For hundreds of years, doctors, nurses and midwives have visually examined newborn babies for the yellowish skin tones that signify jaundice, judging that more extensive jaundice carried a greater risk of illness.
The yellowness comes from a blood byproduct, bilirubin, and a child that develops high levels of bilirubin has a potentially serious condition called hyperbilirubinemia.
Now pediatric researchers say that this longstanding practice of visual inspection is an unreliable method of predicting the baby's risk of hyperbilirubinemia. Only infants with a total absence of visible jaundice can confidently be expected to have a very low risk of hyperbilirubinemia.
"Our study tells clinicians that our ability to estimate a baby's bilirubin level, or predict the baby's risk of developing clinically significant hyperbilirubinemia, by visually observing the extent of visual jaundice, is inadequate, and not very helpful," said study leader Ron Keren, M.D., M.P.H., a pediatrician in the Center for Pediatric Clinical Effectiveness at The Children's Hospital of Philadelphia. Keren also is a faculty member of the University of Pennsylvania School of Medicine.
The study appeared March 22 in the online version of Archives of Disease in Childhood--Fetal and Neonatal Edition.
Neonatal jaundice is very common, occurring in as many as 60 percent of newborns annually, according to the American Academy of Pediatrics. It appears as a yellow skin color, a sign of excess bilirubin, a byproduct of the normal breakdown of red blood cells. In the vast majority of cases, jaundice disappears in one to two weeks as the baby's liver reduces bilirubin to normal levels, permitting the excess to be excreted.
But extremely high levels of bilirubin can cause kernicterus, a potentially life-threatening condition that can result in long-term brain damage, hearing loss and other neurological problems. Although extremely rare, kernicter
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Children's Hospital of Philadelphia