Management Of Neonatal Jaundice Research Articles

Risk of low levels of blood group antibodies mediating hemolysis in ABO-incompatible neonates with negative three hemolysis tests.

To explore the risk of low-level blood group antibody-mediated hemolysis in ABO-incompatible newborns with negative three hemolysis tests, aiming to assist in the identification and management of neonatal jaundice. A retrospective case-control study was performed in 892 children with jaundice. The patients were divided into three groups: group I, ABO compatible, negative three hemolysis tests; group II, ABO incompatible, negative three hemolysis tests; and group III, ABO incompatible, positive three hemolysis tests. We analyzed the differences in clinical data, blood routine and biochemical laboratory results. (1) Patients in group II had higher levels of mean corpuscular volume (MCV), standard deviation of red blood cell volume distribution width (RDW-SD), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), and bile acid (BA) than those in group I (P < 0.05). However, there were no statistically significant differences in the MCV, ALT, ALP and BA levels between groups II and III (P > 0.05). (2) Mean corpuscular hemoglobin concentration (MCHC) >359.5 g/L, cell volume distribution width (RDW-CV) >15.95%, and reticulocyte count (RET) >4.235% were identified as independent predictors of positive hemolysis test results (P < 0.001). The combination of MCHC, RDW-CV, and RET% yielded an AUC of 0.841. Low-level blood group antibody-mediated hemolysis may occur in ABO-incompatible neonates even when three hemolysis tests are negative. Changes in liver function parameters must be monitored. The combination of MCHC, RDW-CV, and RET% can be used to improve the detection rate of HDN.

Management of Neonatal Jaundice during Initial Health Care Visit

Backgrounds: Cholestasis is a bile flow disorder resulting in liver bile retention. It is characterized by intrahepatic (IH) and extrahepatic (EH) cholestasis. Health workers are strategically placed to provide correct information in managing patients with cholestasis. This study aimed to assess the management of neonatal jaundice during initial health care visit. Methods: A cross-sectional study was conducted on infants with cholestasis treated at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Questionnaires as data collection instruments were used. Statistical analysis was performed using Pearson's chi-square test. Results: Subjects consisted of 40 (58%) infants boys, 29 (42%) infants girls, IH cholestasis were 28 (41%), and EH cholestasis were 41 (59%). In both groups, most infants with cholestasis sought medical care between 0 and 1 month. Health workers stated that most subjects were underfed, as indicated by the 14 (20%) intrahepatic and 26 (38%) extrahepatic subjects. In this study, most infants with cholestasis were advised to get sun exposure. Sun exposure began at birth in 21 (30%) intrahepatic and 36 (52%) extrahepatic subjects. There were no significant differences based on underfeeding and sun exposure between the intrahepatic and extrahepatic cholestasis groups (p=0.268; p = 0.168). Conclusion: The management of neonatal jaundice among health workers regarding breastfeeding and sun exposure recommendations did not significantly differ between intrahepatic and extrahepatic cholestasis. Health workers require more knowledge about cholestasis infant management. Correct understanding improves cholestasis infants' outcomes.

Experiences with neonatal jaundice management in hospitals and the community: interviews with Australian health professionals

IntroductionWorldwide, neonatal jaundice accounts for considerable morbidity and mortality. Although severe adverse outcomes, such as hyperbilirubinaemia and kernicterus, are uncommon in high-income countries, these outcomes do occur, have enormous lifelong...

Magnitude and its associated factors of neonatal jaundice among neonates admitted to the neonatal intensive care unit of Dessie Town public hospitals, Amhara region, Ethiopia, 2020: a multicenter cross-sectional study.

