Neonatal Jaundice Screening in Primary Care in Singapore: Utilization Patterns, Weight and Bilirubin Trajectories, and Comparative Outcomes of Nurse-Led Versus Routine Follow-up.

PURPOSE: To describe neonatal jaundice (NNJ) follow-up trends in National Healthcare Group Polyclinics (NHGP), examining healthcare utilization, bilirubin and weight trajectories, predictors of serum bilirubin testing, and outcomes between doctor-led and nurse-led follow-up.

BACKGROUND

In Singapore, infants are reviewed at polyclinics in the first week for neonatal jaundice, with subsequent follow-up by either doctor-led or nurse-led clinic. Evidence from community-based settings is limited, particularly regarding nurse-led care outcomes.

METHODS

Data were collected from retrospective case review of 5,231 neonatal jaundice screening visits from July to October 2024. Visit-level data included demographics, clinical factors, transcutaneous bilirubin (TcB), total serum bilirubin (TSB), weight, and follow-up pathway. Outcomes were healthcare utilization, bilirubin and weight trajectories, predictors of TSB testing, and TcB ≥250 µmol/L at day and beyond, and comparison of doctor-led vs. nurse-led visits after day 8.

RESULTS

TcB was performed in 83.1% of visits, TSB in 21.5%, and doctor consultations in 75.8%, peaking in the first week. Weight decreased to -1.6% by 37-48 hours, regaining by day 4, with +11.7% by day 14. TcB peaked at 73-120 hours (208-211 µmol/L). Malay ethnicity, late preterm status, and ABO incompatibility increased TSB testing risk. G6PD deficiency was associated with prolonged jaundice beyond day 8. After matching, no significant differences in TcB or weight was observed between doctor- and nurse-led visits.

CONCLUSIONS

TcB screening with selective TSB safeguarded infants while minimizing invasive testing. Nurse-led clinics achieved equivalent outcomes to doctor-led visits. Findings support expansion of nurse-led care in primary care systems.