13 Neonatal prolonged jaundice screening – change of practice during Covid pandemic

IntroductionPersistent neonatal jaundice can occur in 15–20% of newborn babies. It was believed that Pregnanediol secreted in human milk inhibits conjugation of bilirubin however, a study based on mass-spectrometry in 1980s did not provide such evidence. A rapid decrease in jaundice when breast feed...

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Published in:Archives of disease in childhood 2023-07, Vol.108 (Suppl 2), p.A131-A131
Main Author: Gowda, Bharath
Format: Article
Language:English
Subjects:
Autism
Autism Spectrum Disorders
Babies
Bilirubin
Breast feeding
Breast milk
Cardiovascular diseases
COVID-19
Heart diseases
Hemoglobin
Hemolysis
Hyperbilirubinemia
Infants
Jaundice
Neonates
Newborn babies
Pandemics
Phlebotomy
Referral
Scientific Concepts
Spectrometry
Teaching Methods
Young Children
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Summary:IntroductionPersistent neonatal jaundice can occur in 15–20% of newborn babies. It was believed that Pregnanediol secreted in human milk inhibits conjugation of bilirubin however, a study based on mass-spectrometry in 1980s did not provide such evidence. A rapid decrease in jaundice when breast feeding is stopped suggests some inhibitor in human milk that remains unknown. The prolonged jaundice screening is aimed at minority of cases that have underlying pathology.BackgroundUntil May 2020, babies were screened by SHO but in the first wave of Covid-19 pandemic, junior doctors were redeployed to adult wards. Hence babies were directly referred to phlebotomist if they are deemed well by the Health Visitor or to A&E if they were unwell.MethodsThe phlebotomists attended a teaching session on prolonged jaundice, and they started to collect vital information including parental report of stool colour, weight gain and adequacy of feeding. Screening was done within 48 hours and Consultant was notified who sent ‘normal screening’ letter or arranged follow-up as necessary.ResultsBefore Covid, 363 babies were seen over three years. Average haemoglobin and bilirubin were 140g/L and 144mmol/L respectively. Two babies had high ALT which normalised on repeat test, and none had conjugated hyperbilirubinemia.In one year during Covid, 121 babies were seen. Average haemoglobin and bilirubin were similar (144g/L and 156mmol/L respectively). One baby had elevated ALT and three had conjugated hyperbilirubinemia that normalised subsequently. None needed referral to Liver Unit.There was no significant difference in timing of the prolonged jaundice screen (21.9 days Vs 24.6 days) between the two groups. An arbitrary level of total bilirubin of >200 mmol/L and haemoglobin
ISSN:0003-9888
1468-2044
DOI:10.1136/archdischild-2023-rcpch.217