الفهرس 
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Abstract
The prevention, detection and management of jaundice in otherwise healthy term and late preterm newborn infants remain a challenge, partly because jaundice is so common and kernicterus is so rare in comparison(American Academy of Pediatrics,2004).
Aim of the work:
The present study aimed to assess the PHC workers practice as regards knowledge about causes , diagnosis ,effective treatment , complications and prevention of neonatal jaundice.
Subject of the method:
We collected data using a self-administered anonymous questionnaire which was distributed to 500 doctors and 1000 nurses working in different PHC units in Kalubia governorates controlled with 25 doctors and 50 nurses working in neonatal hospitals.
This questionnaire included items covering data about neonatal jaundice including diagnosis, clinical monitoring, prevention, opinions and beliefs about treatment options, involvement in continuing medical education, experiences with managed care in addition to physicians’ sociodemographic data and characteristic of practice settings.
Results:
For doctors
The present study showed that 41.3% of PHC doctors assess the severity of NNJ by cephalocaudal evaluation,87% of PHC physicians chose to measure the level of total serum bilirubin to evaluate neonatal jaundice and its presence in neonates but only 33% of PHC physicians used transcutaneous bilirubinometer as a way to check severity of NNJ.
The current study showed that 55.8% of PHC doctors and chose refusing baby to feed as a sign of danger of NNJ, 81.8% of PHC doctors chose convulsion ,14.8% of PHC doctors chose high-pitched cry, 33.7% of PHC doctors chose fever,10.4% of PHC doctors chose arching of the back and lastly 13.6% of PHC doctors chose down turning of the eye.
In current study 60.6% of PHC doctors chose prolonged jaundice as a cause of referral to estimate bilirubin level,45.8% of PHC doctors chose dark urine ,pale stool and lastly 42% of PHC doctors chose jaundice in hand and feet.
In this study 85.2% of PHC doctors chose ABO incompatibility as a cause of NNJ,79% PHC doctors chose RH incompatability,48% of PHC doctors chose sepsis,17.8% of PHC doctors chose germ in breast or breast milk,74.8 of PHC doctors chose prematurity and lastly 95.6% of PHC doctors chose physiological jaundice. And all were ignore writing any other causes.
In current study 87.4% of PHC and 100.0% of pediatricians chose jaundice in 1st 24h or prolonged >2 weeks as a factor associated with sever hyperbillirubinemia then RH incompatibility and only48.4% of PHC doctors and 68% of pediatrician chose G6PD and few percentages chose other signs and these results reveal respondents misconception in this aspect of knowledge.
A fairly adequate knowledge in both of PHC doctors and hospital doctors in prevention of NNJ as a good percentage chose Screening for blood group and RH to all pregnant female then good breast feeding and good antenatal and postnatal care and low percentage of PHC doctors and none of hospital doctor chose screening for TORCH infection.
On asking about need of training reveal that both PHC doctors and hospital neonatal doctors in need to training about NNJ.
For nurses
In question which was asking about hearing about neonatal jaundice reveal that 99.5% heard about it which is a good percentage.
In question tested the knowledge of the nurses about knowing methods of diagnosis of NNJ .Our study revealed that 92.3% diagnose it by eye examination ,89.4% diagnose by skin appearance, 23.4%chose colour of stool but rare chose palm and sole appearance .
In question tested the ability of PHC nurses to diagnose NNJ by colour of urine as 66.8% chose yellow colour ,37.7% chose yellowish green and few percentage chose white colour.
In question tested the ability to recognize complications in NNJ.78.1% of nurses chose refuse to feed ,62.2% chose convulsion , 37.4% chose fever and few numbers chose other signs
So there is misconception in this area of knowledge in comparison between PHC in kalubia governorate. In contrast to hospital nurses which most of them choose all six signs.
Concerning to the common cause of NNJ reveal another area of inadequate knowledge that 85.4% chose physiological cause .54.8% chose prematurity and most of them neglected the other important causes and13% chose incorrect answer (germ in breast of breast milk )
In question tested the attitude of the respondents in treatment of NNJ which reveal another area of inadequate knowledge in both PHC and hospital as most of nurses chose wrong choices as vitamins ,putting baby in sun and fluorescent light. Small percentage chose no treatment and stop breast feeding but 70% of PHC and 80% of hospital nurses chose maintaining breast feeding.
In question tested knowledge of nurses about knowing medical drug as a treatment as 37.6% answered that they used drugs in management ,some mention vitamin DROP ,other mention silymarin and the rest mention hepaticum so it’s obvious that all were respond the question regardless the cause.
In our study a good percentage of both PHC and hospital nurses chose right answers as totally 74.9% chose referral to specialized doctor and 75.4% choose advising mothers to maintain breast feeding ,only 47.4% choose referral to do serum billirubin but 40.1% chose advising parents to put baby in sun or fluorescent light as a wrong choice .
In question tested the knowledge about knowing the effect of sever neonatal jaundice which reveal bad results as less than 50% knew that there are bad effects in contrast to hospital nurses slightly increased up to 78%.
In questions regard receiving and needing of training about NNJ. In our study 97.4% of PHC nurses did not receive any training 99% of them need training and all of hospital neonatal nurses receive training and also need training.
Our study reported that the most of studied doctors and nurses didn’t attend any scientific or educational programs concerning about neonatal jaundice.