Pre-admission consultation and late referral in infants with neonatal cholestasis

Lee, W.S. (2008) Pre-admission consultation and late referral in infants with neonatal cholestasis. Journal of Paediatrics and Child Health, 44 (1-2). pp. 57-61. ISSN 1034-4810, DOI

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Aims: To study factors leading to delayed referral in neonatal cholestasis at a tertiary centre in Malaysia. Methods: A prospective, observational study on consecutive infants with neonatal cholestasis referred to a tertiary unit paediatric liver unit in Malaysia. Results: 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. Conclusions: 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.

Item Type: Article
Uncontrolled Keywords: Late referral; neonatal cholestasis; familial intrahepatic ; cholestasis; biliary atresia; hepatobiliary-disease; hemochromatosis; identification; jaundice
Subjects: R Medicine
R Medicine > RJ Pediatrics
Divisions: Faculty of Medicine
Depositing User: Ms Haslinda Lahuddin
Date Deposited: 10 Jul 2014 01:20
Last Modified: 25 Feb 2019 07:53

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