IMPACT OF DELAYED SCREENING FOR PROLONGED JAUNDICE IN THE NEWBORN

Background Jaundice in the newborn beyond 14 days is a trigger to screen for serious underlying disorders. Early screening may lead to unnecessary investigations on a baby. We evaluated the impact of delayed screening for prolonged jaundice. Methods Babies with prolonged jaundice referred between April 2006 and July 2007 on day 14 by their midwife were assessed from day 21 at a dedicated clinic. Clinical evaluation and investigations were carried out to identify serious underlying pathology. Results from this evaluation were analysed. Results 183 babies were referred with prolonged jaundice. Jaundice resolved completely in 33 babies (18%) prior to assessment. The files of 140 (93.3%) of 150 remaining babies who attended clinic were analysed. The mode age at review was 3 (range 2–9) weeks. The average GA was 38.1±2.0 weeks. The average BW was 3.17±0.63 kg. 43/140 babies (30.7%) were not investigated as they were not jaundiced. 92 of 97 babies with jaundice were investigated. The average bilirubin level was 145±60.4 μmol/l (range 23–302 μmol/l). 112 of 140 babies were reviewed once at the clinic. 40% of babies reviewed at 2 weeks attended more than once compared with 18% of babies seen at 3 weeks and older. 72% were discharged from the clinic. 1 baby with UTI, 2 babies with elevated TSH and 6 babies with cardiac murmurs were identified. Conclusions Delayed clinical evaluation reduced significantly the number of babies investigated for prolonged jaundice without compromising the need to identify serious underlying pathology.