Neonatal jaundice is a prevalent illness affecting approximately 60%-80% of newborns. In severe cases, it can result in severe neurological distress. Approximately 1.1 million neonates are affected annually on a global scale, with the vast majority living in sub-Saharan Africa and southern Asia. It is common in newborns in the first week of life. This study aims to assess the magnitude and determinants of jaundice in newborns admitted to the neonatal intensive care unit (NICU) of public hospitals in the city of Dessie in northern Ethiopia. An institutional cross-sectional study was conducted at the NICU at Dessie town public hospitals from 30 March to 30 April 2020. A systematic random sampling procedure was used to select the study participants. Data were collected through face-to-face interviews with mothers using a structured questionnaire and by reviewing neonatal medical records using a checklist. Binary logistic regression analysis was used to identify the determinants of neonatal jaundice. A significance level of less than 0.05 was used to declare the statistical significance in the final model. A total of 218 neonates with their mothers were included in the study. The prevalence rate of neonatal jaundice was found to be 28.4%. The major associated factors for neonatal jaundice were sepsis [adjusted odds ratio (AOR): 10.13, 95% confidence interval (CI) = 2.36, 43.56], preterm < 37 weeks (AOR: 6.03, 95% CI = 1.41, 25.79) low APGAR score < 7 (AOR: 7.34, 95% CI = 1.34, 39.65), ABO incompatibility (AOR: 24.55 95% CI = 1.58, 68.83), prolonged labor (AOR 9.03, 95% CI = 1.67, 48.33), and Rh incompatibility (AOR = 30.40, 95% CI = 2.01, 66.20). The magnitude of neonatal jaundice among neonates was determined to be high. Therefore, both maternal and neonatal factors contributed significantly to the management of neonatal jaundice and also influenced the use of phototherapy treatment. Proper consideration of these factors is crucial for the prevention and treatment of neonatal jaundice.

Assessment of Knowledge, Attitude and Practice of Management of Neonatal Jaundice Amongst 4th Year Nursing Students at Unam, Main Campus

Background: Neonatal jaundice (NNJ) is the yellowish discoloration of the sclera, skin and mucous membrane in a baby of 0- 28 days of life due to accumulation of bilirubin in the body. NNJ is one of the most common problems in newborns and contributes significantly to neonatal morbidity and mortality. Aim: This study aimed at assessing the knowledge, attitude and practice of NNJ among 40 year Nursing students at UNAM main campus. Method: This study used quantitative approach and employed a cross-sectional study design. Sixty-six (66) 4th year nursing students were enrolled in the study between July 2022 and August 2022. A questionnaire was used to collect data from the participants. The data was analysed descriptively using SPSS. Frequency distributions, percentages and frequency tables were used to summarize and relate variables which were attained from the study. Data was summarized using figures and tables. Results: The findings indicate that all participants had knowledge on jaundice. The majority (91%) of the participants in the present study indicated that disparity between blood groups can cause jaundice. However, some of the participants have indicated poor knowledge regarding NNJ. Some students (9%) have indicated that breastfeeding can lead to NNJ. All participants indicated phototherapy as treatment modality for NNJ. However, some (3%) of the participants also believe that constant fasting and prayers can cure it. The majority of participants indicated the eyes and gonads of the baby must be covered when initiating phototherapy, and that the distance of the phototherapy unit is an important factor to consider when initiating phototherapy. Conclusion: The majority of students showed satisfactory knowledge, attitude and practice on NNJ. However, there is still a need for the Nursing students to have continuous education, reminder and exposure on NNJ so they will be able to teach the mothers when they graduate to prevent the severe morbidity and mortality associated with improper and late treatment of NNJ.

Prevalence, Associated Factors and Management of Neonatal Jaundice by Midwives and Nurses of Selected Health Facilities in Fako Division, Cameroon

Background Neonatal jaundice is a problem commonly faced by neonates and it is responsible for hospital readmissions worldwide. Aim To determine the prevalence, associated factors, and management of neonatal jaundice by midwives and nurses. Methods A hospital-based cross-sectional and retrospective study was conducted. Copies of a well-structured questionnaire were administered to participants in the maternity and neonatal units of Buea and Limbe Regional Hospitals and the Baptist Hospital Mutengene. The files (230) of neonates admitted in these hospitals from January 2019 to March 2022 were studied and data collected using an extraction sheet. Fifty (50) midwives and nurses who had worked for more than six-months participated in the study. A purposive sampling method was used to select the health facilities while the participants were enrolled using a consecutive convenient sampling technique. Respondents who met the inclusion criteria and gave their consent to participate in the study were included. The study received administrative authorization from the Department of Nursing Faculty of Health Sciences, University of Buea and the Regional Delegation of Public Health South West Region. Data collected were entered using a pre-designed EpiData version 28.0 and analyzed. Results The prevalence of neonatal jaundice was 15.2%; 65.7% of the jaundiced neonates were preterm babies, 51.4% of the cases were noticed within the first-week of life, 91.4% had Apgar scores of &lt;6 and 85.7% had low birth weight. The majority of them (68.6%) were resuscitated at birth and more than half were preterm babies. Maternal fever, prolonged labor, premature rupture of the membranes was significantly associated with neonatal jaundice. Half (50%) of the participants reported that they would collect samples for bilirubin only if the baby was still yellow and 82% said it is important to give fluids during phototherapy because it helps keep the baby hydrated. Conclusion The prevalence of neonatal jaundice is a cause for concern. Therefore, midwives and nurses are call upon to educate pregnant women on the predisposing factors and should acquire competencies in order to properly manage babies upon diagnosis.

