Management of neonatal jaundice by a midwife obstetric unit - Critical evaluation
Background. Infants are screened for neonatal jaundice (NNJ) at midwife obstetric units (MOUS) and treated with phototherapy at Bishop Lavis MOU. No information is available on the efficacy of the system. Objective. To determine the effectiveness of the current NNJ screening, treatment with phototherapy and referral system at the MOUs. Methods. Neonates whose total serum bilirubins (TSBs) were screened between 1 August 1999 and 31 July 2001 at Elsies River and Bishop Lavis MOUs, or who were admitted to Bishop Lavis MOU's for phototherapy, or who were referred to Tygerberg Children's Hospital (TBH) for further management were studied retrospectively. The duration of admission, number and location of those transferred, processing time of blood samples and indications for transfer, were recorded. Results. A total of 3 962 infants were screened, of whom 381 were admitted to Bishop Lavis MOU for phototherapy and 40 were transferred to TBH for a possible exchange transfusion. The mean processing time of the blood samples was 6.4 hours (± 1.9 hours). Serious deficiencies were identified in the TSB screening system as reflected by long blood sample to laboratory processing time (BSLPT). Conclusion. The current screening and treatment system is effective as reflected by the number of patients screened and treated at the MOU. Only 10.4% of neonates admitted to Bishop Lavis for phototherapy were transferred to TBH. The long BSLPT should be reduced. Recommendations. More phototherapy units should be set up at the MOUs. Blood processing time would be shortened by contracting a laboratory closer to the MOU.