Don't Rely on Jaundiced Eye for Assessin... (rnicterus a potentially life-threatening...)

Don't Rely on Jaundiced Eye for Assessing Newborns

Date:3/23/2009

rnicterus, a potentially life-threatening condition that can result in long-term brain damage, hearing loss and other neurological problems. Although extremely rare, kernicterus has been increasing in the U.S. over the past two decades, leading some professional organizations to advocate universal bilirubin screening before newborns leave the hospital. The standard treatment for significant hyperbilirubinemia is phototherapy--exposing the baby to ultraviolet lights that chemically change bilirubin under the skin to a harmless form.

The current study was the first systematic analysis of jaundice assessment as a predictor of significant hyperbilirubinemia risk. It was also the largest such study, involving 522 term and late-preterm newborns.

Clinicians have long known that neonatal jaundice progresses from head to foot, as shown by yellowing of the baby's skin. In this study, conducted in the Well Baby Nursery of the Hospital of the University of Pennsylvania, nurses used a five-point scale to grade the farthest extent of jaundice along the newborn's body. The nurses who did the ratings did not know the actual bilirubin levels, which were measured by other caregivers using a noninvasive device.

On analyzing the results, the researchers found that, while there was some correlation between the extent of jaundice as rated by the nurses and the measured bilirubin levels, the extent of jaundice could not be used to estimate the bilirubin level or to accurately predict an infant's risk of developing significant hyperbilirubinemia (defined in this study as a bilirubin level for which phototherapy is recommended). Furthermore, contrary to a common belief that it is harder to visually assess jaundice in dark-skinned infants, there was no significant difference in the results between black and white newborns.

The correlation between visually assessed jaundice and bilirubin level was especially weak
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