Validity of Kramer Scale in Neonatal Hyperbilirubinemia

Abstract

Introduction: Jaundice refers to the yellow discoloration of sclera, skin and mucous membranes. It is a common problem that is faced during the first week of life by nearly every neonate. It is important to determine whether the clinical examination can be used reliably as a clinical screening tool for the diagnosis of neonatal jaundice. The diagnostic accuracy of Kramer’s rule was compared to venous method in this study in order to provide less invasive, time consuming and less painful method of measuring neonatal hyperbilirubinemia. Objective: To determine the diagnostic accuracy of Kramer’s rule of assessing neonatal hyperbilirubinemia taking serum bilirubin as “Gold standard”. Setting: New-born nursery at Paediatric Unit, Liaquat University Hospital, Hyderabad, Sindh. Design: Cross sectional validation study. Subject and Methods: A total of 317 neonates coming under inclusion criteria presenting at new-born nursery were examined. First, baby is undressed and clinical assessment of jaundice done. Then the venous blood sample was collected for serum bilirubin level and sent to diagnostic lab. Data was collected on predetermined pro-forma. Results: The average age of the neonate was 3.51±1.55 days. Sensitivity, specificity, positive predicted value, negative predicted value and accuracy of Kramer’s Rule in detection of neonatal hyperbilirubinemia was 90.7%, 80.5%, 88%, 84.6% and 86.75% respectively. Conclusion: Our study demonstrated that the Kramer’s scale could be better choice for detection and screening of neonatal hyperbilirubinemia. It is a non-invasive and quick method that can avoid babies from getting a skin infection or other complications related to blood sampling.