RECOGNITION OF THE PRESENCE AND SEVERITY OF NEWBORN JAUNDICE BY PARENTS, NURSES, PHYSICIANS, AND ICTEROMETER

Objective. To determine how well parents, nurses, physicians, and an I ngram icterometer can detect the presence and the severity of jaundice in newborns. Setting. Normal newborn nursery in a 340-bed teaching ho spital. Patients or Other Participants Nurses and physicians caring fo r nursery infants and parents of the infants. Interventions. Physician s and nurses examining newborns documented whether they detected jaund ice in the infants and, if so, the estimated bilirubin level and the e xtent of cephalocaudal progression of the jaundice. An assistant taugh t the parents how to examine the infants for jaundice and determine it s cephalocaudal progression. The assistant also obtained icterometer r eadings. Bilirubin testing was performed according to usual clinical p ractice. Outcome Measures Nurse and physician estimates of bilirubin l evels; parent, nurse, and physician assessment of the presence of jaun dice and its cephalocaudal progression; icterometer readings; bilirubi n levels. Results. There was moderate agreement about the presence of jaundice in the infants (pairwise kappa, 0.48) However, all infants wi th bilirubin levels >12 mg/dL were correctly identified as jaundiced b y all examiners. The parents' assessment of cephalocaudal progression and the icterometer readings were most highly correlated with serum bi lirubin levels (adjusted Pearson correlations, 0.71 and 0.57, respecti vely). Conclusions. Many parents can be taught to accurately assess ce phalocaudal progression of jaundice in the hospital. The icterometer i s a useful tool for assessing jaundice severity. Both parent assessmen t and the icterometer were more highly correlated with bilirubin level s than physician and nurse estimates in this study. Additional researc h is needed to determine how accurate these methods of clinical assess ment are at the higher bilirubin levels that typically occur after hos pital discharge.