Related Experiment Video
Updated: Jun 8, 2026
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
An audit of a community protocol for identifying neonatal liver disease
Peter Cartledge1, Neeta Kevlani, Leonie Shapiro
1Children's Liver and GI Unit, Leeds Teaching Hospitals NHS Trust, Paediatric Offices, Ward 39, Old Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. patricia.mcclean@leedsth.nhs.uk
Insights
A split bilirubin test effectively identifies neonatal liver disease in jaundiced infants over two weeks old. Ongoing midwife education is crucial for consistent protocol adherence and early detection of conditions like biliary atresia.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Clinical Practice Guidelines
Background:
- Jaundice beyond two weeks in infants necessitates investigation for liver disease.
- Split bilirubin testing is recognized as good clinical practice for diagnosing neonatal liver conditions.
Purpose of the Study:
- To evaluate the effectiveness of a community midwifery-led split bilirubin testing protocol.
- To assess the protocol's ability to identify infants with significant neonatal liver disease.
Main Methods:
- The Leeds Community Midwifery Team implemented a split bilirubin testing protocol from December 2000 to February 2008.
- A total of 882 infants were tested, and results were compared with liver unit database records for infants with Leeds postcodes.
Main Results:
- Three infants were diagnosed with significant liver disease, including one case of biliary atresia.
- No infants with conjugated bilirubin levels below the study's threshold later presented with liver disease.
- The protocol identified most cases, though some required secondary care referral or were missed by initial assessment.
Conclusions:
- The split bilirubin testing protocol is effective for identifying neonatal liver disease.
- Maintaining protocol compliance requires continuous education for healthcare professionals.
Abstract:
Performing a split bilirubin test to identify liver disease in any infant who remains jaundiced beyond 2 weeks of age has been recognised as good clinical practice. The Leeds Community Midwifery Team performed this test, following an agreed protocol, from December 2000. By February 2008, 882 infants had been tested. Three infants were identified as having significant liver disease, including one with biliary atresia. Examining the liver unit database, a further 38 infants with Leeds post codes presented with neonatal liver disease during the study period. Five infants were identified appropriately by the midwives but not reported via the study protocol, 29 were referred from secondary care, (1) by a general practitioner at 9 days of age and (2) who did not become jaundiced before 3 months, leaving one infant who was 'missed' by the midwives. No infant whose conjugated bilirubin was below the authors' threshold later presented with liver disease. This is an effective protocol for identifying neonatal liver disease but requires ongoing education to maintain compliance.
