Assessing knowledge and skills of maternity care professionals regarding neonatal hyperbilirubinaemia: a nationwide survey

Berthe A M Van Der Geest,Eric A P Steegers,Irwin K M Reiss,Imke M Theeuwen,Jasper V Been

doi:10.1186/s12884-020-03463-0

Abstract

BackgroundNeonatal hyperbilirubinaemia is a physiologic phenomenon, but, when severe, may cause lifelong disability. Maternity care assistants (MCAs) play an important role in timely recognition of severe neonatal jaundice. We assessed knowledge and skills of MCAs regarding neonatal hyperbilirubinaemia.MethodsAll Dutch MCAs (n = 9065) were invited to fill out a questionnaire assessing knowledge, expertise, and handling of neonatal jaundice. Additionally, we developed an e-learning and provided training sessions to a subgroup of MCAs (n = 99), and assessed their knowledge on neonatal hyperbilirubinaemia before and after the training.ResultsOne thousand four hundred sixty-five unique online questionnaires were completed (response 16.2%). The median number of correctly answered knowledge questions was 5 (out of six; IQR 1). Knowledge was significantly better when respondents had had in-service training on neonatal hyperbilirubinaemia in the previous year (p = 0.024). Although 82% of respondents felt highly skilled or skilled to assess jaundice, accuracy of estimation of total serum bilirubin levels by assessing skin colour was generally poor and prone to underestimation. Among participants attending a training session, those who completed the e-learning beforehand had higher pre-training scores (5 (IQR 1) vs. 4 (IQR 2); p < 0.001). The median post-training score was higher than pre-training (6 (IQR 1) vs. 5 (IQR 2); p < 0.001).ConclusionsBackground knowledge of MCAs regarding neonatal hyperbilirubinaemia was adequate, but can be improved by further training. Estimation of total serum bilirubin levels based on skin colour was often inadequate. Approaches to improve timely recognition of jaundiced neonates are needed.

Highlights

Neonatal hyperbilirubinaemia is a physiologic phenomenon, but, when severe, may cause lifelong disability
As Maternity care assistant (MCA) have a firstline role in the recognition of potentially severe neonatal jaundice, we aimed to examine their current state of knowledge and skills regarding hyperbilirubinaemia
We found that background knowledge on neonatal hyperbilirubinaemia among MCAs was generally adequate, with further evidence indicating that this knowledge could be improved by training or e-learning

Summary

Introduction

Neonatal hyperbilirubinaemia is a physiologic phenomenon, but, when severe, may cause lifelong disability. Maternity care assistants (MCAs) play an important role in timely recognition of severe neonatal jaundice. Neonatal jaundice, caused by elevated total serum bilirubin (TSB) levels, occurs in approximately 60–80% of all liveborn infants [1]. When TSB is highly elevated, bilirubin can cross the bloodbrain barrier and may cause Kernicterus Spectrum Disorder (KSD) [3]. KSD and its devastating consequences are entirely preventable by timely recognition and treatment of potentially severe hyperbilirubinaemia. Some countries advise universal screening for neonatal hyperbilirubinaemia by quantifying TSB or transcutaneous bilirubin (TcB) levels at least once during the first week of life [7]. In most countries, including in the Netherlands, visual inspection by maternity care professionals is relied on as a first-line approach to identifying neonates requiring total bilirubin quantification [8, 9]. Visual estimation of jaundice is known to be inaccurate and ineffective in preventing KSD [8, 10, 11]

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