Understanding community detection, testing and management of neonatal jaundice in term infants in the UK: a mixed methods study

BACKGROUND: Neonatal jaundice affects 60-80% of newborns, with bilirubin testing recommended for suspected jaundice. In the UK, detection largely falls to community midwifery services. Challenges in neonatal jaundice pathways have been identified but are not well understood. AIM: Explore and understand community neonatal jaundice pathways in the UK and identify improvement opportunities. METHODS: A mixed-methods study of community midwifery jaundice pathways in three UK NHS trusts in a diverse urban area including: (1) pathway mapping workshops, (2) cross-sectional analysis of detection, testing and admission in term infants, (3) time-motion exploration of serum bilirubin testing activity. Local data was triangulated with (4) a national survey of Heads of Midwifery. FINDINGS: Pathways and practice varied and deviated from NICE guidance locally and nationally, with many challenges identified. Among 16,760 eligible infants, 27% were assessed as jaundiced, of which 77% were not tested within 6 hours. Black infants were significantly less likely to be assessed or tested. 64% of infants re-admitted were not tested in the community. While there was variation in local testing rates, readmission rates were similar. No subsequent kernicterus was detected. DISCUSSION: Community pathways were inconsistent and deviated from guidance, with under-testing and ethnic inequalities. It was not clear whether testing variation impacted clinical outcomes. Future research should compare and evaluate efficacy, costs and implementation of neonatal jaundice interventions and pathways, including the impact on disparities and new testing technologies. CONCLUSION: Community jaundice pathways require further exploration, particularly access and inequalities to testing, and impact of new technologies.