Santos Silva Ermelinda, Moreira Silva Helena, Azevedo Lijnzaat Lia, Melo Cláudia, Costa Elísio, Martins Esmeralda, Lopes Ana Isabel
Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge Viterbo Ferreira, nº 228, 4050-313, Porto, Portugal.
Gastroenterology Unit, Paediatrics Division, Departmento da Criança e do Adolescente, Centro Materno-Infantil do Norte, Centro Hospitalar do Porto, Largo da Maternidade Júlio Dinis, 4050-651, Porto, Portugal.
Eur J Pediatr. 2017 Mar;176(3):361-369. doi: 10.1007/s00431-016-2847-y. Epub 2017 Jan 12.
Jaundice and pale stools are major indicators of neonatal liver disease. Prognosis depends on timely diagnosis and management. We evaluated the clinical practices among healthcare professionals concerning jaundiced newborns and their ability to recognize pale stools. We supplied a questionnaire and a panel with eight photographs of stools, both locally validated, to physicians and nurses of the National Healthcare Service. Analysis was conducted according to professional status, specialization and years of experience of professionals and level of healthcare. Questionnaires were administered to 266 participants (100 physicians, 166 nurses). The decision to send patients to medical observation depended on the intensity of jaundice for a significant percentage of nurses. Concerning jaundiced newborns breastfed and otherwise healthy, 28.9% of physicians would never request a conjugated bilirubin assay, and only 43.3% would request it after 14 days old; for those with other signs/symptoms of disease, only 69.1% of physicians would request it immediately. Multiple linear regression analysis identified specialization as an independent variable significantly associated with the ability to recognize pale stools.
A significant percentage of healthcare professionals assumed clinical practices that preclude the timely recognition of cholestasis/pale stools, reinforcing the idea of educational needs. Specialization, rather than years of experience of professionals, was associated with better skills and practices. What is Known: • Neonatal cholestasis is a condition with some rare underlying entities having high mortality and morbidity. Early diagnosis is crucial to improve prognosis. Yet, many cases remain late recognized and referred. • Studies evaluating the ability of healthcare professionals to recognize neonatal cholestasis are scarce. What is New: • In this study, a significant percentage of professionals assumed clinical practices that preclude timely recognition of neonatal cholestasis and pale stools, reinforcing the idea of educational needs. • Specialization of professionals was associated with better skills and practices.
黄疸和浅色粪便为新生儿肝病的主要指标。预后取决于及时诊断和治疗。我们评估了医护人员对黄疸新生儿的临床诊疗行为及其识别浅色粪便的能力。我们向国家医疗服务体系的医生和护士发放了一份问卷以及一组包含八张粪便照片的图板，二者均经过本地验证。分析依据专业人员的职业状态、专业领域、工作经验年限以及医疗水平展开。共向266名参与者（100名医生、166名护士）发放了问卷。对于相当比例的护士而言，将患者送去医学观察的决定取决于黄疸的严重程度。对于母乳喂养且无其他健康问题的黄疸新生儿，28.9%的医生从不要求检测结合胆红素，只有43.3%的医生会在婴儿14日龄后要求检测；对于有其他疾病体征/症状的新生儿，只有69.1%的医生会立即要求检测。多元线性回归分析确定专业领域是与识别浅色粪便能力显著相关的独立变量。
相当比例的医护人员采取的临床诊疗行为妨碍了对胆汁淤积/浅色粪便的及时识别，这凸显了开展教育的必要性。与专业人员的工作经验年限相比，专业领域与更好的技能和诊疗行为相关。已知信息：• 新生儿胆汁淤积是一种由一些罕见潜在病因导致的疾病，具有较高的死亡率和发病率。早期诊断对于改善预后至关重要。然而，许多病例仍被延误诊断和转诊。• 评估医护人员识别新生儿胆汁淤积能力的研究较少。新发现：• 在本研究中，相当比例的专业人员采取的临床诊疗行为妨碍了对新生儿胆汁淤积和浅色粪便的及时识别，这凸显了开展教育的必要性。• 专业人员的专业领域与更好的技能和诊疗行为相关。
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