Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study
Objective Determine the sensitivity and specificity of neonatal jaundice visual estimation by primary healthcare workers (PHWs) and physicians as predictors of hyperbilirubinaemia.Design Multicentre observational cohort study.Setting Hospitals in Chandigarh and Delhi, India; Dhaka, Bangladesh; Durba...
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BMJ Publishing Group
2021-12-01
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| Online Access: | https://bmjopen.bmj.com/content/11/12/e048145.full |
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| author | Praveen Kumar Rajiv Bahl Samir K Saha Anil Narang Martin W Weber Pallab Ray Gary L Darmstadt Emmanuel Addo-Yobo Davidson H Hamer John B Carlin A K Deorari Prakash M Jeena Eduardo Mazzi MAK Azad Chowdhury Yaw Abu-Sarkodie Kojo Yeboah-Antwi Andres E Bartos Eric Foote |
| author_facet | Praveen Kumar Rajiv Bahl Samir K Saha Anil Narang Martin W Weber Pallab Ray Gary L Darmstadt Emmanuel Addo-Yobo Davidson H Hamer John B Carlin A K Deorari Prakash M Jeena Eduardo Mazzi MAK Azad Chowdhury Yaw Abu-Sarkodie Kojo Yeboah-Antwi Andres E Bartos Eric Foote |
| author_sort | Praveen Kumar |
| collection | DOAJ |
| description | Objective Determine the sensitivity and specificity of neonatal jaundice visual estimation by primary healthcare workers (PHWs) and physicians as predictors of hyperbilirubinaemia.Design Multicentre observational cohort study.Setting Hospitals in Chandigarh and Delhi, India; Dhaka, Bangladesh; Durban, South Africa; Kumasi, Ghana; La Paz, Bolivia.Participants Neonates aged 1–20 days (n=2642) who presented to hospitals for evaluation of acute illness. Infants referred for any reason from another health facility or those needing immediate cardiopulmonary resuscitation were excluded.Outcome measures Infants were evaluated for distribution (head, trunk, distal extremities) and degree (mild, moderate, severe) of jaundice by PHWs and physicians. Serum bilirubin level was determined for infants with jaundice, and analyses of sensitivity and specificity of visual estimations of jaundice used bilirubin thresholds of >260 µmol/L (need for phototherapy) and >340 µmol/L (need for emergency intervention in at-risk and preterm babies).Results 1241 (47.0%) neonates had jaundice. High sensitivity for detecting neonates with serum bilirubin >340 µmol/L was found for ‘any jaundice of the distal extremities (palms or soles) OR deep jaundice of the trunk or head’ for both PHWs (89%–100%) and physicians (81%–100%) across study sites; specificity was more variable. ‘Any jaundice of the distal extremities’ identified by PHWs and physicians had sensitivity of 71%–100% and specificity of 55%–95%, excluding La Paz. For the bilirubin threshold >260 µmol/L, ‘any jaundice of the distal extremities OR deep jaundice of the trunk or head’ had the highest sensitivity across sites (PHWs: 58%–93%, physicians: 55%–98%).Conclusions In settings where serum bilirubin cannot be measured, neonates with any jaundice on the distal extremities should be referred to a hospital for evaluation and management, where delays in serum bilirubin measurement and appropriate treatment are anticipated following referral, the higher sensitivity sign, any jaundice on the distal extremities or deep jaundice of the trunk or head, may be preferred. |
| format | Article |
| id | doaj-art-946831f73ba04e3695f3d6b4fe736bc3 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-946831f73ba04e3695f3d6b4fe736bc32024-12-08T09:20:08ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2020-048145Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort studyPraveen Kumar0Rajiv Bahl1Samir K Saha2Anil Narang3Martin W Weber4Pallab Ray5Gary L Darmstadt6Emmanuel Addo-Yobo7Davidson H Hamer8John B Carlin9A K Deorari10Prakash M Jeena11Eduardo Mazzi12MAK Azad Chowdhury13Yaw Abu-Sarkodie14Kojo Yeboah-Antwi15Andres E Bartos16Eric Foote17Department of Commerce, Manipal Academy of Higher Education, Manipal, Karnataka, India8 Organisation mondiale de la Sante, Geneva, Switzerland13 Child Health Research Foundation, Dhaka, Bangladesh7 Departments of Pediatrics and Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IndiaChild and Adolescent Health and Development Division, WHO Regional Office for Europe, Copenhagen, Denmark7 