Protocol for Implementing Continuous Nursing Care after Kasai Procedure in Infants with Biliary Atresia

Biliary atresia (BA) is a severe cholangiopathy of infancy characterized by progressive obstruction of the extrahepatic bile ducts. Kasai portoenterostomy remains the standard initial treatment, but postoperative complications such as cholangitis, malnutrition, and progressive jaundice remain common and can compromise long-term outcomes. Conventional discharge guidance often lacks continuity, leading to poor family adherence and delayed recognition of complications once the infant returns home. To address this gap, we developed and implemented a standardized protocol for continuity of nursing care (CNC) following Kasai portoenterostomy in infants with BA. The protocol integrates structured discharge education, a six-month follow-up schedule with clinic or tele-clinic visits, remote monitoring through telephone or secure messaging, and targeted parental training in nutrition, medication management, and early symptom recognition. Nurses use unified follow-up forms, predefined escalation thresholds, and weekly data verification to ensure data accuracy and consistent delivery of interventions. The primary objective of this study was to describe the CNC protocol in sufficient detail to enable replication. A secondary objective was to present representative outcomes comparing infants managed with CNC versus historical controls receiving routine nursing care. Infants in the CNC group showed greater postoperative weight gain and more rapid declines in total bilirubin levels within six months, while rates of cholangitis and rehospitalization showed favorable but statistically nonsignificant trends. Parental satisfaction was significantly higher in the CNC group, reflecting improved engagement and perceived support. This protocol offers a practical framework that other centers can adapt to strengthen postoperative nursing care and family participation in the management of infants with biliary atresia.