Assessing knowledge and skills of maternity care professionals regarding neonatal hyperbilirubinaemia: a nationwide survey

Abstract

Background Neonatal hyperbilirubinaemia is a physiologic phenomenon, but, when severe, may cause lifelong disability. Maternity care assistants (MCAs) play an important role in timely recognition of severe neonatal jaundice. We assessed knowledge and skills of MCAs regarding neonatal hyperbilirubinaemia. Methods All Dutch MCAs (n = 9065) were invited to fill out a questionnaire assessing knowledge, expertise, and handling of neonatal jaundice. Additionally, we developed an e-learning and provided training sessions to a subgroup of MCAs (n = 99), and assessed their knowledge on neonatal hyperbilirubinaemia before and after the training. Results One thousand four hundred sixty-five unique online questionnaires were completed (response 16.2%). The median number of correctly answered knowledge questions was 5 (out of six; IQR 1). Knowledge was significantly better when respondents had had in-service training on neonatal hyperbilirubinaemia in the previous year (p = 0.024). Although 82% of respondents felt highly skilled or skilled to assess jaundice, accuracy of estimation of total serum bilirubin levels by assessing skin colour was generally poor and prone to underestimation. Among participants attending a training session, those who completed the e-learning beforehand had higher pre-training scores (5 (IQR 1) vs. 4 (IQR 2); p < 0.001). The median post-training score was higher than pre-training (6 (IQR 1) vs. 5 (IQR 2); p < 0.001). Conclusions Background knowledge of MCAs regarding neonatal hyperbilirubinaemia was adequate, but can be improved by further training. Estimation of total serum bilirubin levels based on skin colour was often inadequate. Approaches to improve timely recognition of jaundiced neonates are needed.

Assessment, management, and incidence of neonatal jaundice in healthy neonates cared for in primary care: a prospective cohort study

“…Strikingly, in a substantial proportion of neonates being assessed as ‘quite yellow’ or ‘very yellow’, no TcB or TSB was quantified. This observation corresponds with a previous study among MCAs regarding neonatal hyperbilirubinaemia, which showed structural underestimation of TSB levels and common application of a so-called ‘wait-and-see approach’ in visibly jaundiced neonates 30 . Moreover, despite being strongly recommended by the national guideline 4 , TSB was not quantified in two neonates who developed visible jaundice within 24 h after birth.…”

“…In the current study, we did not prospectively explore the considerations underlying these decisions. Previous studies indicate that lack of knowledge on guideline recommendations 31 , 32 , and systematic underestimation of the severity of jaundice based on visual assessment likely contributed 30 . Other potential reasons for non-compliance may include a belief that the recommendations in the guideline do not reflect the best care for the neonate (e.g., a healthcare provider may consider the phototherapy thresholds too conservative as evidence on exact phototherapy thresholds is lacking 33 , and TSB quantification is avoided to keep the neonate in primary care), or practical challenges regarding feasibility of guideline compliance in daily practice.…”

Severe neonatal hyperbilirubinaemia: lessons learnt from a national perinatal audit

“…Additionally, and especially in the home setting, it may take several hours before TSB test result is obtained. Other potential explanations for the delay may be a wait-and-see approach and underestimation of the severity of hyperbilirubinaemia and its potential consequences in otherwise healthy neonates, which has also been shown in a nationwide survey among MCAs 27. ET was performed in only 28% of the neonates, whereas all neonates had a TSB level above ET threshold.…”