Evaluation of Knowledge and Practice of Nurses Toward Neonatal Jaundice Management

Neonatal jaundice is one of the most common clinical conditions affecting newborns worldwide and remains a major concern in neonatal care. It is characterized by yellow discoloration of the skin and sclera caused by elevated bilirubin levels in the neonate’s bloodstream (Dzantor, Serwaa, & Abdul-Mumin, 2023). Although neonatal jaundice is often physiological and self-limiting, failure to identify and manage pathological cases in a timely manner may lead to serious complications such as kernicterus, permanent neurological damage, and even death (Abdel Khalek, 2016; Dzantor et al., 2023). Nurses play a pivotal role in the early detection, monitoring, and management of neonatal jaundice, particularly in neonatal and maternity units; therefore, their knowledge and clinical practice are crucial for ensuring safe and effective neonatal care.

Globally, approximately 60% of full-term and up to 80% of preterm newborns develop jaundice during the first week of life (Ramzan, Alam, & Nigar, 2024; Saddozai et al., 2022). The burden of neonatal hyperbilirubinemia is greater in low- and middle-income countries due to limited resources, inadequate monitoring systems, and variations in clinical practice. Evidence suggests that although nurses often have general awareness of neonatal jaundice, substantial gaps exist in their understanding of risk factors, intervention thresholds, and correct phototherapy practices (Alsuhaymi, 2025). Previous studies have demonstrated a positive association between nurses’ knowledge and appropriate clinical practice, whereas others have reported poor knowledge and practice levels, indicating the need for targeted educational interventions (Dzantor et al., 2023; El-Suez Canal Study, 2022).

Effective management of neonatal jaundice requires early identification of risk factors, accurate monitoring of bilirubin levels, timely initiation of interventions such as phototherapy or exchange transfusion, adequate feeding support, and strict adherence to evidence-based protocols (American Academy of Pediatrics [AAP], 2022). In Pakistan, studies conducted in tertiary care hospitals have revealed that only a small proportion of nurses demonstrate good knowledge of neonatal jaundice, while the majority exhibit fair to poor knowledge levels (Ramzan et al., 2024). Given the critical role of nurses as primary caregivers in neonatal units and the documented gaps between knowledge and practice, this study aims to evaluate nurses’ knowledge and practice regarding neonatal jaundice management in a public sector hospital in Pakistan. The findings are expected to inform the development of targeted educational strategies, policy recommendations, and quality improvement initiatives to enhance neonatal outcomes.

A descriptive cross-sectional study was conducted at Aziz Bhatti Shaheed Teaching Hospital, Gujrat, over a period of four months from August 2025 to November 2025. The study included a sample of 109 registered nurses, calculated from a total population of 150 using a 5% margin of error through Slovin’s formula, and participants were selected using a convenient sampling technique. Eligible participants were registered nurses working in neonatal units, NICU, postnatal wards, or pediatric departments with at least six months of clinical experience and direct involvement in neonatal care, while nurses on long-term leave, nursing students or trainees, administrative staff, and those who declined participation or failed to complete the questionnaire were excluded. Formal permission was obtained from hospital administration prior to data collection, and informed written consent was secured from all participants. Data were collected using structured questionnaires, including a demographic information form, an adopted knowledge questionnaire on neonatal jaundice management consisting of 28 items with True/False/Don’t Know responses (Salia et al., 2021), and an adopted practice questionnaire comprising six Yes/No statements assessing evidence-based practices. Knowledge scores were categorized as good (75–100%), average (50–74%), or poor (<50%), while practice scores were classified as good (5–6), fair (3–4), or poor (0–2). Confidentiality was strictly maintained throughout the study, and collected data were analyzed using SPSS version 24, with frequencies and percentages calculated to assess nurses’ knowledge and practices.

Table 1 presents the demographic characteristics of the participants (n = 78). The majority of participants were aged 20–25 years (31.2%) and male (57.8%). Most respondents were fathers (59.0%) and single (46.8%). Regarding professional background, 45.0% held a Post RN BScN qualification, and the majority were working as staff nurses (88.1%).

Table 1. Demographics characteristics of participants (n=78)

Table 2. Overall knowledge of nurses regarding neonatal jaundice

 Table 2 shows the overall knowledge of nurses regarding neonatal jaundice (n = 109). The majority of nurses (65.1%) had poor knowledge, while 29.4% had moderate knowledge. Only a small proportion (5.5%) demonstrated good knowledge about neonatal jaundice. This indicates that most nurses need further education and training on this topic.

Table 3. Overall practices of nurses regarding neonatal jaundice

Table 3 shows the overall practices of nurses regarding neonatal jaundice (n = 109). Nearly half of the nurses (46.8%) demonstrated good practices, while 44.0% showed fair practices. A smaller proportion (9.2%) exhibited poor practices. This indicates that although some nurses follow appropriate practices in managing and preventing neonatal jaundice, a significant number still engage in incorrect or suboptimal practices, emphasizing the need for continued training and reinforcement of evidence-based neonatal care.

