title: Pre-admission consultation and late referral in infants with neonatal cholestasis.
abstract: OBJECTIVE
  To study factors leading to delayed referral in neonatal cholestasis at a tertiary centre in Malaysia.
  
  
  METHODS
  A prospective, observational study on consecutive infants with neonatal cholestasis referred to a tertiary unit paediatric liver unit in Malaysia.
  
  
  RESULTS
  Thirty-one of the 65 (43%) patients studied encountered delay or had an inappropriate action taken before referral. Factors leading to delayed referral, which adversely affected the outcome of biliary atresia (BA) and neonatal acute liver failure, were repeated reassurances by medical and paramedical staff (n = 17, 26%), failure of hospital services at the referring hospital (n = 7, 11%) and parental refusal for referral (n = 5, 8%). Only three (14%) of the 22 patients who developed liver failure had liver transplantation (LT). The 1-year survival rate with native liver for BA was 35%, while overall 1-year survival rate (native liver and LT) was 41%.
  
  
  CONCLUSIONS
  Repeated false reassurance, failure of hospital services and parental refusal all contributed to delayed referral in neonatal cholestasis. In addition to education of medical and public health workers, and parents on the importance of early referral in neonatal cholestasis, health authorities in Malaysia should consider the feasibility of universal stool colour screening in newborn infants to improve the outcome of BA.
authors.affiliation: Department of Paediatrics, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia. leews@um.edu.my
authors.forename: Way Seah
authors.initials: WS
authors.lastname: Lee
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001656:Biliary Atresia / Q000150:complications / Q000175:diagnosis; D002779:Cholestasis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D002983:Clinical Competence; D034462:Dissent and Disputes; D042241:Early Diagnosis; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000150:complications / Q000175:diagnosis; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation; D008296:Malaysia; D008297:Male; D010290:Parents / Q000523:psychology; D011368:Professional-Family Relations; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome