Rationalized assessment of prolonged jaundice is safe and cost-effective

Area of Science:

• Neonatal Medicine
• Pediatric Gastroenterology
• Clinical Auditing

Background:

• Prolonged jaundice (PJ) in healthy term neonates is common but can indicate serious liver disease.
• Current assessment methods for PJ show significant variation.
• A balanced approach is needed to avoid over-investigation while detecting pathology early.

Purpose of the Study:

• To audit the management of prolonged jaundice in neonatal units.
• To evaluate the impact of a rationalized investigation algorithm based on BSPGHAN guidelines.
• To assess the effectiveness and cost-efficiency of the new algorithm.

Main Methods:

• Prospective audit of PJ management over two years in two Level 3 neonatal units.
• Comparison of practice before and after implementing a standardized algorithm (clinical exam, stool inspection, split bilirubin).
• Inclusion of 197 neonates referred with PJ (105 pre-algorithm, 92 post-algorithm).

Main Results:

• No underlying liver pathology was identified in the studied neonates with PJ.
• The rationalized algorithm led to a significant reduction in return appointments (28 vs. 7) and repeat investigations (37 vs. 7).
• Cost savings of £1575-£2625 annually in laboratory costs were observed.

Conclusions:

• A rationalized approach to assessing prolonged jaundice is effective, reduces workload, and is cost-effective.
• Selective screening for PJ has limitations, as evidenced by three infants with biliary atresia diagnosed late.
• Population-based screening methods warrant further consideration for identifying cholestatic liver disease.