Antenatal jaundice instruction and acute bilirubin encephalopathy in Nigeria

BackgroundAcute Bilirubin Encephalopathy (ABE) is common in Nigeria. Parents’ inability to recognize jaundice and delays in seeking care are significant barriers to its prevention.MethodsWe compared associations of (1) interactive antenatal maternal jaundice instruction with postnatal reinforcement, (2) standard postnatal instruction, and (3) no maternal instruction with the incidence of ABE among 647 jaundice admissions stratified for risk factors identified in initial descriptive analysis.ResultsEighty-three (83/647;12.8%) admissions developed ABE including eleven jaundice-related deaths. ABE was present at admission in 20/22 (90.9%) if mothers received no jaundice instruction and no antenatal care, 42/182 (23.1%) if received antenatal care but no instruction, 16/95 (16.8%) if received postnatal instruction only, and 4/337 (1.2%) if mothers received both antenatal and postnatal instruction (p < .001). ABE was highly associated with out-of-hospital delivery, number of antenatal clinic visits, and birth attendant, but these risks were mitigated by antenatal/postnatal instruction. Admission rates with bilirubin levels below treatment guidelines (12 mg/dL) were higher following instruction (30.7%) than with no instruction (14.4%). Limiting subjects to those meeting admission criteria increased ABE rates in all groups without altering conclusions.ConclusionInteractive antenatal instruction with postnatal reinforcement resulted in timely care seeking and a lower incidence of ABE.ImpactEmpowering mothers to participate in neonatal jaundice management is critical in low-income countries where jaundice monitoring and follow up are unreliable.Instructing mothers about jaundice in antenatal clinics with postnatal reinforcement is more effective than standard postpartum instruction in facilitating jaundice detection, timely care seeking, and lowering the incidence of acute bilirubin encephalopathy (ABE).Antenatal training also mitigates risks for ABE associated with out-of-hospital deliveries, limited antenatal care, and unskilled birth attendants.Impact: Adding structured jaundice instruction in antenatal clinics could greatly reduce bilirubin induced brain injury in countries where ABE is common.

Analisa Faktor yang Mempengaruhi Kejadian Ikterik pada Neonatus

Jaundice is a symptom that is common in newborns. This jaundice usually disappears by the end of the first week or no later than the first ten days. This study aims to analyze the factors that influence the incidence of jaundice in neonates. This study used the literature review method by searching journals using three databases: PubMed, Google Scholar, and SpringerLink. Journal inclusion criteria published 2016 - 2021. Research results of jaundice in neonates. Factors that influence the incidence of neonatal jaundice in the Asian region, especially Southeast Asia, are maternal and perinatal. Maternal factors include gestational age, complications, pregnancy (incompatibility, ABO blood group, Rh and DM), type of delivery, and race. Perinatal factors include neonatal asphyxia, infection, birth trauma, low intake of breast milk, low birth weight (LBW), gender, and medication. The management of neonatal jaundice includes exposing the baby to the sun, phototherapy, adequate nutritional intake, and adequate breastfeeding. For this reason, health education and support from the husband and family are needed for the mother so that the baby does not experience jaundice.

A Descriptive Study on Management of Neonatal Jaundice in Children Hospital Lahore

A Descriptive Study on Management of Neonatal Jaundice in Children Hospital Lahore

Prevalence and management of neonatal jaundice in a hospital, Jos-Nigeria

Neonatal jaundice (hyperbilirubinemia) is one of the most common conditions that require medical attention in neonates. The medical condition is because of the imbalance between bilirubin production and its excretion. The accumulation of serum bilirubin in excess, elevates the values of bilirubin in neonates up to a high concentration as noted in the medical laboratory assay causing the yellowish colouration of skin and the eye. A retrospective study was carried out in OLA hospital from 2019 t0 2021 for neonates delivered within the period. The incidence of neonatal jaundice (hyperbilirubinemia) in this study was 11.7%. The most common risk factor associated with neonatal jaundice (hyperbilirubinemia) is ABO incompatibility, Preterm gestation and low birth weight (&lt;2.5kg). Neonatal jaundice (hyperbilirubinemia) is a common problem encountered in Neonatal Intensive Care Units of hospitals as seen in OLA Hospital in Jos. The recommended strategies that is involve in the prevention and control of neonatal jaundice include; health education on neonatal jaundice, identification of risk factors, early detection of neonatal jaundice, proper assessment of babies with neonatal jaundice and early referral for good medical management.

