Is visual assessment of jaundice reliable as a screening tool to detect significant neonatal hyperbilirubinemia?

Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel.
The Journal of pediatrics (Impact Factor: 4.02). 06/2008; 152(6):782-7, 787.e1-2. DOI: 10.1016/j.jpeds.2007.11.003
Source: PubMed

ABSTRACT To assess the reliability of visual assessment of bilirubin levels (BiliEye) in newborns as a screening tool to detect significant neonatal hyperbilirubinemia.
5 neonatologists and 17 nurses estimated 3,532 BiliEye in 1,129 term and late preterm (> or = 35 weeks) infants before discharge from the nursery, at 62 +/- 24 hours. Total serum bilirubin (TSB) levels were measured concomitantly.
Mean TSB and BiliEye were 6.7 +/- 2.9 mg/dL (range, 0.4-18.2 mg/dL) and 6.6 +/- 3.2 mg/dL (range, 0.0-17.2 mg/dL), respectively, with good correlation (Pearson's r = 0.752, P < .0001), but other measures of agreement were poor. 61.5% of the 109 babies with TSB levels in high-risk zones were clinically misclassified. The area under curve (AUC) of the receiver-operating characteristics plotted for these high-risk zones was 0.825, but became low for early discharge (< or = 36 hours; AUC = 0.638) and late preterm (35-37 weeks; AUC = 0.613). There was significant interobserver variation (low weighted kappa, 0.363).
Although there was good correlation between BiliEye and actual TSB level, visual assessment was unreliable as a screening tool to detect significant neonatal hyperbilirubinemia before discharge. Babies with TSB levels within high-risk zones may be clinically misdiagnosed as low-risk, resulting in inadequate follow-up.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Transcutaneous bilirubinometry is widely used to predict hyperbilirubinemia by using several devices. The aim of this study was to compare the predictive ability of BiliCheck vs JM-103 in identifying neonates not at risk of significant hyperbilirubinemia, putting the data obtained with the two instruments on our transcutaneous bilirubin nomogram built with the BiliCheck. Transcutaneous bilirubin (TcB) measurement was performed when jaundice appeared in newborn babies and/or just before discharge from the hospital. It was performed at the forehead with the two instruments within 5 minutes by two experienced neonatologists, each one blind to the value obtained by the other. Blood samples were drawn to obtain total serum bilirubin (TSB) levels soon after TcB measurements. A total of 627 paired-sample measurements were obtained from 298 newborn babies. Out of the total population studied, 16 newborn babies (5.4%) showed significant hyperbilirubinemia defined as TSB value >17 mg/dL, or as need for phototherapy treatment according to the AAP guidelines. TcB measurements showed false negative results in the first 60 hours of life using both devices. After the 60th hour of life, TcB measurements using both devices successfully predicted newborn babies not at risk of significant hyperbilirubinemia, being the JM-103 more reliable than BC because of fewer false positive results. Our study shows that both BC and JM-103 can exclude subsequent significant hyperbilirubinemia when the measurements are performed after the 60th hour of life. Nevertheless, the transcutaneous pre-discharge screening should be considered only as the first step, and it has to be followed by a follow-up through the first days after discharge.
    Italian Journal of Pediatrics 07/2013; 39(1):46. · 1.34 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Hyperbilirubinaemia is one of the most frequent problems in otherwise healthy newborn infants. Early discharge of the healthy newborn infants, particularly those in whom breastfeeding is not fully established, may be associated with delayed diagnosis of significant hyperbilirubinaemia that has the potential for causing severe neurological impairments. We present the shared Italian guidelines for management and treatment of jaundice established by the Task Force on hyperbilirubinaemia of the Italian Society of Neonatology.The overall aim of the present guidelines is to provide an useful tool for neonatologists and family paediatricians for managing hyperbilirubinaemia.
    Italian Journal of Pediatrics 01/2014; 40(1):11. · 1.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introducción: La predicción del riesgo de hiperbilirrubinemia significativa a través de la medición de una bilirrubina previa al alta ha sido validada en neonatos. La estimación visual de la extensión de la ictericia es comúnmente usada para la decisión de la obtención de la prueba de bilirrubina. Objetivo: Determinar la confiabilidad de la evaluación visual de la ictericia en la detección del riesgo de hiperbilirrubinemia significativa. Métodos: 123 neonatos fueron examinados antes del alta por un pediatra quien asignó la extensión de la ictericia según su progresión céfalo-caudal. Una medida simultánea de bilirrubina transcutánea fue hecha por otro observador. Luego se comparó la calificación del riesgo de hiperbilirrubinemia significativa por ambos métodos, a través de un nomograma clasificado por zonas de riesgo. Resultados: El porcentaje de coincidencia global en relación a la designación de riesgo por ambos métodos fue 73%, pero esta proporción decreció a 56,3% cuando se analizó sólo para las zonas de alto riesgo. De hecho, 18 (43,7%) de los 32 neonatos calificados de alto riesgo por la prueba transcutánea fueron erróneamente identificados por la evaluación visual como niños de bajo riesgo. Conclusiones: A pesar de que la concordancia general entre la estimación visual de la ictericia y la bilirrubina real es aceptable, la confiabilidad de la valoración visual como el procedimiento primario para identificar el riesgo de una hiperbilirrubinemia significativa es limitada. La detección de la severidad de la ictericia debe basarse en otros métodos, como la medición de la bilirrubina sérica o transcutánea.
    Archivos venezolanos de puericultura y pediatría 03/2011; 74(1):7-11.