Abstract:
Neonatal jaundiced due to elevated bilirubin levels is common and often self-limiting. However, Prolonged Jaundice (PJ) may indicate underlying conditions like metabolic or hepatic disorders which require prompt screening. The National Institute of Health and Care Excellence (NICE) provides a framework for PJ screening. Biliary Atresia (BA) is a rare but serious cause of jaundice in neonates and is the primary indication for liver transplantation. The University Hospital Sussex NHS Trust’s Nurse- led clinic, established in 2018 and has refined protocols for assessing PJ cases, improving diagnosis and management in line with updated guidelines.
This study aims to assess the efficiency of the nurse-led PJ clinic at the Royal Alexandra Children’s Hospital (RACH) in seeing patients within an appropriate timeframe and identifying any potential BA cases. A retrospective review evaluated the nurse-led PJ clinic at the Royal Alexandra Children Hospital between January 2022 and October 2024. Descriptive analysis, including graphical presentations of frequency distribution was used to present the data. Patient notes were also reviewed to look at the laboratory investigation results (from Trust online software ICE) that were flagged in line with the PJ proforma.
No BA cases or other significant pathology was identified within the studies timeframe. From the results, it was highlighted that 21.64% of patients were seen by 4 weeks, 67.53% of were seen between 4 to 6 weeks and 10.83% of patients were seen after 6 weeks of age. The results from the study showed room for improvement. This included actions to see patients by week 4, ensuring investigations to be successfully collected in the first visit and putting in place a 2- tier investigation pathway to reduce the costs of unnecessary follow up visits and tests. A nurse-led service for PJ evaluation could be considered cost effective.
