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Assessing for neonatal jaundice in the community: an integrative systematic review
Lucy J Hives1, Gill Thomson1, Cath Harris2
1Maternal, Parental and Infant Nutrition and Nurture Unit, University of Lancashire, UK.
Insights
Assessing newborn jaundice in the community is challenging. Transcutaneous Bilirubinometry (TcB) offers a more accurate and efficient method than visual checks, but further research is needed for diverse populations.
Area of Science:
- Neonatal care
- Public health
- Medical diagnostics
Background:
- Neonatal jaundice is common, but untreated hyperbilirubinemia can cause kernicterus.
- Early jaundice recognition and assessment are crucial for timely intervention.
- Current knowledge on community-based jaundice assessment feasibility is limited.
Purpose of the Study:
- To review community-based neonatal jaundice assessment in high-income countries.
- To identify barriers and facilitators to accurate jaundice assessment outside hospital settings.
Main Methods:
- An integrative review of nine studies from five databases.
- Narrative synthesis of findings on jaundice assessment methods and experiences.
Main Results:
- Jaundice assessment methods include visual inspection, Transcutaneous Bilirubinometry (TcB), and Total Serum Bilirubin (TSB).
- TcB is more accurate, less invasive, and less costly than TSB, and superior to visual assessment.
- Key themes identified include communication, knowledge, resources, and setting variations.
Conclusions:
- Clear communication pathways and professional training are essential for effective jaundice management.
- Further research is required to establish optimal TcB thresholds and its accuracy in infants with darker skin tones.
Background:
Jaundice is a common condition in newborn babies, usually resolving within two weeks post-birth. A small number of babies develop hyperbilirubinaemia, which if untreated can lead to kernicterus. It is essential to recognise jaundice and assess the bilirubin level as quickly as possible so that timely treatment can be provided. However, currently, there is a lack of knowledge about the feasibility of assessing jaundice reliably in the community.
Aim:
This integrative review explores the experiences, barriers and facilitators to assessing for neonatal jaundice in community settings in high-income countries.
Methods:
Five databases (MEDLINE, PsycINFO, CINAHL, Embase and Overton) and backward and forward chaining were undertaken. Findings were analysed and synthesised using a narrative-based approach.
Discussion:
Searches identified 7076 hits, and after exclusions, nine studies were included. Jaundice assessment methods included visual assessment, Transcutaneous Bilirubinometer (TcB), and Total Serum Bilirubin (TSB). Six themes were developed: 1) Communication, 2) Knowledge and skills, 3) Time and resources, 4) Variation in post-discharge care, 5) Type of community setting and 6) Impact of community screening. TcB was reported to be more accurate than visual inspection, and less time consuming, invasive and costly than TSB.
Conclusion:
Available insights highlight the need for clear communication and care pathways, and training and education for healthcare professionals and parents. Further research is needed to determine the optimal TcB derived threshold values for hyperbilirubinaemia and accuracy among babies with dark skin tones.
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