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J Pediatr. 2008 Jun;152(6):782-7, 787.e1-2. doi: 10.1016/j.jpeds.2007.11.003. Epub 2008 Jan 22.

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

Author information

1
Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel. arik.riskin@b-zion.org.il

Abstract

OBJECTIVE:

To assess the reliability of visual assessment of bilirubin levels (BiliEye) in newborns as a screening tool to detect significant neonatal hyperbilirubinemia.

STUDY DESIGN:

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.

RESULTS:

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).

CONCLUSIONS:

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.

PMID:
18492516
DOI:
10.1016/j.jpeds.2007.11.003
[Indexed for MEDLINE]

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