Wijnja. K. (2015) Can General Practitioners recognize alarm symptoms of neonatal cholestasis and do they follow the guideline ‘hyperbilirubinemia? A survey focusing on jaundice and pale colored stools. thesis, Medicine.
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Abstract
Background. Biliary atresia (BA) is a rare liver disease in which a congenital obstruction in the biliary tract leads to cholestasis. Persistent jaundice beyond three weeks of age, pale stools and dark urine are important clues. The result in an untreated child is cirrhosis and death within two years. For an effective operation early recognition is vital: the sooner the better, internationally the 60th day of life is held as criterion. Despite the guideline ‘hyperbilirubinemia’, created to help the General practitioner recognize an infant with cholestasis and determine further policy, and recognizable symptoms a lot of infant with BA are referred too late and therefore operated on too late. The Infant Stool Colour Card is an effective screening method for recognition of pale stools. Goal of this study was to identify if a screening method like this one is useful in the Netherlands. To answer this we first have to identify the delaying factor in the process of making the diagnosis, referring the infant and operating the infant. The main question is: ‘Do General Practitioners recognize alarm symptoms associated with cholestasis when facing a jaundiced newborn and do they follow the guideline?’ Material and methods. A pilot study was conducted among 50 General practitioners. They had to answer six casuistry questions focused on recognition of alarm symptoms and following the guideline. Subsequently they assessed six colour pictures of normal stools and four pictures of pale stools. At each picture they had to choose whether the stools were ‘normal’ or ‘abnormal’ and if they would refer the infant. Results. None of the General practitioners answered all casuistry questions exactly according to the guideline. 56% of the general practitioners answered more than 50% of the casuistry questions incorrect. 36% recognized all pictures of abnormal stools. Of this 36% of general practitioners 22% also recognized all pictures of normal stools. No significant difference was found between general practitioners with more experience vs. general practitioners with less experience in the casuistry section (p=1.0), recognition of all ten pictures of stools (p=0.21) or recognition of abnormal stools (p=0.48). Conclusion. Our study shows that GPs do not always recognize abnormal stools and do not always follow the guideline. This may be one of the factors associated with the late referral and operation among Dutch infants. The implementation of a screening method could improve the recognition and thereby time of diagnosis with a timely operation.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Hulscher, Dr. J.B.F. and Department of Pediatric surgery University Medical Center Gr |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:48 |
| Last Modified: | 25 Jun 2020 10:48 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/897 |
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