Assessing knowledge and skills of maternity care professionals regarding neonatal hyperbilirubinaemia: a nationwide survey

Abstract

Background: Neonatal hyperbilirubinaemia is a physiologic phenomenon, but, when severe, may cause lifelong disability. Maternity care assistants (MCAs) play an important role in timely recognition of severe neonatal jaundice. We assessed knowledge and skills of MCAs regarding neonatal hyperbilirubinaemia.

Methods: All Dutch MCAs (n = 9065) were invited to fill out a questionnaire assessing knowledge, expertise, and handling of neonatal jaundice. Additionally, we developed an e-learning and provided training sessions to a subgroup of MCAs (n = 99), and assessed their knowledge on neonatal hyperbilirubinaemia before and after the training.

Results: One thousand four hundred sixty-five unique online questionnaires were completed (response 16.2%). The median number of correctly answered knowledge questions was 5 (out of six; IQR 1). Knowledge was significantly better when respondents had had in-service training on neonatal hyperbilirubinaemia in the previous year (p = 0.024). Although 82% of respondents felt highly skilled or skilled to assess jaundice, accuracy of estimation of total serum bilirubin levels by assessing skin colour was generally poor and prone to underestimation. Among participants attending a training session, those who completed the e-learning beforehand had higher pre-training scores (5 (IQR 1) vs. 4 (IQR 2); p < 0.001). The median post-training score was higher than pre-training (6 (IQR 1) vs. 5 (IQR 2); p < 0.001).

Conclusions: Background knowledge of MCAs regarding neonatal hyperbilirubinaemia was adequate, but can be improved by further training. Estimation of total serum bilirubin levels based on skin colour was often inadequate. Approaches to improve timely recognition of jaundiced neonates are needed.

Keywords: Experience; Expertise; Knowledge; Maternity care assistants; Maternity care professionals; Neonatal hyperbilirubinaemia; Neonatal jaundice; Recognition; Skills.

Fig. 1

Flowchart online survey

Fig. 2

Visual skin colour assessment of photo cases (above) and estimated TSB level per photo case (below) by maternity care assistants who participated in the online survey. The white bars indicate the correct TSB range. TSB = total serum bilirubin; MCA = maternity care assistant

Fig. 3

Maternity care assistant’s action plan according to neonate’s skin colour as assessed visually. TSB = total serum bilirubin

Fig. 4

Maternity care assistant’s action plan according to estimated total serum bilirubin level. TSB = total serum bilirubin

Fig. 5

Estimated total serum bilirubin level according to estimated skin colour

Fig. 6

Self-assessed versus actual ability of maternity care assistants to estimate total serum bilirubin via visual inspection. Maternity care assistants (MCAs) were asked to estimate the total serum bilirubin (TSB) level of a neonate based on two photographs. For each case, we noted the number of 50 μl/L ranges by which MCAs were off when estimating TSB levels. The median number of ranges per MCA was calculated across the three cases. In this figure the self-assessed capability of recognising jaundiced neonates in time was plotted against the median number of ranges by which the specific MCA was off when estimating TSB level

Fig. 7

Flowchart of training session questionnaire inclusion. MCA = maternity care assistant