Epidemiological Investigation of Neonatal Jaundice in Tikrit City: Assessing Neonatal Risk Factors from 2022 to 2023

Objectives: This study aimed to assess the prevalence of neonatal jaundice and explore associated risk factors in Tikrit City, Iraq.&#x0D; Methods: The current study was a cross sectional study involved 312 neonates (204 of them with jaundice and 108 without jaundice ), attending Salahaddin General hospital from 1st October 2022 to 30th January 2023. The Study sample was convenient . Jaundiced and Non-jaundiced neonates were enrolled into the study when they enter the wards of pediatrics and neonatal intensive care unites in Salahaddin General Hospital and those visits outpatient clinics of pediatricians and the general population during a free neonatal jaundice screening campaign in Tikrit City.&#x0D; Results: The prevalence of neonatal jaundice is (9.2%). The most frequent cases was having total serum bilirubin(TSB) level ≤18 milligram/dc liter(mg\dl) (84.8%).The mean ±standard deviation (SD) of hyperbilirubinemia level is (15 ± 3.366 mg\dl ) and the high TSB level was reported among male gender(58.3%).The percent of preterm babies was (33.3%) of total sample .The most cases had normal weight (66.7%) at time of delivery ,mean ±SD of weight is (2698.5±693.54gram) and had no bruises or hematoma as cephalohematoma (89.2%).There was no blood diseases in about (72.5%) of total sample and no history of infection in (68.1%) of cases. The most frequent methods of feeding was breast feeding (39.7%). Regarding to time of appearance of jaundice, the most frequent cases were among those with age group (≤5 days )(89.7%) .The mean±SD for age of neonate at time of admission is (6.2±3.6 day).&#x0D; Blood group incompatibility(ABO incompatibility) was found in (60.8%) of cases with TSB level ≤18 mg/dl and (11.3%) of cases of TSB level &lt;18 mg\dl . While Rhesus incompatibility(Rh incompatibility) was found in (13.2%) of cases with TSB level ≤18 mg/dl .&#x0D; Conclusion: This study highlights a prevalence of 9.2% for neonatal jaundice in Tikrit City and identifies important risk factors such as blood group incompatibility and preterm birth. Early detection and appropriate management of neonatal jaundice are crucial to prevent potential complications and ensure optimal neonatal care.

Diagnostic Accuracy of Portable, Handheld Point-of-Care Tests vs Laboratory-Based Bilirubin Quantification in Neonates

Quantification of bilirubin in blood is essential for early diagnosis and timely treatment of neonatal hyperbilirubinemia. Handheld point-of-care (POC) devices may overcome the current issues with conventional laboratory-based bilirubin (LBB) quantification. To systematically evaluate the reported diagnostic accuracy of POC devices compared with LBB quantification. A systematic literature search was conducted in 6 electronic databases (Ovid MEDLINE, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar) up to December 5, 2022. Studies were included in this systematic review and meta-analysis if they had a prospective cohort, retrospective cohort, or cross-sectional design and reported on the comparison between POC device(s) and LBB quantification in neonates aged 0 to 28 days. Point-of-care devices needed the following characteristics: portable, handheld, and able to provide a result within 30 minutes. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data extraction was performed by 2 independent reviewers into a prespecified, customized form. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was performed of multiple Bland-Altman studies using the Tipton and Shuster method for the main outcome. The main outcome was mean difference and limits of agreement in bilirubin levels between POC device and LBB quantification. Secondary outcomes were (1) turnaround time (TAT), (2) blood volumes, and (3) percentage of failed quantifications. Ten studies met the inclusion criteria (9 cross-sectional studies and 1 prospective cohort study), representing 3122 neonates. Three studies were considered to have a high risk of bias. The Bilistick was evaluated as the index test in 8 studies and the BiliSpec in 2. A total of 3122 paired measurements showed a pooled mean difference in total bilirubin levels of -14 μmol/L, with pooled 95% CBs of -106 to 78 μmol/L. For the Bilistick, the pooled mean difference was -17 μmol/L (95% CBs, -114 to 80 μmol/L). Point-of-care devices were faster in returning results compared with LBB quantification, whereas blood volume needed was less. The Bilistick was more likely to have a failed quantification compared with LBB. Despite the advantages that handheld POC devices offer, these findings suggest that the imprecision for measurement of neonatal bilirubin needs improvement to tailor neonatal jaundice management.

Neonatal Jaundice Management: Improving Clinical Knowledge of Jaundice for Improved Attitudes and Practices to Enhance Neonatal Care.

Neonatal jaundice is a common medical condition that affects neonates in the early days of life. Nurses and midwives play important role in the identification and management of neonatal jaundice and the promotion of good neonatal health and education. Their clinical knowledge of neonatal jaundice may influence their attitude and practices toward the identification and management of neonatal jaundice. The study results showed that the level of good knowledge, attitudes, and practices toward neonatal jaundice management was 69.30% (140/202), 64.90% (131/202), and 62.90% (127/202), respectively. The inferential statistics showed a positive association between good knowledge and attitudes toward neonatal jaundice and good practices of neonatal jaundice management. Suggestively, nurses and midwives who have and demonstrate better clinical knowledge and exhibit positive attitudes are more likely to implement appropriate practices for the management of neonatal jaundice. Healthcare providers should therefore invest in life-long learning activities for staff, especially in the study setting.

Neonatal Jaundice Management: Knowledge, Attitude, and Practice Among Nurses and Midwives in the Northern Region, Ghana.

Nurses and midwives play important role in managing neonatal jaundice and provide nursing health education to mothers on preventive and remedial measures to neonatal jaundice. However, the Knowledge, Attitudes, and Practices of nurses and midwives towards neonatal jaundice is not well understood in the Northern Region of Ghana. The study assessed the knowledge, attitudes, and practices of nurses and midwives towards the management of neonatal jaundice. This is a hospital-based descriptive cross-sectional study, conducted between the periods of January 2021 to August 2021 in the Tamale Teaching Hospital, Northern Region, Ghana. Descriptive analysis such as mean, standard deviation, frequencies, and percentages were performed to give general description of the variables. Simple Pearson Chi-square test and logistic regression models were performed to test the level of associations between the outcome and independent variables and predictors for neonatal jaundice. A p-value of <.05 was considered statistically significant for the test of association. Among the 202 nurses and midwives, the mean age was 30.6 ± 3.8 years and majority were females (71.3%). The overall good knowledge, attitudes, and practices score towards neonatal jaundice was 69.30%, 64.90%, and 62.90%, respectively. After adjusting for other variables, good knowledge (adjusted odds ratio [AOR] = 22.41(10.21-49.18) p < .001) and good attitude (AOR = 25(11.86-55.07) p < .001) were positively associated with practices towards neonatal jaundice. The participants demonstrated substantial knowledge, attitudes, and practices towards neonatal jaundice. However, there still exist some gaps in their knowledge, attitudes, and practices towards neonatal jaundice that need to be addressed to improve neonatal health outcomes in the study setting.

Current status of neonatal jaundice management in Japan.

This nationwide survey aimed to determine the status of jaundice management in Japan. A questionnaire about bilirubin level measurements and neonatal jaundice treatment was sent to 330 institutions providing neonatal care. The responses were analyzed according to institution level. Of 330 institutions, 172 responded (52.1% response rate). Total bilirubin levels were measured in the central laboratory using spectrophotometry at 134 institutions and a blood gas analyzer at 81 institutions. Unbound bilirubin (UB) levels were measured by 79 institutions, while transcutaneous bilirubin measurements were taken at 63 institutions. There was no association between institution level and UB or transcutaneous bilirubin measurement. For phototherapy criteria, the Murata-Imura criteria were adopted by 67 institutions, Nakamura criteria by 36, and Morioka criteria by 39. Light-emitting diodes (LED) were used by 160 institutions versus fluorescent lights by 31. When a blue LED was used, 119 institutions used the high mode. There is no standard for increasing light intensity. No association was found between institution level and phototherapy criteria. UB was measured in 14 of 63 institutions using the Murata-Imura criteria. There is a large variation in the management and treatment of neonatal jaundice among institutes in Japan.

