Home health nurse clinical assessment of neonatal jaundice - Comparison of3 methods

Objective: To compare 3 methods of clinical assessment of jaundice in newbo rns by home health nurses. Design: Prospective clinical trial. Setting: Homes of newborns living within 10 miles of a 340-bed community ho spital where they were delivered. Participants: Home health nurses and newborn patients (less than or equal t o2 weeks old). Interventions: The nurses examined the newborns and documented whether they detected jaundice. In new borns thought to have jaundice, the nurses estim ated bilirubin levels, documented the extent of caudal progression of the j aundice, and determined the Ingram (Cascade Health Care Products, Salem, Or e) icterometer readings from the newborns' noses. Total serum bilirubin tes ts were obtained from all newborns studied. Outcome Measures: Nurse assessment of the presence of jaundice and its caud al progression, nurse estimates of bilirubin levels, icterometer readings, and bilirubin levels. Results: The nurses determined that 82 (50%) of the 164 newborns had jaundi ce. Their estimates of bilirubin levels were most highly correlated with se rum bilirubin levels (Pearson correlation, 0.61). All newborns with bilirub in levels greater than or equal to 291 mu mol/L (greater than or equal to 1 7 mg/dL) were recognized by the nurses as having jaundice. These newborns h ad icterometer readings greater than or equal to 3.5 and had estimated bili rubin levels of greater than or equal to 274 mu mol/L (greater than or equa l to 16 mg/dL). Conclusions: The method of evaluation that each nurse was accustomed to usi ng was the most accurate in determining the severity of newborn jaundice. T hese results suggest that postpartum home health nurses can effectively eva luate newborns for the presence and severity of jaundice.