title: An audit of a community protocol for identifying neonatal liver disease.
abstract: Performing a split bilirubin test to identify liver disease in any infant who remains jaundiced beyond 2 weeks of age has been recognised as good clinical practice. The Leeds Community Midwifery Team performed this test, following an agreed protocol, from December 2000. By February 2008, 882 infants had been tested. Three infants were identified as having significant liver disease, including one with biliary atresia. Examining the liver unit database, a further 38 infants with Leeds post codes presented with neonatal liver disease during the study period. Five infants were identified appropriately by the midwives but not reported via the study protocol, 29 were referred from secondary care, (1) by a general practitioner at 9 days of age and (2) who did not become jaundiced before 3 months, leaving one infant who was 'missed' by the midwives. No infant whose conjugated bilirubin was below the authors' threshold later presented with liver disease. This is an effective protocol for identifying neonatal liver disease but requires ongoing education to maintain compliance.
authors.affiliation: Children's Liver and GI Unit, Leeds Teaching Hospitals NHS Trust, Paediatric Offices, Ward 39, Old Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. patricia.mcclean@leedsth.nhs.uk
authors.forename: Peter
authors.initials: P
authors.lastname: Cartledge
authors.forename: Neeta
authors.initials: N
authors.lastname: Kevlani
authors.forename: Leonie
authors.initials: L
authors.lastname: Shapiro
authors.forename: Patricia
authors.initials: P
authors.lastname: McClean
mesh_terms: D000367:Age Factors; D001656:Biliary Atresia / Q000175:diagnosis / Q000453:epidemiology; D001663:Bilirubin / Q000097:blood; D002985:Clinical Protocols; D003153:Community Health Services / Q000379:methods; D004739:England / Q000453:epidemiology; D006801:Humans; D006932:Hyperbilirubinemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000209:etiology; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D008485:Medical Audit; D008880:Midwifery / Q000379:methods
chemical_list: D001663:Bilirubin