Mothers’ Knowledge Regarding Home Care Management of Neonatal Jaundice in Qaladze - Sulaymaniyah City

Background and Objectives: Jaundice is the most common condition requiring medical attention in newborn babies. The mother has a significant role in reducing the effects. Early discharge of mothers and neonates from the hospitals increased the responsibility of mothers in recognizing jaundice has increased. This study aimed to assess the level of the mothers’ knowledge regarding home care management of neonatal jaundice. Methods: A quantitative, cross-sectional descriptive study was carried out in the Neonatal Intensive Care Unit at Shahidan Qaladze Teaching Hospital from the period of January 2021 to March 2022. Purposive (non-probability) sampling techniques were used to recruit participants. The study sample included 114 mothers. Data was collected using a questionnaire prepared by the investigator, and direct interviews were conducted. Descriptive statistics including, frequencies and percentages, and inferential statistical analysis of Chi-square was used to analyze the data. Results: The results show that 34.2% of the mothers were between 26-32 years. Concerning occupation, more than three-quarters (86%) of the sample were housewives. The study demonstrated that the majority (64.9%) of mothers did not have enough in-formation about jaundice. There was a statistically significant association between parents’ relatives and the source of information regarding the mother’s knowledge. The study showed a statistically significant association between mothers’ knowledge and early initiation of breastfeeding. Factors associated with mother’s knowledge include the mother’s age, occupation, years of formal education, residency areas, received health education on neonate jaundice, and the source of information. Conclusion and Recommendations: The study concluded that most mothers had a deficit of knowledge regarding home care management of neonatal jaundice. It is recommended to provide mothers with comprehensive health education about neonatal jaundice care to improve their knowledge and practice in caring for neonates with jaundice.

Intérêt de la bilirubinémie en néonatalogie : recommandations pour une utilisation coordonnée par le LBM de la biologie délocalisée et des tests rapides d’orientation diagnostique

In pediatrics, accurate measurement of total serum bilirubin (TSB) is of major importance for reliable diagnosis and appropriate management of neonatal jaundice. However, several studies evidenced poor comparability of results obtained with the different available methods either in central lab or in POCT, on serum, capillary blood or transcutaneous. This situation is partly due to the lack of Reference Materials, especially for high bilirubin concentrations but also on poor communication between central lab and neonatology unit. To progress on these issues, we have compiled some data from CNRHP to propose guidelines for choice, use and management of POCT devices and to help clinical laboratories to achieve a better answer to clinical needs with specific local constraints. The results from several CNRHP studies are presented: traceability to International System of Units, inter-laboratories comparability, POCT vs central labs comparisons with POCT CO-oximeter or photometer, integration of transcutaneous bilirubinometer. We propose, based on an analysis of devices advantages and issues, guidelines to help labs either to improve neonates monitoring in their local context; we distinguished the choices inside laboratory for a better harmonization of results compared to published thresholds and outside lab contexts, to organize a coordinated chain with POCT devices, with capillary and/or transcutaneous approaches.

Impact of National Clinical Practice Guidelines on Exchange Transfusion for Severe Neonatal Hyperbilirubinemia in Singapore

Aims: To review the incidence of double volume exchange transfusion for severe neonatal hyperbilirubinemia in infants ≥35 weeks’ gestational age before and after implementation of National Clinical Practice Guidelines (NCPGNJ), analyze etiologies for severe hyperbilirubinemia, readmission rates for phototherapy and neurodevelopmental outcomes up to 2 years.&#x0D; Study Design: Retrospective study&#x0D; Place and Duration of Study: KK Women’s and Children’s Hospital, Singapore, between January 2016 and December 2021.&#x0D; Methodology: National Clinical Practice Guidelines on Evaluation and Management of Neonatal Jaundice (NCPGNJ) was implemented in January 2019. We retrospectively reviewed the medical records of neonates in our center who underwent double volume exchange transfusion for severe neonatal hyperbilirubinemia before and after implementation of the national clinical practice guidelines.&#x0D; Results: Overall, 56 infants underwent double volume exchange transfusion for severe hyperbilirubinemia during the study period. There was a decline in the incidence of exchange transfusion from 107 per 100 000 live births in epoch 1 (2016-2018) to 61 per 100 000 live births in epoch 2 (2019-2021). There was a steady decline in overall phototherapy rates (p=0.06), readmission rates for phototherapy (p=0.04) and number of neonates needing exchange transfusion (p=0.25). ABO-hemolytic disease of the newborn was the most common etiology. One infant had delayed presentation of severe hyperbilirubinemia and eventually developed cerebral palsy. The rest of the infants had normal neurodevelopmental and audiological assessments at follow-up.&#x0D; Conclusion: The evidence-based National Clinical Practice Guidelines (NCPGNJ) has reduced the incidence of exchange transfusion. It provides a unified framework for all healthcare professionals who manage neonates with hyperbilirubinemia in different healthcare settings.

