newborn infants. Indian J Pediatr. 2006;73(5):409-12.

Hannam S, Mcdonnell M, Rennie JM. Investigation of prolonged neonatal jaundice. Acta Paediatr. 2000;89(6):694-7.