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. 2017 Aug 24;12(8):e0183882.
doi: 10.1371/journal.pone.0183882. eCollection 2017.

Maternal detection of neonatal jaundice during birth hospitalization using a novel two-color icterometer

Bolajoko O Olusanya  1 , Tina M Slusher  2   3 , Donald O Imosemi  4 , Abieyuwa A Emokpae  5
Affiliations

Maternal detection of neonatal jaundice during birth hospitalization using a novel two-color icterometer

Bolajoko O Olusanya et al. PLoS One. .

Abstract

Background: Mothers are frequently the first to observe the onset of jaundice in their newborn infants before the decision to seek treatment. However, simple-to-use tools that could facilitate early detection of jaundice and assist mothers to seek professional care, especially after hospital discharge, are rare. This study therefore, set out to evaluate the performance of a -two-color icterometer (Bilistrip™) as a possible screening tool for detecting significant jaundice by mothers or care-givers in the first week of life.

Methods: Prior to discharge, mothers in a maternity hospital were trained to use the Bilistrip™ on the blanched skin of their baby's nose to ascertain absence (Light Yellow) or presence (Dark Yellow) of significant jaundice. Their babies had transcutaneous bilirubin (TcB) measurements independently, along with total serum bilirubin (TSB) if indicated. The reliability of Bilistrip™ as a screening test for significant jaundice was determined at different TcB and TSB thresholds. The predictive performance of Bilistrip™ was also evaluated with multivariable logistic regression.

Results: Some 2492 mother-infant pairs were enrolled over 15 months, of which 347 (13.9%) chose Dark Yellow. The mean TcB for Dark Yellow (10mg/dL) was significantly higher (p<0.001) than for Light Yellow (6.1mg/dL). Bilistrip™ showed increasing sensitivity (47.0% - 92.6%) and negative predictive value (NPV) (91.4% - 99.9%) for selected TcB thresholds (≥10mg/dL, ≥12mg/dL, ≥15mg/dL, and ≥17mg/dL). Among neonates with TSB measurements (n = 124), Bilistrip™ was associated also with increasing sensitivity (86.8% - 100%) and NPV (62.5% - 100%). The sensitivity and NPV for detecting neonates requiring phototherapy were 95.8% respectively. Only one of the 24 neonates who required phototherapy was missed by the Bilistrip™.

Conclusions: Bilistrip™ is a potential decision-making tool for empowering mothers to detect neonates with clinically significant jaundice that may require close monitoring or treatment, and neonates not requiring treatment for jaundice in the first week of life.

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Conflict of interest statement

Competing Interests: Draeger Medical Telford, PA loaned the JM103® transcutaneous bilirubinometer; Advanced Instruments Norwood, MA provided BR2 kits at a subsidized cost for our Advanced Bilirubin Stat-Analyzer. Bilimetrix and sponsors had no role in conceptualizing, analyzing, interpreting, writing, or the decision to submit this paper for publication. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Baby tested with Bilistrip™ by a mother.
Fig 2
Fig 2. Age-specific TcB levels for the two-color options on Bilistrip™.
See this image and copyright information in PMC

References

    1. National Institute for Health and Clinical Excellence (NICE), UK. Neonatal jaundice. (Clinical guideline 98.), 2010. www.nice.org.uk/CG98. Accessed 15 April 2017.
    1. The Young Infants Clinical Signs Study Group. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. Lancet 2008;371:135–142. doi: 10.1016/S0140-6736(08)60106-3 - DOI - PubMed
    1. Burke BL, Robbins JM, Bird TM, Hobbs CA, Nesmith C, Tilford JM. Trends in hospitalizations for neonatal jaundice and kernicterus in the United States, 1988–2005. Pediatrics 2009;123:524–532. doi: 10.1542/peds.2007-2915 - DOI - PubMed
    1. Lain SJ, Roberts CL, Bowen JR, Nassar N. Early discharge of infants and risk of readmission for jaundice. Pediatrics 2015;135:314–321. doi: 10.1542/peds.2014-2388 - DOI - PubMed
    1. Herbert HK, Lee AC, Chandran A, Rudan I, Baqui AH. Care seeking for neonatal illness in low- and middle-income countries: a systematic review. PLoS Med 2012;9(3):e1001183 doi: 10.1371/journal.pmed.1001183 - DOI - PMC - PubMed

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