Article Text

  1. D. J. Heintz1,
  2. S. R. Denton1,
  3. L. Shah1,
  4. J. A. Lazerson1,
  5. D. A. Gremse1
  1. 1Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV.


Background Monitoring jaundice and its potential complications is important in the care of newborns. Studies of the accuracy of clinical assessment in predicting clinically significant jaundice in the hospital setting have produced variable results, and there is little published information about the clinical assessment of neonatal jaundice in the ambulatory setting. The aims of this study are to determine how well general pediatricians can predict a newborn's bilirubin concentration and determine whether the transcutaneous bilirubinometer (TcB) correlates with total serum bilirubin (TSB) measurement in the Hispanic population.

Methods Resident physicians evaluated newborns ages 2 to 7 days for jaundice during routine follow-up visits. Clinical evaluation of jaundice was determined using the Kaplan method, which is based on the cephalocaudad progression of visible icterus. Attending physicians also estimated the degree of jaundice and whether they believed that the bilirubin was high enough to warrant hospitalization or further clinical visits (yes/no). Skin color for ethnicity was documented by comparing skin swatches, and three TcB (Minolta/Hill Rom JM-103) readings were taken from the sternum of the neonate. Total serum bilirubin levels were obtained if indicated by clinical judgment or if the TcB average exceeded the 85th percentile for age.

Results 139 newborns (86% Hispanic) were enrolled. Resident and attending physicians correctly estimated the bilirubin level compared to the TcB measurement 61% and 58% of the time, respectively. Only five infants warranted a TSB and two were hospitalized for phototherapy. In both cases, residents did not recognize that the jaundice was significant while the attending correctly determined the need for hospitalization in one of the two cases. While the TcB and the TSB matched in one case, the TcB underestimated the TSB by 6 to 24% (5 cases).

Conclusions The data suggest that general pediatricians may not accurately predict bilirubin concentration based on physical examination, which underscores the importance of TcB measurement as a valuable screening tool. This study reaffirms the conclusions of other studies regarding the underestimation of TcB compared to TSB. Further studies are needed to test the validity of TcB measurements, especially in Hispanic infants.

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