ABSTRACT

Background

Hyperbilirubinaemia is a common cause of hospital admission of newborn infants; however, maternal visual assessment of jaundice may reduce unnecessary hospital visits.

Aims

To investigate the validity of maternal visual assessment of neonatal jaundice to identify infants with hyperbilirubinaemia requiring phototherapy or who have significant hyperbilirubinaemia ≥239.4 µmol/L (14 mg/dL).

Methods

A prospective study of the diagnostic accuracy of maternal visual assessment of jaundice was conducted at a university hospital in Bangkok. Mothers were trained to assess for neonatal jaundice using their infant’s palms as a skin colour reference. Trained mothers who were blinded to transcutaneous bilirubin or serum bilirubin values assessed their infants and reported ‘jaundice’ or ‘no jaundice’, and determined jaundice severity using dermal icterus zones. Sensitivity and negative predictive values were used to assess the validity of visual assessment for neonatal jaundice.

Results

In 180 mothers, the median (min/max) transcutaneous or serum bilirubin value in their infants was 177.8 µmol/L (119.7–309.5). The sensitivity and negative predictive values (95% CI) of maternal assessment for detecting hyperbilirubinaemia requiring phototherapy were 91.7% (73.0–99.0) and 96.6% (87.9–99.1), respectively, and for identifying significant hyperbilirubinaemia were 92.9% (76.5–99.1) and 96.6% (87.9–99.1), respectively. The accuracy of maternal report of dermal zones for serum bilirubin levels was only 44.5%. In 56 infants who received a second jaundice assessment, the sensitivity of maternal assessment for detecting increased transcutaneous or serum bilirubin was 93.9% (83.1–98.7).

Conclusion

Teaching mothers to visually assess their infants for neonatal jaundice was demonstrated to be feasible.

Abbreviations

CI, confidence interval; MB, microbilirubin; min/max, minimum/maximum; NPV, negative predictive value; OPD, outpatient department; PPV, positive predictive value; SD, standard deviation; TcB, transcutaneous bilirubin

中文翻译：

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新生儿黄疸产妇视觉评估的有效性：在泰国进行的一项基于医院的研究

摘要

背景

高胆红素血症是新生儿入院的常见原因；然而，孕产妇对黄疸的视觉评估可能会减少不必要的医院就诊。

宗旨

研究新生儿黄疸的母亲视觉评估的有效性，以识别需要光疗的高胆红素血症或显着高胆红素血症≥239.4 µmol/L (14 mg/dL)的婴儿。

方法

在曼谷的一家大学医院进行了一项关于母亲黄疸视觉评估诊断准确性的前瞻性研究。母亲接受了培训，以使用婴儿的手掌作为肤色参考来评估新生儿黄疸。对经皮胆红素或血清胆红素值不知情的受过训练的母亲评估其婴儿并报告“黄疸”或“无黄疸”，并使用皮肤黄疸区确定黄疸严重程度。敏感性和阴性预测值用于评估新生儿黄疸视觉评估的有效性。

结果

在 180 位母亲中，她们婴儿的经皮或血清胆红素值中位数（最小/最大）为 177.8 µmol/L (119.7–309.5)。母体评估检测需要光疗的高胆红素血症的敏感性和阴性预测值 (95% CI) 分别为 91.7% (73.0-99.0) 和 96.6% (87.9-99.1)，用于识别显着高胆红素血症为 92.9% (76.5-99.1) ) 和 96.6% (87.9–99.1)，分别。母体真皮区血清胆红素水平报告的准确率仅为 44.5%。在接受第二次黄疸评估的 56 名婴儿中，母亲评估检测经皮或血清胆红素升高的敏感性为 93.9% (83.1-98.7)。

结论

事实证明，教导母亲目视评估婴儿的新生儿黄疸是可行的。

缩写

CI，置信区间；MB，微胆红素；最小/最大，最小/最大；NPV，阴性预测值；OPD，门诊部；PPV，阳性预测值；SD，标准差；TcB，经皮胆红素