Detection of Neonatal Jaundice among the Newborn Using Kramer?s Criteria

Devi, Sri; Dash, Manjubala; chitra, Felicia

doi:10.4172/2161-1165.1000355

Cited by 7 publications

(12 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…During assessment, the neonate was fully undressed, and assessment was conducted under blue fluorescent light. Besides, by using the thumb, the skin of neonate was blanched to observe the underlying skin color from the head to toes following standard procedure described by Devi et al [ 6 ].…”

Section: Methodsmentioning

confidence: 99%

“…Of 315 respondents with complete data, 182 (57.8%) were males with the median (IQR) age of 4 [2][3][4][5][6][7][8] days. More than half (58.4%) of the neonates were delivered by spontaneous vaginal delivery and half of the neonates 158 (50.2%) were born at preterm with median (IQR) birth weight of 2500 (1700-3000) grams Table 1.…”

Section: Socio-demographic Characteristics Of the Participantsmentioning

confidence: 99%

“…Kramer’s method is user friendly because it is non-invasive, does not require any machine and so can be used effectively in resource limited settings. The technique was introduced by Kramer, and showed a positive correlation between progressions of skin discoloration and serum bilirubin levels [ 5 , 6 ] due to skin thickness differences. According to Kramer, the assessment should begin from the head towards the feet which portray the five zones of the cephalo-caudal progression of jaundice.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reliability of visual assessment of neonatal jaundice among neonates of black descent: a cross-sectional study from Tanzania

et al. 2021

View full text Add to dashboard Cite

Background Jaundice is common among neonates and if untreated can lead to kernicterus. Diagnosing neonatal jaundice (NJ) using Kramer’s method (visual assessment) is considered user-friendly in resource-limited areas. However, there are conflicting findings on reliability of the Kramer’s method in the diagnosis of NJ, particularly of black descent. Therefore, study aimed to determine the accuracy of Kramer’s method in comparison to the total serum bilirubin (TSB) test in the diagnosis of NJ among neonates of black descent in Tanzania. Methods A cross-sectional study was conducted between June and July 2020 at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania. A total of 315 neonates were recruited consecutively. In each neonate, jaundice was assessed using Kramer’s method and TSB test. NJ A total of 315 neonates were recruited i. A 2 X 2 table was created for the determination of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (+LR/−LR), and diagnostic accuracy (effectiveness) of Kramer’s method. Cohen kappa (κ) was used to analyze the agreement between Kramer’s method and TSB. Association between independent variables and presence of jaundice were assessed using the chi-square test and the p < 0.05 was considered to be statistically significant. Results The prevalence of NJ was 49.8% by Kramer’s method and 63.5% by TSB. The Sensitivity, Specificity, PPV, and NPV of Kramer’s method were 70.5, 86.1, 89.8, and 62.6%, respectively. The +LR and –LR were 5.07 and 0.34, respectively. The diagnostic accuracy of Kramer’s method was 76.1%. There was a moderate agreement between Kramer’s method and TSB results (κ = 0.524, P<0.001). No significant relationship was observed between the independent variables and the presence of NJ. Conclusion Kramer has a good positive predictive value. However, due to low sensitivity and NPV one cannot say that overall predictive ability is good. Also, clinical assessment by Kramer’s method should not be used for screening of NJ. Further studies are needed to investigate the utility of other non-invasive techniques in detecting NJ among neonates of black descent.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Socio-demographic Characteristics Of the Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reliability of visual assessment of neonatal jaundice among neonates of black descent: a cross-sectional study from Tanzania

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In case of severe anemia or active bleeding, blood transfusions with 20–25 ml/kg of concentrate red cells over 180–240 minutes were given. Neonatal jaundice was evaluated according to the Modified Kramer’s Scale as well as serum bilirubin levels, if available [ 20 ]. Phototherapy was used to treat jaundice with four hour-long sessions at a time; however, light therapy was often withheld due to hyperthermia.…”