Departments of Pediatrics and Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, IndiaDepartment of Pediatrics, Stanford University School of Medicine, Stanford, California, USASchool of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, GhanaDepartment of Global Health, Boston University School of Public Health, Boston, Massachusetts, USAClinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, and University of Melbourne, Parkville, Victoria 3052, Australia8 Department of Pediatrics, Division of Neonatology, All India Institute of Medical Sciences, New Delhi, Delhi, India5 Department of Paediatrics and Child Health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa6 Department of Pediatrics, Hospital del Nino Dr Ovidio Aliaga Uria, La Paz, Plurinational State of Bolivia10 Department of Neonatology, Dhaka Shishu Hospital, Dhaka, Bangladesh11 Kwame Nkrumah University of Science and Technology, Kumasi, GhanaPublic Health Unit, Fr Thomas Alan Rooney Memorial Hospital, Kumasi, Asankrangwa, Ghana12 Department of Pediatrics, Hospital Materno-Infantil, La Paz, Plurinational State of Bolivia1 Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USAObjective Determine the sensitivity and specificity of neonatal jaundice visual estimation by primary healthcare workers (PHWs) and physicians as predictors of hyperbilirubinaemia.Design Multicentre observational cohort study.Setting Hospitals in Chandigarh and Delhi, India; Dhaka, Bangladesh; Durban, South Africa; Kumasi, Ghana; La Paz, Bolivia.Participants Neonates aged 1–20 days (n=2642) who presented to hospitals for evaluation of acute illness. Infants referred for any reason from another health facility or those needing immediate cardiopulmonary resuscitation were excluded.Outcome measures Infants were evaluated for distribution (head, trunk, distal extremities) and degree (mild, moderate, severe) of jaundice by PHWs and physicians. Serum bilirubin level was determined for infants with jaundice, and analyses of sensitivity and specificity of visual estimations of jaundice used bilirubin thresholds of >260 µmol/L (need for phototherapy) and >340 µmol/L (need for emergency intervention in at-risk and preterm babies).Results 1241 (47.0%) neonates had jaundice. High sensitivity for detecting neonates with serum bilirubin >340 µmol/L was found for ‘any jaundice of the distal extremities (palms or soles) OR deep jaundice of the trunk or head’ for both PHWs (89%–100%) and physicians (81%–100%) across study sites; specificity was more variable. ‘Any jaundice of the distal extremities’ identified by PHWs and physicians had sensitivity of 71%–100% and specificity of 55%–95%, excluding La Paz. For the bilirubin threshold >260 µmol/L, ‘any jaundice of the distal extremities OR deep jaundice of the trunk or head’ had the highest sensitivity across sites (PHWs: 58%–93%, physicians: 55%–98%).Conclusions In settings where serum bilirubin cannot be measured, neonates with any jaundice on the distal extremities should be referred to a hospital for evaluation and management, where delays in serum bilirubin measurement and appropriate treatment are anticipated following referral, the higher sensitivity sign, any jaundice on the distal extremities or deep jaundice of the trunk or head, may be preferred.https://bmjopen.bmj.com/content/11/12/e048145.full |
| spellingShingle | Praveen Kumar Rajiv Bahl Samir K Saha Anil Narang Martin W Weber Pallab Ray Gary L Darmstadt Emmanuel Addo-Yobo Davidson H Hamer John B Carlin A K Deorari Prakash M Jeena Eduardo Mazzi MAK Azad Chowdhury Yaw Abu-Sarkodie Kojo Yeboah-Antwi Andres E Bartos Eric Foote Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study BMJ Open |
| title | Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study |
| title_full | Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study |
| title_fullStr | Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study |
| title_full_unstemmed | Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study |
| title_short | Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study |
| title_sort | validation of visual estimation of neonatal jaundice in low income and middle income countries a multicentre observational cohort study |
| url | https://bmjopen.bmj.com/content/11/12/e048145.full |
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