Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok, Thailand.
Paediatr Int Child Health. 2020 Nov;40(4):242-247. doi: 10.1080/20469047.2020.1816670. Epub 2020 Sep 29.
Hyperbilirubinaemia is a common cause of hospital admission of newborn infants; however, maternal visual assessment of jaundice may reduce unnecessary hospital visits.
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).
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.
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).
Teaching mothers to visually assess their infants for neonatal jaundice was demonstrated to be feasible.
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.
高胆红素血症是新生儿住院的常见原因；然而，母亲对黄疸的目测评估可减少不必要的住院就诊。
研究母亲目测新生儿黄疸的有效性，以识别需要光疗的高胆红素血症婴儿或胆红素值显著升高（≥239.4μmol/L[14mg/dL]）的婴儿。
在曼谷的一家大学医院进行了一项关于母亲目测黄疸的诊断准确性的前瞻性研究。使用婴儿手掌作为皮肤颜色参考，对母亲进行目测黄疸的培训。受过培训的母亲在不知道经皮胆红素或血清胆红素值的情况下评估自己的婴儿，并报告“黄疸”或“无黄疸”，并用皮肤黄疸区确定黄疸严重程度。使用敏感性和阴性预测值评估目测评估新生儿黄疸的有效性。
在 180 位母亲中，其婴儿的经皮或血清胆红素中位数（最小/最大值）为 177.8μmol/L（119.7-309.5）。母亲评估对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），对识别显著高胆红素血症的敏感性和阴性预测值分别为 92.9%（76.5-99.1）和 96.6%（87.9-99.1）。母亲对皮肤区血清胆红素水平的报告准确性仅为 44.5%。在 56 位接受第二次黄疸评估的婴儿中，母亲评估对经皮或血清胆红素升高的敏感性为 93.9%（83.1-98.7）。
教授母亲目测婴儿黄疸是可行的。
CI，置信区间；MB，微量胆红素；min/max，最小/最大；NPV，阴性预测值；OPD，门诊；PPV，阳性预测值；SD，标准差；TcB，经皮胆红素。
