NS Kwong

Background - Neonatal jaundice constitutes significant portion of admission case load in many regional hospitals. Traditionally, jaundice babies were admitted through A&E department basing on loose criteria. This practice drains heavily on the medical and nursing manpower, Moreover, it also hinders infant-maternal bonding by requiring admission to hospital for observation and therapy.

Method - The Neonatal jaundice Shared care programme was first started in TMH in August 1995 in collaboration with Department of Health. Five Maternal and Child Health Centres (MCHCs) in Yuen Long and Tuen Mun regions joined TMH as a network, to serve the local population of NT (west) with annual delivery of about 6700 per year. A unified and agreed standard protocol for managing jaundice babies was adopted. Jaundice babies were first screened at MCHCs according to such protocol. Those with significant jaundice were advised and referred to TMH as ambulatory cases for further workup including serum bilurubin assay. Only moderate to severe jaundice cases with serum bilirubin level > 250 umol/l need direct admission to ward as inpatients for specific therapy, while others were given advice and discharged home, They will be reassessed the next day at MCHCs, or in hospital for repeat serum bilirubin assay as outpatient until stable.

Result - From 14th August 1995 to 16th June 1997 a total of 980 new cases attended our service, with 1155 subsequent followup visits arranged. Amongst 980 babies, 468 (47.8%) were admitted on initial visit occasion. These elective and planned clinical admissions accounted for half of total admitted for neonatal jaundice, while the other half were unplanned admission through A&E Department. Average hospital stay was 2 days. 485 (49.4%) babies were solely on breast feeding. 380 (38.8%) babies were formula fed, while 110 (11.2%) babies were on mixed breast and formula feeding. The average age of onset of jaundice was 3 days, with average age at presentation at day 4 of life, with mean serum bilirubin 244 umol/L. There was mild seasonal fluctuation in the attendance rate with more during winter months which concurred with seasonal birth pattern. Mean time taken per hospital visit was minutes.

Conclusion - A standard and unified protocol for managing neonatal jaundice helps streamlining care of these babies. The shared-care approach both satisfies the primary care health provider in providing a backup support, as well as appears more reassuring to the clients in offering timely referral in coordinated manner.