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

Hatzenbuehler, Lindsay A.; Zaidi, Anita K. M.; Sundar, Shiyam; Sultana, Shazia; Abbasi, F.; Rizvi, Arjumand

doi:10.1038/jp.2010.13

Cited by 21 publications

(15 citation statements)

References 14 publications

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“…Mothers and other care-givers should be encouraged to look for jaundice by blanching the skin (on the nose in particular), looking at the gums and examining the eyes [ 4 ]. The use of Kramer’s chart (see Additional file 3 : Figure S1) especially in primary care settings remains valuable despite its limitation in correlating with the severity of jaundice [ 37 , 38 ]. So also is blanching of the gums possibly with an icterometer, particularly in dark-skinned babies [ 39 ].…”

Section: Reviewmentioning

confidence: 99%

Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings

et al. 2015

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Hyperbilirubinaemia is a ubiquitous transitional morbidity in the vast majority of newborns and a leading cause of hospitalisation in the first week of life worldwide. While timely and effective phototherapy and exchange transfusion are well proven treatments for severe neonatal hyperbilirubinaemia, inappropriate or ineffective treatment of hyperbilirubinaemia, at secondary and tertiary hospitals, still prevails in many poorly-resourced countries accounting for a disproportionately high burden of bilirubin-induced mortality and long-term morbidity. As part of the efforts to curtail the widely reported risks of frequent but avoidable bilirubin-induced neurologic dysfunction (acute bilirubin encephalopathy (ABE) and kernicterus) in low and middle-income countries (LMICs) with significant resource constraints, this article presents a practical framework for the management of late-preterm and term infants (≥35 weeks of gestation) with clinically significant hyperbilirubinaemia in these countries particularly where local practice guidelines are lacking. Standard and validated protocols were followed in adapting available evidence-based national guidelines on the management of hyperbilirubinaemia through a collaboration among clinicians and experts on newborn jaundice from different world regions. Tasks and resources required for the comprehensive management of infants with or at risk of severe hyperbilirubinaemia at all levels of healthcare delivery are proposed, covering primary prevention, early detection, diagnosis, monitoring, treatment, and follow-up. Additionally, actionable treatment or referral levels for phototherapy and exchange transfusion are proposed within the context of several confounding factors such as widespread exclusive breastfeeding, infections, blood group incompatibilities and G6PD deficiency, which place infants at high risk of severe hyperbilirubinaemia and bilirubin-induced neurologic dysfunction in LMICs, as well as the limited facilities for clinical investigations and inconsistent functionality of available phototherapy devices. The need to adjust these levels as appropriate depending on the available facilities in each clinical setting and the risk profile of the infant is emphasised with a view to avoiding over-treatment or under-treatment. These recommendations should serve as a valuable reference material for health workers, guide the development of contextually-relevant national guidelines in each LMIC, as well as facilitate effective advocacy and mobilisation of requisite resources for the optimal care of infants with hyperbilirubinaemia at all levels.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0358-z) contains supplementary material, which is available to authorized users.

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Section: Reviewmentioning

confidence: 99%

Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings

et al. 2015

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“…In developing countries lacking routine screening protocols, significant jaundice is often missed. 4 In north Vietnam, national screening protocols and management guidelines are lacking for newborn jaundice. A recent regional study of tertiary referrals for jaundice in northern Vietnam showed that 22% of infants had serum bilirubin levels requiring exchange transfusion, and 28% demonstrated signs of acute bilirubin encephalopathy on admission to hospital.…”

Section: What This Paper Addsmentioning

confidence: 99%

“…Mothers were taught how to give a jaundice score by blanching the skin with digital pressure to assess the underlying skin color in sufficient ambient light. Mothers were asked to score and record the level of jaundice once daily for six consecutive days as follows: none (0), face (1), chest (2), legs and/or arms (3), or palms of hands and/or feet (4).…”

Section: Training Modulementioning

confidence: 99%

Home‐use icterometry in neonatal hyperbilirubinaemia: Cluster‐randomised controlled trial in Vietnam

Luu

Tran

et al. 2014

J Paediatrics Child Health

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“…Controversial findings on reliability of this technique for detecting NJ have been reported worldwide. Studies conducted in Pakistan (2010) and Indonesia (2017) reported that Kramer’s method is reliable in detection of NJ and darker skin color is not a matter of concern [ 7 , 8 ]. However, a study conducted in United State of America (USA) reported that Kramer’s method alone is not reliable in detecting NJ especially in darkly pigmented neonates [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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

Cited by 21 publications

References 14 publications

Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings

Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings

Home‐use icterometry in neonatal hyperbilirubinaemia: Cluster‐randomised controlled trial in Vietnam

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

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