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An audit of a community protocol for identifying neonatal liver disease
  1. Peter Cartledge1,
  2. Neeta Kevlani1,
  3. Leonie Shapiro2,
  4. Patricia McClean1
  1. 1Children's Liver and GI Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Biochemistry Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Dr Patricia McClean, Children's Liver and GI Unit, Leeds Teaching Hospitals NHS Trust, Paediatric Offices, Ward 39, Old Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK; patricia.mcclean{at}


Performing a split bilirubin test to identify liver disease in any infant who remains jaundiced beyond 2 weeks of age has been recognised as good clinical practice. The Leeds Community Midwifery Team performed this test, following an agreed protocol, from December 2000. By February 2008, 882 infants had been tested. Three infants were identified as having significant liver disease, including one with biliary atresia. Examining the liver unit database, a further 38 infants with Leeds post codes presented with neonatal liver disease during the study period. Five infants were identified appropriately by the midwives but not reported via the study protocol, 29 were referred from secondary care, (1) by a general practitioner at 9 days of age and (2) who did not become jaundiced before 3 months, leaving one infant who was ‘missed’ by the midwives. No infant whose conjugated bilirubin was below the authors' threshold later presented with liver disease. This is an effective protocol for identifying neonatal liver disease but requires ongoing education to maintain compliance.

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  • Funding No funding, performed as departmental audit.

  • Competing interests None.

  • Ethics This audit is registered with the Leeds Teaching Hospitals NHS Trust audit department. The chairman of the Local Research Ethics Committee (LREC) advised that REC approval was not appropriate.

  • Provenance and peer review Not commissioned; externally peer reviewed.