title: Clinical practices among healthcare professionals concerning neonatal jaundice and pale stools.
abstract: Jaundice and pale stools are major indicators of neonatal liver disease. Prognosis depends on timely diagnosis and management. We evaluated the clinical practices among healthcare professionals concerning jaundiced newborns and their ability to recognize pale stools. We supplied a questionnaire and a panel with eight photographs of stools, both locally validated, to physicians and nurses of the National Healthcare Service. Analysis was conducted according to professional status, specialization and years of experience of professionals and level of healthcare. Questionnaires were administered to 266 participants (100 physicians, 166 nurses). The decision to send patients to medical observation depended on the intensity of jaundice for a significant percentage of nurses. Concerning jaundiced newborns breastfed and otherwise healthy, 28.9% of physicians would never request a conjugated bilirubin assay, and only 43.3% would request it after 14 days old; for those with other signs/symptoms of disease, only 69.1% of physicians would request it immediately. Multiple linear regression analysis identified specialization as an independent variable significantly associated with the ability to recognize pale stools.
  
  
  CONCLUSIONS
  A significant percentage of healthcare professionals assumed clinical practices that preclude the timely recognition of cholestasis/pale stools, reinforcing the idea of educational needs. Specialization, rather than years of experience of professionals, was associated with better skills and practices. What is Known: • Neonatal cholestasis is a condition with some rare underlying entities having high mortality and morbidity. Early diagnosis is crucial to improve prognosis. Yet, many cases remain late recognized and referred. • Studies evaluating the ability of healthcare professionals to recognize neonatal cholestasis are scarce. What is New: • In this study, a significant percentage of professionals assumed clinical practices that preclude timely recognition of neonatal cholestasis and pale stools, reinforcing the idea of educational needs. • Specialization of professionals was associated with better skills and practices.
authors.affiliation: Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal. ermelinda.dca@chporto.min-saude.pt.|Gastroenterology Unit, Paediatrics Division, Departmento da Criança e do Adolescente, Centro Materno-Infantil do Norte, Centro Hospitalar do Porto, Largo da Maternidade Júlio Dinis, 4050-651, Porto, Portugal. ermelinda.dca@chporto.min-saude.pt.
authors.forename: Ermelinda
authors.initials: E
authors.lastname: Santos Silva
authors.affiliation: Paediatrics Division, Departamento da Criança e do Adolescente, Centro Materno-Infantil do Norte, Centro Hospitalar do Porto, Largo da Maternidade Júlio Dinis, 4050-651, Porto, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Moreira Silva
authors.affiliation: Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.
authors.forename: Lia
authors.initials: L
authors.lastname: Azevedo Lijnzaat
authors.affiliation: Paediatrics Division, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Rua de Cupertino de Miranda, 4764-958, Vila Nova de Famalicão, Portugal.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Melo
authors.affiliation: UCIBIO, Department of Biological Sciences, Faculdade de Farmácia, Universidade do Porto, Rua Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.
authors.forename: Elísio
authors.initials: E
authors.lastname: Costa
authors.affiliation: Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.|Metabolic Diseases Unit, Paediatrics Division, Departmento da Criança e do Adolescente, Centro Materno-Infantil do Norte, Centro Hospitalar do Porto, Largo da Maternidade Júlio Dinis, 4050-651, Porto, Portugal.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Martins
authors.affiliation: Gastroenterology Unit, Paediatrics Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1600-190, Lisboa, Portugal.|Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisboa, Portugal.
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: Lopes
mesh_terms: D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000150:complications / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005243:Feces; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000150:complications / Q000175:diagnosis*; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D001663:Bilirubin
keywords: Biliary atresia; Dark urine; Neonatal cholestasis; Newborn jaundice; Pale stools