Implementing Continuous Nursing Care After Kasai Procedure in Infants with Biliary Atresia
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Yuandi Cheng1, Wei Zuo1, Wei Gao1
1Department of Newborn Surgery, Anhui Provincial Children's Hospital.
Insights
A new continuity of nursing care (CNC) protocol improved outcomes for infants with biliary atresia (BA) post-Kasai portoenterostomy. This standardized approach enhances infant weight gain and bilirubin levels, alongside increased parental satisfaction.
Area of Science:
- Pediatric Surgery
- Infant Health
- Nursing Care Protocols
Background:
- Biliary atresia (BA) is a severe infantile cholangiopathy requiring Kasai portoenterostomy, yet postoperative complications and poor discharge adherence are common.
- Current care gaps lead to delayed complication recognition and suboptimal infant outcomes after BA surgery.
- A standardized protocol is needed to ensure continuity of care and improve family engagement post-infant surgery.
Purpose of the Study:
- To describe a novel continuity of nursing care (CNC) protocol for infants with biliary atresia (BA) post-Kasai portoenterostomy, facilitating replication.
- To evaluate the impact of the CNC protocol on infant outcomes and parental satisfaction compared to routine care.
Main Methods:
- Implementation of a standardized CNC protocol including structured discharge education, 6-month follow-up (clinic/tele-clinic), remote monitoring, and parental training.
- Use of unified nursing follow-up forms, predefined escalation thresholds, and weekly data verification for consistent intervention delivery.
- Comparison of outcomes (weight gain, bilirubin levels, complication rates) and parental satisfaction between infants managed with CNC and historical controls.
Main Results:
- Infants in the CNC group demonstrated enhanced postoperative weight gain and faster total bilirubin decline within 6 months.
- Trends towards reduced cholangitis and rehospitalization rates were observed in the CNC group, though not statistically significant.
- Significantly higher parental satisfaction was reported in the CNC group, indicating improved engagement and support.
Conclusions:
- The developed CNC protocol provides a replicable framework to enhance postoperative nursing care for infants with biliary atresia.
- This structured approach strengthens family participation and supports better management of infants undergoing Kasai portoenterostomy.
- Adapting this protocol can improve clinical outcomes and family-centered care in BA management across different centers.
Abstract:
Biliary atresia (BA) is a severe cholangiopathy of infancy characterized by progressive obstruction of the extrahepatic bile ducts. Kasai portoenterostomy remains the standard initial treatment, but postoperative complications such as cholangitis, malnutrition, and progressive jaundice remain common and can compromise long-term outcomes. Conventional discharge guidance often lacks continuity, leading to poor family adherence and delayed recognition of complications once the infant returns home. To address this gap, we developed and implemented a standardized protocol for continuity of nursing care (CNC) following Kasai portoenterostomy in infants with BA. The protocol integrates structured discharge education, a 6-month follow-up schedule with clinic or tele-clinic visits, remote monitoring through telephone or secure messaging, and targeted parental training in nutrition, medication management, and early symptom recognition. Nurses use unified follow-up forms, predefined escalation thresholds, and weekly data verification to ensure data accuracy and consistent delivery of interventions. The primary objective of this study was to describe the CNC protocol in sufficient detail to enable replication. A secondary objective was to present representative outcomes comparing infants managed with CNC versus historical controls receiving routine nursing care. Infants in the CNC group showed greater postoperative weight gain and more rapid declines in total bilirubin levels within 6 months, while rates of cholangitis and rehospitalization showed favorable but statistically nonsignificant trends. Parental satisfaction was significantly higher in the CNC group, reflecting improved engagement and perceived support. This protocol offers a practical framework that other centers can adapt to strengthen postoperative nursing care and family participation in the management of infants with biliary atresia.
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