Factors influencing jaundice follow-up rates in a multi-ethnic Asian population: a cross-sectional study

OBJECTIVE: To evaluate the factors affecting neonatal jaundice monitoring in primary care, specifically in normal-risk newborns, with the aim of optimising jaundice follow-up care through a risk-stratified approach. DESIGN: Cross-sectional study. SETTING: Seven primary care clinics in Singapore. PATIENTS: 5391 healthy newborns with jaundice at hospital discharge. MAIN OUTCOME MEASURES: Jaundice visit rates within 90 days postdischarge. RESULTS: 5391 newborns attended 26 494 jaundice visits between 2022-2023, with 4593 (85.2%) determined to be normal-risk for severe hyperbilirubinaemia. compared with high-risk newborns, normal-risk newborns had significantly fewer visits (five visits, IQR 2-7 vs five visits, IQR 4-7), higher birth weight (3.13 kg, SD 0.47 vs 2.94 kg, SD 0.43), fewer newborns reaching phototherapy thresholds (8.4% vs 27.9%), and lower jaundice discharge rate (71.4% vs 75.6%). Chinese (compared with Malay) (incidence rate ratio (IRR) 1.15, 95% CI 1.11 to 1.19) and male (IRR 1.10, 95% CI 1.07 to 1.13) newborns had higher follow-up rates, while higher birth weight (IRR 0.752, 95% CI 0.728 to 0.778) and normal-risk (compared with high risk) (IRR 0.93, 95% CI 0.90 to 0.97) were associated with lower follow-up rates. Among normal-risk newborns >7 days old, none exceeded phototherapy thresholds; a risk-based approach could have safely avoided 3652 out of 22 053 follow-up visits (16.6%) in this group. CONCLUSION: Our study provides insights into factors influencing jaundice follow-up visit rates. A risk-stratified approach to jaundice monitoring may optimise follow-up care. Further study is needed to implement and evaluate its effectiveness.