Comparison of Visual Assessment of Neonatal Jaundice by Kramer's rule with total serum bilirubin levels in a Tertiary care hospital of Nepal.

Abstract

Introduction:- Neonatal jaundice is one of the most frequently encountered clinical problems in newborns. Early intervention is needed to prevent complications caused by increased level of serum bilirubin. Kramer’s method is a non invasive visual assessment technique to estimate the bilirubin levels in neonates with jaundice especially useful in low income settings like Nepal. This study was conducted to determine whether visual assessment of neonatal jaundice could serve as a screening step for neonatal hyperbilirubinemia and this type of non-invasive measurement of neonatal jaundice has not been done in our settings. Materials and

Methods:- A prospective cross sectional study was performed over a period of 12 months at Emergency Ward, Neonatal Intermediate Care Unit (NIMCU), Neonatal Intensive Care unit (NICU) of Kanti Children’s Hospital, Maharajgunj Kathmandu where term neonates with jaundice were assessed visually for jaundice by a single pediatrician and categorized into different dermal zones according to Kramer’s rule and mean of three observations was taken as visual estimation of jaundice and compared with total serum bilirubin levels.

Results:- The common causes of neonatal jaundice were physiological jaundice (56.17%) low birth weight (18.5%) and sepsis (17.3%). The visual assessment of neonatal jaundice was highly correlated with total serum bilirubin level (Pearson's correlation coefficient=0.837 with p value <0.0001).

Conclusion Visual assessment of neonatal jaundice by Kramers’s rule was highly correlated with total serum bilirubin level. So, it can be used as a screening tool for predicting neonatal hyperbilirubinemia.