Accuracy of Clinical Judgment in Neonatal Jaundice

Moyer, Virginia A.; Ahn, Chul Soo; Sneed, Stephanie

doi:10.1001/archpedi.154.4.391

Cited by 178 publications

(129 citation statements)

References 9 publications

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“…Most previous studies on the clinical assessment of neonatal hyperbilirubinemia were conducted in the United States or Europe, were limited to a single or bi-ethnic study population and evaluated the clinical assessment of jaundice by a single observer compared to a serum bilirubin measurement taken in all the enrolled subjects (Supplementary Table 1). [5][6][7][8][9][10][11][12] Riskin et al 6 showed that neonatologists' identification of jaundice, and predicted serum bilirubin levels based on the Kramer scale, was highly correlated with serum total bilirubin levels (r ¼ 0.682, P<0.001). This study concluded: 'the clinical impression of jaundice by anyexperienced clinician is a reliable method to assess newborns for y(neonatal hyperbilirubinemia) and serum bilirubin levels are necessary only in severely jaundiced neonates.'…”

Section: Discussionmentioning

confidence: 99%

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Validity of neonatal jaundice evaluation by primary health-care workers and physicians in Karachi, Pakistan

et al. 2010

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Objective: The purpose of this study was to validate primary health-care workers' and physicians' visual assessment of neonatal hyperbilirubinemia in Karachi, Pakistan.Study Design: We compared primary health-care workers' and physicians' clinical identification of jaundice in infants <60 days old.Result: Primary health-care workers identified 1-to 20-day-old neonates with hyperbilirubinemia X15 mg per 100 ml (260 mmol l À1 ) with 83.3% sensitivity and 50.5% specificity; neonates aged 1 to 6 days were identified with 76.2% sensitivity and 60.7% specificity. Physicians identified neonates aged 1 to 20 days with hyperbilirubimemia X15 mg per 100 ml (260 mmol l À1 ) with 51.4% sensitivity and 90.7% specificity, and neonates aged 1 to 6 days with 50% sensitivity and 88.5 % specificity. The primary health-care workers' and physicians' assessments showed fair interobserver agreement (k statistic 0.29).Conclusion: Primary health-care workers identified hyperbilirubinemic neonates with adequate sensitivity. With proper training and supervision, their assessment could improve the referral of hyperbilirubinemic neonates in low-resource settings in the developing world.

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Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12] We evaluated the validity of an adapted Kramer scale when used by HCW and PHY to evaluate infants <60 days of age, with a focus on neonates aged 1 to 20 days, presenting to community clinics in Karachi, Pakistan.…”

Section: Introductionmentioning

confidence: 99%

Validity of neonatal jaundice evaluation by primary health-care workers and physicians in Karachi, Pakistan

et al. 2010

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“…Depending on various methods of bilirubin estimation in different laboratories, the frequency of breast feeding,ethnic makeup of people and regional variations the incidence of hyperbilirubinemia changes [7][8][9] . The severe jaundice and kernicterus has been found in some healthy full term newborns dischared early with no apparent hemolysis.…”

Section: Introductionmentioning

confidence: 99%

Study of Correlation of Cord Blood Bilirubin with Neonatal Hyperbilirubinemia

Ahire¹,

Sonawane²,

Gaikwad³

et al. 2016

MVP J Med Sci

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Introduction: Neonatal Hyperbilirubinemia (NH) is a universal problem affecting nearly 60% of term and 80% of preterm neonates during first week of life. Early discharge of healthy term newborns is a common practice because of medical, social and economic constraints. Insignificant number (6.5%) of babies, NH is a cause for readmission. The present study was conducted to correlate the Cord Blood Bilirubin (CBB) level with subsequent NH. Methods: Study was performed at the Department of Pediatrics in a Medical College Hospital and Research Centre. Intramurally delivered, 113 Healthy fullterm newborns during 1-year period were prospectively enrolled. CBB was estimated. Serum Bilirubin estimation was done at 48 hours and 5 day of age and later if required. Results: Significant NH in our study is 3.5%. Mean total bilirubin on second postnatal day was 10.58 mg/dl and on fifth post natal day was 10.81 mg/dl. Using CBB level of ≥3 mg/dl as a cut-off, NH can be predicted with sensitivity of 100%, specificity of 98.17 %, positive predictive value of 66.67 % and negative predictive value of 100%. Conclusion: A 100% Negative Predictive Value in the present study suggests that in Healthy Term babies (without RH and ABO incompatibility with Cord Blood Bilirubin ≤3mg/dl) cord serum bilirubin can help to identify those newborns who are unlikely to require further evaluation and intervention. These newborns can be discharged with assurance to Parents. Babies with CBB level ≥3mg/dl should be followed more frequently.

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“…Thus, lower thresholds for starting phototherapy (PHT) may be appropriate. 3,4 Although TSB measurement is reliable, it is a painful and time-consuming procedure. 1 Bilirubin levels before and during PHT are measured as TSB and obtained by heel stick or venous blood draws.…”

Section: Introductionmentioning

confidence: 99%

Covered skin transcutaneous bilirubin estimation is comparable with serum bilirubin during and after phototherapy

et al. 2011

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Objective: To determine whether transcutaneous bilirubin (TcB) from covered skin (TcB-C) during and after discontinuing phototherapy (PHT) is reliable in treating neonatal jaundice.Study Design: In this prospective observational study, before starting PHT, part of the forehead was covered. TcB-C and TcB from exposed skin (TcB-E) to PHT were measured before starting PHT, on a 12-hourly basis while receiving PHT and 6 h after stopping PHT. We used ANOVA (analysis of variance) and Bonferroni's t-tests.Result: A total of 39 infants were enrolled (mean gestation 39 weeks, 51% males and 80% Hispanic).

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Accuracy of Clinical Judgment in Neonatal Jaundice

Abstract: Clinical examination with visual assessment for jaundice in newborns is neither reliable nor accurate. The decision to perform serum bilirubin testing should be based on additional factors.

Cited by 178 publications

References 9 publications

Validity of neonatal jaundice evaluation by primary health-care workers and physicians in Karachi, Pakistan

Validity of neonatal jaundice evaluation by primary health-care workers and physicians in Karachi, Pakistan

Study of Correlation of Cord Blood Bilirubin with Neonatal Hyperbilirubinemia

Covered skin transcutaneous bilirubin estimation is comparable with serum bilirubin during and after phototherapy

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