The present study assessed the knowledge of nurses regarding neonatal jaundice and examined its association with demographic variables. The findings indicate that the overall knowledge among nurses was poor, with 65.1% of participants demonstrating low knowledge, 29.4% having moderate knowledge, and only 5.5% exhibiting good knowledge (Table 4.7). This suggests a considerable knowledge gap among nurses, highlighting the need for targeted educational interventions and continuous professional development to improve neonatal care practices. These results are consistent with previous studies, which also reported inadequate knowledge of neonatal jaundice among nurses, emphasizing the need for enhanced training programs (Agarwal et al., 2017; Arabi et al., 2019).

Overall, the findings of this study highlight a critical need for structured training programs, workshops, and continuing education for nurses at all levels, with special focus on younger nurses and those with lower academic qualifications. Strengthening knowledge in neonatal jaundice can improve early recognition, management, and prevention of serious complications such as kernicterus, seizures, and developmental impairments.

The findings of this study indicate that the overall knowledge of nurses regarding neonatal jaundice was suboptimal, with the majority of participants (65.1%) demonstrating poor knowledge. Only a small proportion (5.5%) had good knowledge, suggesting a significant knowledge gap in identifying causes, danger signs, complications, prevention, and management of neonatal jaundice. This underscores the need for structured educational programs and ongoing professional training for nurses to improve neonatal care outcomes. The nearly half of the nurses demonstrated good practices regarding neonatal jaundice, a considerable proportion still showed fair or poor practices, highlighting the need for ongoing training and reinforcement of evidence-based neonatal care.

1.     Alsuhaymi, S. (2025). NICU nurses’ knowledge and attitudes regarding neonatal jaundice: A systematic review. The Queen’s University of Belfast.

2.     Abdel Khalek, W. (2016). Impact of an educational program on nurses’ knowledge and practice regarding neonatal jaundice. Pediatrics Nursing Faculty of Nursing, Port Said University.

3.     Ali, R., Shaikh, M. H., Khan, N., Abdullah, & Ahmad, I. (2023). Perception of neonatal jaundice among students at a private nursing institute in Karachi. Journal of Gandhara Nursing and Allied Health Sciences, 3(2). https://doi.org/10.37762/jgnahs.106

4.     Assuit University Children Hospital. (2019). Assessment of nursing practice regarding neonates with hyperbilirubinemia. ASNJ. https://doi.org/10.21608/asnj.2019.74200

5.     Dzantor, E. K., Serwaa, D., & Abdul-Mumin, A. (2023). Neonatal jaundice management: Improving clinical knowledge of jaundice for improved attitudes and practices to enhance neonatal care. SAGE Open Nursing, 9, 1-10. https://doi.org/10.1177/23779608231220257

6.     Delibaş, H., & Akça, S. Ö. (2022). Knowledge levels of neonatal intensive care nurses on neonatal jaundice and its treatment. Gümüşhane Sağlık Bilimleri Dergisi, 11(1), 229 236. https://doi.org/10.37989/gumussagbil.976141

7.     Dzantor, E. K., Serwaa, D., & Abdul Mumin, A. (2023). Neonatal jaundice management: Improving clinical knowledge of jaundice for improved attitudes and practices to enhance neonatal care. SAGE Open Nursing, 9, 1 10. https://doi.org/10.1177/23779608231220257

8.     Gerges, M. S., El Sayed Ouda, W., Mohammed, M. F., & Kafl, R. H. (2022). Assessment of nurses’ knowledge and practice regarding neonatal jaundice in neonatal intensive care unit at Suez Canal University Hospitals. Trends in Nursing & Health Care Journal, 5(2), 1 14. https://doi.org/10.21608/tnhcj.2022.281289

9.     Ibrahim, M. M., Ouda, W. E. S., Ismail, S. S., & Elewa, A. (2019). Assessment of nursing care provided to neonates undergoing phototherapy. Egyptian Journal of Health Care, 10(1), 1 12. https://doi.org/10.21608/ejhc.2019.26740

10.   Kandula, U. R., Dwivedi, M., Singh, S., Verma, S., & Gupta, S. (2024). Knowledge regarding neonatal jaundice and its management among staff nurses. International Journal of Research in Paediatric Nursing, 6(1), 52 61. https://doi.org/10.33545/26641291.2024.v6.i1a.155

11.   Mishra, V. D., & Khan, M. U. (2020). A study to assess the knowledge of staff nurses regarding the care of newborn during phototherapy in selected hospitals of Jaipur. International Journal of Research in Paediatric Nursing, 2(2), B151 B156.

12.   Ramzan, A., Alam, I. M., & Nigar, Z. (2024). Assessment of knowledge regarding neonatal jaundice among nurses working in tertiary care hospitals Lahore. Annals of Human and Social Sciences, 5(3), 722 728.

13.   Saddozai, S. U., Gul, J., Shukat, R., Jabeen, N., Mehmood, A., Abdullah, Z., & Ali, M. (2022). Knowledge, attitude, and practice (KAP) of mothers regarding neonatal jaundice in the hospital of KPK, Pakistan. Pakistan Journal of Medical & Health Sciences, 16(9), 807. https://doi.org/10.53350/pjmhs22169807