Page 173 - 16Neonatal Jaundice_compressed

8 Information

Clinical question
What information and support should be given to parents/carers of babies with neonatal
hyperbilirubinaemia?
a) At the time of birth
b) At the time of recognition of jaundice (FOR ALL BABIES)
c) At the time of formal assessment/diagnosis
d) During monitoring
e) During treatment with phototherapy and other interventions
f) At discharge and follow-up

Description of included studies
Two studies 228-230 of EL 3 were included. One 228 examined barriers to follow-up in the first week
of life and the other 229;230 (reported in two publications) investigated maternal concerns about
jaundice

Review findings
228
A qualitative study in the USA examined barriers to first-week follow-up for jaundice. Four
focus groups, one each for physicians and nurses and two for parents, comprising seven to nine
participants each, were held. Sessions lasted from 90 to 120 minutes and were led by an
experienced facilitator supported by a second observer/facilitator. Participants were asked about
their experiences, and for possible suggestions for improving this experience. In total, nine
physicians, eight nurses and 14 parents attended the focus groups. Tapes of each session were
transcribed and summarised. Responses were grouped into categories based on themes including
communication and information, systems and processes of care, and knowledge/education. The
experiences and solutions relating to information are listed in Table 8.1.

Table 8.1 Problems and solutions regarding information about jaundice
Experiences Reported by Solutions Reported by
Communication gaps during hand-over MD, RN Notify community healthcare MD, RN
provider when baby born
Missing key information, e.g. birth details, MD, RN Provide easy access to lab MD, RN
lab tests
Provide parents with contact P
numbers
Early discharge limits time for parental RN Parental education throughout MD, RN, P
education continuum of care
Reluctance to educate parents prenatally MD, RN Increase physician awareness of MD, RN
risks to near-terms
Poor understanding of risks to near-terms MD
MD = medical doctor; RN = registered nurse; P = parent.

An ethnographic study from the USA 229;230 examined maternal concerns about neonatal
jaundice. In all, 47 mothers of healthy breastfeeding babies with jaundice were interviewed.
The mean maternal age was 27 years. Over half of multiparous mothers had had a previous
baby with jaundice and three-quarters had breastfed a previous baby. Hyperbilirubinaemia was
defined as serum bilirubin > 170 micromol/litre. The interviews were held between 2.5 and

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