Detection of hyperbilirubinaemia in jaundiced full-term neonates by eye or by bilirubinometer?

Abstract

The aim of this study was to compare predictions of hyperbilirubinaemia by eye, performed by trained physicians and nurses, with predictions obtained using two commercial bilirubinometers. Jaundice was assessed in 92 white and 48 non-white healthy full-term neonates using three non-invasive methods and by total serum bilirubin as the reference method. Clinical assessment of cephalocaudal progression of jaundice was carried out independently by a physician and by nurses. Simultaneously, the Minolta Airshields JM-102 was applied on the sternum, the BiliCheck on both the forehead and the sternum, and finally, serum bilirubin concentrations were determined. The Minolta JM-102 showed the best performance with r 2 =0.90, an intraclass correlation coefficient (ICC) of 0.93, and a 95% confidence interval (CI) of ±4 units (approx. 56 lmol/l). The BiliCheck performed slightly better on the forehead than over the sternum with r 2 =0.90, an ICC of 0.88, and a CI of ±62 lmol/l. Assessment of jaundice by eye was least accurate with r 2 =0.74, an ICC of 0.67, and a CI of ±1.5 zones (corresponding to ±75 lmol/l). Skin pigmentation and ambient light both adversely affected noninvasive bilirubin estimation. Conclusion: All three non-invasive methods are well suited for estimation of serum bilirubin but show large confidence intervals. In healthy term newborns, hyperbilirubinaemia (>250 lmol/l) can be safely ruled out by eye if jaundice does not reach the abdomen or the extremities (Kramer zones 1 and 2), with <22 units (<230 lmol/l) for the Minolta JM-102, or with a cut-off of 190 lmol/l for the BiliCheck. If these respective thresholds are exceeded, serum bilirubin concentrations should be measured.

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

“…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.'…”

“…Similarly, Madlon-Kay et al 7,8 found that nurses trained in clinical assessment of jaundice adequately (r ¼ 0.61, P<0.01) identified newborns with total serum bilirubin levels <12 mg per 100 ml (205 mmol l À1 ), and all three infants with serum bilirubin levels X17 mg per 100 ml (290 mmol l À1 ) as having jaundice requiring referral to hospital. Szabo et al 9,10 reported that trained nurses and PHYs were able to identify neonates with jaundice that did not reach the abdomen or extremities in whom hyperbilirubinemia did not exceed 250 mmol l À1 .…”

“…[5][6][7][8][9][10][11][12] This study showed that a clinical assessment tool used to identify infants with jaundice extending to the distal extremities shows some promise for guiding referral of infants with moderate to severe hyperbilirubinemia in a developing country setting, where sophisticated and expensive equipment is not widely available. [7][8][9][10][11] HCWs identified both infants aged 1 to 20 days (sensitivity 83.3%) and those <1 week old (aged 1 to 6 days) (sensitivity 76.2%) with (Kramer level 5). Thus, few infants with clinical signs of moderate to severe hyperbilirubinemia would be missed, which in turn, prevents long-term health-care costs due to the associated morbidity and mortality resulting from untreated hyperbilirubinemia.…”

“…[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.…”

Reliability of Transcutaneous Bilirubin Devices in Preterm Infants: A Systematic Review

“…4 However, visual assessment of serum bilirubin has been shown to correlate poorly with measured bilirubin levels in recent studies. 2,5,6 Blood sampling for estimation of serum bilirubin is one of the most common tests ordered in the neonatal units. The blood sampling is often done by heel prick and is painful, with potential longterm consequences.…”