6065 Utility of urinalysis in well babies who present to Prolonged Jaundice Clinic

Objectives Neonatal jaundice is common with up to 60% of term babies and 80% of preterm babies developing jaundice within the first week of life. In term babies, Prolonged Jaundice (PJ) is defined as jaundice lasting more than 14 days.¹ In keeping with current NICE guidelines,¹ our trust performs urinalysis on all babies presenting to PJ clinic even if they are well. However, routine urinalysis may have limited utility, given the low incidence of UTIs in PJ babies in the UK.² Furthermore, several national bodies³ ⁴ do not currently include urinalysis as part of PJ screening. This audit aims to determine the frequency of abnormal urinalysis and cultures in the cohort of well babies attending our local PJ clinic and to recommend changes to our protocol. Methods Data from clinic letters and laboratory reports (Biochemistry and Microbiology) was collected for all patients who attended our PJ clinic in the year 2022. All patients had urinalysis done as part of the PJ screen. Urine was only sent for culture and sensitivities if the urinalysis was suggestive of an infection. Results A total of 117 patients attended our PJ clinic in 2022. 2 patients had jaundice that was fully resolved at time of attendance so did not have a PJ screen done. 2 patients had urine samples contaminated with stools (therefore urinalysis inaccurate) but reassuring serum bilirubin levels. 9 patients had incomplete documentation regarding urinalysis results. The above patients were therefore excluded from our audit. Of the 104 remaining patients, only 1 had a positive urinalysis result (positive for leucocytes). The subsequent urine culture was negative. It is worth noting that 1 patient included in our study was initially diagnosed with Breast Milk jaundice but was later found to have Congenital Hypothyroidism. Conclusion In our cohort of well babies who attended our PJ clinic and had a valid urinalysis done as part of the PJ screen, none were found to have a urinary infection. We propose that babies with PJ who are otherwise well are unlikely to have a UTI. We are therefore reviewing our local protocol to recommend the cessation of routine urinalysis on babies who present to PJ clinic who are found to be otherwise well on history and examination, reducing time wastage (for both healthcare professional and parent(s)) and cost. References National Institute for Health and Care Excellence (NICE). Jaundice in Newborn Babies under 28 Days (published 2010, updated 2016). Accessed 8th February 2023. Steadman S et al. Archives of Disease in Childhood. Is screening for urine infection in well infants with prolonged jaundice required? Local review and meta-analysis of existing data July 2016. British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN). Guideline for the Investigation of Neonatal Conjugated Jaundice (updated 2016). Accessed 8th February 2023. Children's Liver Disease Foundation. Jaundice Protocol (published 2011, updated 2019). Accessed 21st February 2023.