Yellowness not the bottom-line in jaundice: Study

Philadelphia, March 27: The long-standing practice of visually examining a newborn's skin for hints of yellow might not actually be a reliable and accurate method to predict his risk of jaundice, results of a new study claim.

Yellowish eye or skin tone, deemed to be the apparent indicator of jaundice, develops due to high levels of bilirubin, a byproduct of the normal breakdown of red blood cells. While all newborns have neonatal jaundice, in most cases, it disappears within weeks.

Jaundice occurs when a baby develops high levels of bilirubin. Extremely elevated bilirubin levels (hyperbilirubinemia) may cause kernicterus, permanently damaged brain centers, hearing loss and liver damage.

Severe cases are treated by phototherapy. The ultraviolet light breaks down bilirubin into a harmless form. If the neonatal jaundice fails to clear up with simple phototherapy, neonates may require exchange transfusions.

The study, first to question jaundice assessment as an accurate predictor of hyperbilirubinemia, enrolled 522 term and late-preterm newborns.

Following the common pediatric practice that jaundice progresses from head to toe, the nurses recorded the ‘jaundice visual assessment scores’ using a five-point scale. The higher the score, the higher were the levels of bilirubin, pediatricians comprehend.

Separately, a team of caregivers measured the bilirubin levels for each neonate using a noninvasive device. The visual assessment made by nurses was "only moderately correlated with bilirubin concentration" the researchers found.

Moreover, the association between visually examined jaundice and bilirubin levels was especially weak in late-preterm infants, born between 35 and 38 weeks of gestation.

Also, visual assessment in dark-skinned infants was difficult. And “less experienced observers may be less capable of accurately assessing a complete absence of jaundice,” study leader Dr. Ron Keren, a pediatrician in the Center for Pediatric Clinical Effectiveness at the Children’s Hospital of Philadelphia, feared.

Putting forth his concluding remarks, Karen wrote, "All in all, the benefits of objective results from universal bilirubin screening may outweigh the benefit in reducing testing and costs from pursuing a selective screening approach."

The results of the study feature online in the Archives of Disease in Childhood--Fetal and Neonatal Edition.