Factors Related to Surgery for Biliary Atresia AfterImplementing the Infant Stool Color Card Screening

• Main Authors: Pi-Ling Hsieh, 謝碧玲
• Other Authors: 李雅玲
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/46384257177891729369

碩士 === 國立臺灣大學 === 護理學研究所 === 99 === Background and Purpose: Biliary atresia (BA) is the childhood liver disease with the highest mortality rate in Taiwan. Early detection and treatment by Kasai portoenterostomy has been shown to improve chances of long-term survival significantly. Taiwan’s introduction of the infant stool color card into the national Child Healthcare Handbook (CHH) in 2004 has effectively raised the ratio of BA infants receiving a Kasai portoenterostomy within the critical sixty-days of life period, thus increasing the ratio of infants attaining critical bile circulation and surviving long-term. With the stool color card now a standard item on the CHH, this study explores factors that influence mothers’ decisions to request biliary atresia surgery for their BA infants. Research method: Researchers conducted this study between July 1st and October 31st, 2010 using a cross-sectional observational design and purposive sampling. The sample population included mothers whose infants 1) had received a Kasai portoenterostomy, 2) were born between 2004 and 2009, and 3) were registered on the Taiwan Children Liver Foundation (TCLF) database. The researcher assigned recruited subjects into one of two groups. The first included the 52 subjects whose children had received a Kasai portoenterostomy within sixty days of life; The second included the 26 whose children received the operation after sixty days of life. Data was collected using a structured questionnaire. Descriptive and influencing factor analyses were performed using SPSS 17.0 for Windows and R software. Results: 1. This study identified significant differences between the two groups in terms of the following BA infant characteristic variables: 1) gender (p=0.037); 2) identification of abnormal stool color within forty days of birth (p=0.000); 3) identification of abnormal stool color (p=0.000)); 4) age at initial identification of abnormal stool color and medical referral (p=0.000); and 5) age at time of first inpatient BA examination (p=0.000). There was a high degree of homogeneity between the two groups in terms of examined attributes. 2. This study identified significant differences between the two groups in terms of the following aspects of subject mothers’ infant stool color card experiences: 1) medical staff provision of incorrect guidance / information regarding jaundice (p=0.037) and 2) mother provision of infant stool sample to medical staff (p=0.042). 3. Intergroup differences in terms of mothers’ confidence (p=0.001) and acceptance (p=0.020) of/satisfaction (p=0.000) with nursing guidance: Subjects in the over 60-day group recorded mean scores for self-confidence, acceptance and satisfaction that were lower than their within 60-day group peers. 4. Identified positive predictive factors related to a BA infant receiving a Kasai portoenterostomy during the first sixty days of life included: 1) being male (p=0.015); 2) abnormal stool color card results received during first forty days of life (p=0.033); 3) BA mother awareness that infant jaundice is normally resolved within two weeks (p=0.034); 4) willing and able to self-research medical information on abnormal stool color (p=0.002); and 5) satisfaction with stool color card information and guidance provided by medical staff (p=0.026). Identified positive predictive factors related to a BA infant receiving the procedure after the first sixty days of life included: 1) relatively advanced infant age at first stool color card test (p=0.013); 2) small or single-parent family (p=0.018); and 3) BA mother feels sufficiently confident to self-diagnose stool color card results (p=0.036). Conclusions: Study findings can be applied to help medical teams implement more effective and comprehensive infant stool color card procedures. This study recommends the creation of a TCLF Stool Color Card Information Center responsible to work with public healthcare staff nationwide to conduct regular infant stool color card education at grassroots level healthcare stations and medical facilities such as mother and child hospitals, post-partum care centers, infant care centers and so on. Such would significantly enhance awareness and understanding amongst healthcare staff and the general public about stool color cards as well as help ensure clinical nurses deliver appropriate and proper guidance to the parents of newborn infants on the stool color card and abnormal jaundice care. The expected result is better overall medical care for infants with biliary atresia. Keywords: infant stool color card, screening, biliary atresia, Kasai portoenterostomy