The Role of Nutrition in the Prevention and Management of Neonatal Jaundice in Ghana

Despite the well-established importance of nutrition in health and wellness, nutrition’s involvement in the management and prevention of neonatal jaundice varies greatly from one guideline to another, to the extent that some guidelines do not include the role of nutrition in the prevention and management of neonatal jaundice. In addition, mothers typically translate their nutrition knowledge into the care of their babies. Hence, it is prudent for mothers to have the requisite knowledge needed to prevent any health condition, including neonatal jaundice. This study, therefore, sought to investigate and consolidate practices that elucidate the role nutrition plays in the prevention and management of neonatal jaundice in Ghana. The study was a multi-center nested, case-control study involving 120 cases and 120 controls of neonates in three referral hospitals in Ghana. Assessment of nutrition knowledge showed that with regards to the WHO (2004 &amp; 2017) infant feeding recommendations, mothers of babies with neonatal jaundice had a higher nutrition score than mothers with healthy babies. During treatment of neonatal jaundice, babies were mostly fed breastmilk only, and, in a few cases, extra fluids were given if the baby is not exclusively breastfed or there is a risk of dehydration during phototherapy. No probiotic supplements were given, and micronutrient supplementation may or may not be given, depending on the prevailing health conditions of the neonate. It is recommended that further assessment should be carried out to identify the effectiveness of the nutrition education given during antenatal and postnatal education sessions at hospitals, clinics, and health centers. Keywords Breastfeeding, Malnutrition, Neonatal jaundice, nutrition education, World Health Organisation (WHO).

O81 - Clinical outcomes and cost-effectiveness of large-scale midwifery-led, home phototherapy and neonatal jaundice surveillance

We aimed to evaluate a large midwifery-led, paediatrician-overseen home jaundice surveillance and home phototherapy (HPT) program. This is a uniquely holistic model of care, where the surveillance and management of neonatal jaundice is part of the overall midwifery-led care for women who have recently given birth and their infants. We conducted a retrospective cohort study over 2019. Included were all infants with birth gestation ≥ 35 weeks, discharged at 4–96 hours and receiving care from midwifery-at-home (a 12-hour daily, 365-days hospital-based outreach service, supported by hospital paediatricians). Phototherapy was delivered via BiliSoft blanket with treatment thresholds determined by standard nomograms. The main outcomes of interest were unplanned readmissions, and cost-effectiveness based on hospital finance department actual costs. Also examined were parental compliance, device issues and safety. During 2019, 4308 infants received home jaundice surveillance with 86% hospital-discharged before 72 hours, 82% exclusively breastfed and 69% having overseas-born mothers. Four hundred infants received HPT, comprising 101 continuing from inpatient phototherapy (IPT), 56 rebounding after IPT, and 243 home-diagnosed as needing phototherapy and triaged to HPT. Only 1/400 (0.25%) HPT infants required readmission. Additionally, there were 80 home-diagnosed jaundiced infants triaged to immediate readmission for IPT. Maximal serum bilirubin was 454 µmol/L. No exchange transfusion, encephalopathy or HPT-device problems occurred. An early 2019 bilirubin analyser upgrade resulted in higher bilirubin readings and some unintended subthreshold phototherapy. Supported by midwives, most parents managed HPT with ease. HPT cost $640/day compared to $2100/day for infant IPT readmission and $1000/day for a longer birth-admission stay. Up to 2 weeks’ midwifery-at-home care for the whole cohort cost $2 m less than a 2-day longer birth-admission stay. Large-scale, midwifery-led, paediatrician-overseen jaundice surveillance and HPT can achieve very low unplanned readmission rates and be cost-effective.