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

Journal of Perinatology volume 30, pages 616–621 (2010)Cite this article

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Abstract

Objective:

The purpose of this study was to validate primary health-care workers' and physicians' visual assessment of neonatal hyperbilirubinemia in Karachi, Pakistan.

Study Design:

We compared primary health-care workers' and physicians' clinical identification of jaundice in infants <60 days old.

Result:

Primary health-care workers identified 1- to 20-day-old neonates with hyperbilirubinemia ⩾15 mg per 100 ml (260 μmol l−1) with 83.3% sensitivity and 50.5% specificity; neonates aged 1 to 6 days were identified with 76.2% sensitivity and 60.7% specificity. Physicians identified neonates aged 1 to 20 days with hyperbilirubimemia ⩾15 mg per 100 ml (260 μmol l−1) with 51.4% sensitivity and 90.7% specificity, and neonates aged 1 to 6 days with 50% sensitivity and 88.5 % specificity. The primary health-care workers' and physicians' assessments showed fair interobserver agreement (κ statistic 0.29).

Conclusion:

Primary health-care workers identified hyperbilirubinemic neonates with adequate sensitivity. With proper training and supervision, their assessment could improve the referral of hyperbilirubinemic neonates in low-resource settings in the developing world.

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References

  1. Narayanan I, Banwalikar J, Mehta R, Ghorpade M, Peesay MR, Nanda S et al. A simple method of evaluation of jaundice in the newborn. Ann Trop Paediatr 1990; 10: 31–34.

    Article  CAS  PubMed  Google Scholar 

  2. Connolly AM, Volpe JJ . Clinical features of bilirubin encephalopathy. Clin Perinatol 1990; 17: 371–379.

    Article  CAS  PubMed  Google Scholar 

  3. Goswami V, Kumar DA, Singh V, Chandra J . Evaluation of simple clinical signs of illness in young infants (0–2 months) and its correlation with WHO IMCI algorithm (7 days to 2 months). Indian Pediatr 2006; 43: 1042–1049.

    PubMed  Google Scholar 

  4. Kramer LI . Advancement of dermal icterus in the jaundiced newborn. Am J Dis Child 1969; 118: 454–458.

    CAS  PubMed  Google Scholar 

  5. Ebbesen F . Relationship between the cepahlo-pedal progress of clinical icterus and the serum bilirubin concentration in newborn infants without blood type sensitization. Acta Obstet Gynecol Scand 1975; 54: 329–332.

    Article  CAS  PubMed  Google Scholar 

  6. Riskin A, Kuglman A, Abend-Weinger M, Green M, Hemo M, Bader D . In the eye of the beholder: how accurate is clinical estimation of jaundice in newborns? Acta Paediatr 2003; 92: 574–576.

    Article  CAS  PubMed  Google Scholar 

  7. Madlon-Kay DJ . Recognition of the presence and severity of newborn jaundice by parents, nurses, physicians, and icterometer. Pediatrics 1997; 100: E3.

    Article  CAS  PubMed  Google Scholar 

  8. Madlon-Kay DJ . Home health nurse clinical assessment of neonatal jaundice: comparison of 3 methods. Arch Pediatr Adolesc Med 2001; 155: 583–586.

    Article  CAS  PubMed  Google Scholar 

  9. Szabo P, Wolf M, Ulrich Bucher H, FauchŸre JC, Haenesse D, Arlettaz R . Detection of hyperbilirubinaemia in jaundiced full-term neonates by eye or by bilirubinometer. Eur J Pediatr 2004; 163: 722–727.

    Article  PubMed  Google Scholar 

  10. Szabo P, Wolf M, Ulrich Bucher HU, Haenesse D, FauchŸre JC, Arlettaz R . Assessment of jaundice in preterm neontates: comparison between clinical assessment, two transcutaneous bilirubinometers and serum bilirubin values. Acta Paediatr 2004; 93: 1491–1495.

    Article  CAS  PubMed  Google Scholar 

  11. Knudsen A, Brodersen R . Skin colour and bilirubinemia in neonates. Arch Dis Child 1989; 64: 605–609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Moyer VA, Ahn C, Sneed S . Accuracy of clinical judgement in neonatal jaundice. Arch Pediatr Adolesc Med 2000; 154: 391–394.

    Article  CAS  PubMed  Google Scholar 

  13. Young Infants Clinical Signs Study Group. Clinical signs predicting severe illness in young infants: a multicentre study. Lancet 2008; 12: 135–142.

    Google Scholar 

  14. Subcommittee on Hyperbilirubinemia. Management of hyperbilirbubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114: 297–316.

    Article  Google Scholar 

  15. Kaplan M, Hammerman C . Understanding and preventing severe neonatal hyperbilirubinemia: is bilirubin neurotoxicity really a concern in the developed world?. Clin Perinatol 2004; 31: 555–575, x.

    Article  PubMed  Google Scholar 

  16. Landis JR, Koch GG . The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.

    Article  CAS  PubMed  Google Scholar 

  17. StataCorp. Stata Statistical Software: Release 10.0. Stata Corporation, College Station: TX, 2005.

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Acknowledgements

We thank the study participants from the three study communities for their willingness to participate in the study; the lady health visitors (Razia Awaldad, Nasira A Jabbar, Mussarat Omer); Save the Children-US (through a grant from the Bill & Melinda Gates Foundation) who provided funding for the data collection and analysis; Martin Weber and Rajiv Bahl from the Child and Adolescent Health and Development Department at the World Health Organization, David Hamer at Boston University and John Carlin at the University of Melbourne, for their technical help in study design, and Dr Marie Deiner-West and Dr John McGready of the Biostatistics Department, and Dr Rosa Crum of the Epidemiology Department at the Johns Hopkins Bloomberg School of Public Health for their professional advice in the data analysis and reporting of results.

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Authors and Affiliations

  1. Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    L Hatzenbuehler, A Rizvi & G L Darmstadt

  2. Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan

    A K M Zaidi, S Sundar, S Sultana, F Abbasi & A Rizvi

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  1. L Hatzenbuehler
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  2. A K M Zaidi
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  3. S Sundar
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  4. S Sultana
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  5. F Abbasi
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  6. A Rizvi
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  7. G L Darmstadt
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Corresponding author

Correspondence to G L Darmstadt.

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Competing interests

The investigators have no competing interests and received no financial gain from the study results.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Hatzenbuehler, L., Zaidi, A., Sundar, S. et al. Validity of neonatal jaundice evaluation by primary health-care workers and physicians in Karachi, Pakistan. J Perinatol 30, 616–621 (2010). https://doi.org/10.1038/jp.2010.13

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