Lee Way Seah
Department of Paediatrics, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia.
J Paediatr Child Health. 2008 Jan;44(1-2):57-61. doi: 10.1111/j.1440-1754.2007.01170.x. Epub 2007 Jul 19.
To study factors leading to delayed referral in neonatal cholestasis at a tertiary centre in Malaysia.
A prospective, observational study on consecutive infants with neonatal cholestasis referred to a tertiary unit paediatric liver unit in Malaysia.
Thirty-one of the 65 (43%) patients studied encountered delay or had an inappropriate action taken before referral. Factors leading to delayed referral, which adversely affected the outcome of biliary atresia (BA) and neonatal acute liver failure, were repeated reassurances by medical and paramedical staff (n = 17, 26%), failure of hospital services at the referring hospital (n = 7, 11%) and parental refusal for referral (n = 5, 8%). Only three (14%) of the 22 patients who developed liver failure had liver transplantation (LT). The 1-year survival rate with native liver for BA was 35%, while overall 1-year survival rate (native liver and LT) was 41%.
Repeated false reassurance, failure of hospital services and parental refusal all contributed to delayed referral in neonatal cholestasis. In addition to education of medical and public health workers, and parents on the importance of early referral in neonatal cholestasis, health authorities in Malaysia should consider the feasibility of universal stool colour screening in newborn infants to improve the outcome of BA.
研究马来西亚一家三级医疗中心新生儿胆汁淤积延迟转诊的相关因素。
对转诊至马来西亚一家三级儿科肝病科的连续性新生儿胆汁淤积婴儿进行前瞻性观察研究。
在65例研究患者中，有31例（43%）在转诊前出现延迟或采取了不当措施。导致延迟转诊并对胆道闭锁（BA）和新生儿急性肝衰竭结局产生不利影响的因素包括医护人员反复给予安慰（17例，26%）、转诊医院的医疗服务故障（7例，11%）以及家长拒绝转诊（5例，8%）。在22例发生肝衰竭的患者中，仅有3例（14%）接受了肝移植（LT）。BA患儿保留自身肝脏的1年生存率为35%，而总体1年生存率（保留自身肝脏和接受LT）为41%。
反复给予错误安慰、医疗服务故障和家长拒绝均导致了新生儿胆汁淤积的延迟转诊。除了对医护人员、公共卫生工作者和家长开展关于新生儿胆汁淤积早期转诊重要性的教育外，马来西亚卫生当局应考虑在新生儿中进行普遍粪便颜色筛查的可行性，以改善BA的结局。