Section: Methodsmentioning

confidence: 99%

“Assessing Today for a Better Tomorrow”: An observational cohort study about quality of care, mortality and morbidity among newborn infants admitted to neonatal intensive care in Guinea

Alves

N’fanly²,

Diallo³

et al. 2021

PLoS ONE

View full text Add to dashboard Cite

Background Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed. Objective To determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality. Methods Prospective observational cohort study of newborns admitted to the hospital between mid-February and mid-March 2019 after birth in other institutions. Data were collected on maternal/prenatal history, delivery, and in-hospital care via convenience sampling. Associations of patient characteristics with in-hospital death were assessed using cause-specific Cox proportional-hazards models. Results Half of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42–11.25, p = <0.0001). Hypothermia at admission was also associated with a higher hazard of death (HR 2.00, 95%-CI 1.10–3.65, p = 0.023). Conclusion Neonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.

show abstract

“…Kramer's method is user friendly because is non-invasive, doesn't require any machine so it can be used as a screening and diagnosing tool in resource limited areas. The technique was introduced by Kramer, and showed a positive correlation between progressions of skin discoloration and serum bilirubin levels (5,6) due to skin thickness differences. According to Kramer, the assessment should begin from the head towards the feet which portray the five zones of the cephalic-caudal progression of jaundice.…”

Section: Introductionmentioning

confidence: 99%

Reliability of Visual Assessment for Diagnosis of Neonatal Jaundice Among Neonates of Black Descent: A Cross-Sectional Study From Tanzania.

Dionis

Chillo

Bwire

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Jaundice is common among neonates and if untreated can lead to kernicterus. Diagnosing of jaundice in neonates using Kramer’s method (visual assessment) is considered user friendly in resource limited areas. However, there are conflicting finding on reliability of the Kramer’s method in diagnosis of neonatal jaundice (NJ) particularly of black descent. Therefore, this study aimed to determine diagnostic accuracy of Kramer’s method in comparison with total serum bilirubin (TSB) test in diagnosis of NJ among neonates of black descent in Tanzania. Methods: A cross-sectional study was conducted between June and July 2020 at Muhimbili National Hospital (MNH) in Dar es Salaam Tanzania. A total of 315 neonates were recruited consecutively. In each neonates’ jaundice was assessed by using Kramer’s method and TSB test. A 2 X 2 table was created for determination of sensitivity, specificity, positive predictive values (PPV), negative predictive value (NPV), positive and negative likelihood ratios (+LR/-LR) and diagnostic accuracy (effectiveness). Cohen kappa (κ) was used to analyze the agreement between Kramer’s method and TSB. Association between independent variables and presence of jaundice were assessed using chi-square test and the p ˂ 0.05 was considered to be statistical significance. Results: The prevalence of NJ was 49.8% by Kramer’s method and 63.5% by TSB. The Sensitivity, Specificity, PPV, and NPV of the Kramer’s method were 70.5%, 86.1%, 88.8%, and 62.6%, respectively. The +LR and –LR were 5.07 and 0.34 respectively. The diagnostic accuracy of the Kramer’s method was 76.1%. There was a moderate agreement between Kramer’s method and TSB results (κ= 0.524, P˂0.001). No significance relationship between the independent variables and presence of NJ. Conclusion: Kramer’s method was found to be inefficient in detecting NJ among neonates of black descent. However, it can be used as a predictor of NJ and whenever available invasive techniques should be applied.

show abstract

Detection of Neonatal Jaundice among the Newborn Using Kramer?s Criteria

Cited by 7 publications

References 5 publications

Reliability of visual assessment of neonatal jaundice among neonates of black descent: a cross-sectional study from Tanzania

Reliability of visual assessment of neonatal jaundice among neonates of black descent: a cross-sectional study from Tanzania

“Assessing Today for a Better Tomorrow”: An observational cohort study about quality of care, mortality and morbidity among newborn infants admitted to neonatal intensive care in Guinea

Reliability of Visual Assessment for Diagnosis of Neonatal Jaundice Among Neonates of Black Descent: A Cross-Sectional Study From Tanzania.

Contact Info

Product

Resources

About