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Clinical practices among healthcare professionals concerning neonatal jaundice and pale stools
Ermelinda Santos Silva1,2, Helena Moreira Silva3, Lia Azevedo Lijnzaat4
1Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal. ermelinda.dca@chporto.min-saude.pt.
Insights
Many healthcare professionals delay diagnosing neonatal cholestasis, indicated by jaundice and pale stools. Specialization in healthcare professionals is linked to better recognition skills, highlighting the need for targeted education to improve infant liver disease outcomes.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Clinical Practice Evaluation
Background:
- Neonatal cholestasis, a serious condition, requires early diagnosis for better outcomes.
- Delayed recognition and referral of neonatal cholestasis are common issues.
- Limited studies assess healthcare professionals' ability to identify neonatal cholestasis and pale stools.
Purpose of the Study:
- To evaluate clinical practices of healthcare professionals regarding jaundiced newborns.
- To assess the ability of physicians and nurses to recognize pale stools in infants.
- To identify factors influencing the timely diagnosis of neonatal liver disease.
Main Methods:
- A questionnaire and validated stool photographs were administered to 266 healthcare professionals (physicians and nurses).
- Data analysis considered professional status, specialization, years of experience, and healthcare level.
- Multiple linear regression was used to identify significant predictors of recognizing pale stools.
Main Results:
- A significant percentage of nurses based decisions on jaundice intensity rather than other indicators.
- Many physicians showed reluctance in ordering conjugated bilirubin assays for jaundiced newborns.
- Specialization was identified as a key factor independently associated with better pale stool recognition.
Conclusions:
- Healthcare professionals' practices often hinder the timely recognition of neonatal cholestasis and pale stools.
- There is a clear need for enhanced educational initiatives for healthcare providers.
- Professional specialization, more than experience, correlates with improved diagnostic skills and practices for neonatal liver conditions.
Abstract:
Jaundice and pale stools are major indicators of neonatal liver disease. Prognosis depends on timely diagnosis and management. We evaluated the clinical practices among healthcare professionals concerning jaundiced newborns and their ability to recognize pale stools. We supplied a questionnaire and a panel with eight photographs of stools, both locally validated, to physicians and nurses of the National Healthcare Service. Analysis was conducted according to professional status, specialization and years of experience of professionals and level of healthcare. Questionnaires were administered to 266 participants (100 physicians, 166 nurses). The decision to send patients to medical observation depended on the intensity of jaundice for a significant percentage of nurses. Concerning jaundiced newborns breastfed and otherwise healthy, 28.9% of physicians would never request a conjugated bilirubin assay, and only 43.3% would request it after 14 days old; for those with other signs/symptoms of disease, only 69.1% of physicians would request it immediately. Multiple linear regression analysis identified specialization as an independent variable significantly associated with the ability to recognize pale stools.
Conclusion:
A significant percentage of healthcare professionals assumed clinical practices that preclude the timely recognition of cholestasis/pale stools, reinforcing the idea of educational needs. Specialization, rather than years of experience of professionals, was associated with better skills and practices. What is Known: • Neonatal cholestasis is a condition with some rare underlying entities having high mortality and morbidity. Early diagnosis is crucial to improve prognosis. Yet, many cases remain late recognized and referred. • Studies evaluating the ability of healthcare professionals to recognize neonatal cholestasis are scarce. What is New: • In this study, a significant percentage of professionals assumed clinical practices that preclude timely recognition of neonatal cholestasis and pale stools, reinforcing the idea of educational needs. • Specialization of professionals was associated with better skills and practices.
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