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. 2021 Jun 7;18(11):6173.
doi: 10.3390/ijerph18116173.

Kramer Score, an Evidence of Its Use in Accordance with Indonesian Hyperbilirubinemia Published Guideline

Mahendra Tri Arif Sampurna  1   2 , Muhammad Pradhika Mapindra  3 , Muhammad Pradhiki Mahindra  3 , Kinanti Ayu Ratnasari  3 , Siti Annisa Dewi Rani  3 , Kartika Darma Handayani  1 , Dina Angelika  1 , Agus Harianto  1 , Martono Tri Utomo  1 , Risa Etika  1 , Pieter J J Sauer  4
Affiliations

Kramer Score, an Evidence of Its Use in Accordance with Indonesian Hyperbilirubinemia Published Guideline

Mahendra Tri Arif Sampurna et al. Int J Environ Res Public Health. .

Abstract

Background: In some hospitals in low/middle-income countries, methods to determine the bilirubin level in newborn infants are unavailable and based on a clinical evaluation, namely a clinical score designed by Kramer. In this study, we evaluated if this score can be used to identify those infants that need phototherapy. Method: Infants admitted between November 2018 and June 2019 to three hospitals in Surabaya, Indonesia were included. The jaundice intensity was scored using the Kramer score. Blood was sampled for total serum bilirubin (TSB) measurement. The infants were categorized into Treatment Needed (TN) group when treatment with phototherapy was indicated and the No Treatment Needed (NTN) group when phototherapy was not indicated, based on the Indonesian Guideline for hyperbilirubinemia. Result: A total of 280 infants with a mean birth weight of 2744.6 ± 685.8 g and a gestational age of 37.3 ± 2.3 weeks were included. Twenty-seven of 113 (24%) infants with Kramer score 2 needed phototherapy, compared with 41 of 90 (46%) infants with score 3 and 20 of 28 (71%) of infants with score 4. The percentage of infants that needed phototherapy was higher with decreasing gestational age. Conclusion: The Kramer score is an invalid method to distinguish between those infants needing phototherapy and those infants where this treatment is not indicated.

Keywords: Indonesia guideline; Kramer score; hyperbilirubinemia; phototherapy; reliability.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Serum Bilirubin Level in relation to the Kramer score for all infants. Each dot represents one infant.
Figure 2
Figure 2
Number of infants needing phototherapy for each Kramer score. Black Bars infants who needed therapy (TN group); white bars infants where phototherapy was not indicated (NTN group).
Figure 3
Figure 3
The number of infants needing phototherapy for each Kramer score in relation to gestational age. Black Bars infants who needed therapy (TN group); white bars infants where phototherapy was not indicated (NTN group).
See this image and copyright information in PMC

References

    1. Olusanya B.O., Osibanjo F.B., Slusher T.M. Risk factors for severe neonatal hyperbilirubinemia in low and middle-income countries: A systematic review and meta-analysis. PLoS ONE. 2015;10:e0117229. doi: 10.1371/journal.pone.0117229. - DOI - PMC - PubMed
    1. Hansen T.W.R., Wong R.J., Stevenson D.K. Molecular physiology and pathophysiology of bilirubin handling by the blood, liver, intestine, and brain in the newborn. Physiol. Rev. 2020;100:1291–1346. doi: 10.1152/physrev.00004.2019. - DOI - PubMed
    1. Maisels J., McDonagh A. Phototherapy for neonatal jaundice. N. Engl. J. Med. 2008;358:920–928. doi: 10.1056/NEJMct0708376. - DOI - PubMed
    1. Mabogunje C.A., Olaifa S.M., Olusanya B.O. Facility-based constraints to exchange transfusions for neonatal hyperbilirubinemia in resource-limited settings. World J. Clin. Paediatr. 2016;5:182. doi: 10.5409/wjcp.v5.i2.182. - DOI - PMC - PubMed
    1. Olusanya B.O., Ogunlesi T.A., Kumar P., Boo N.Y., Iskander I.F., Almeida M.F., Vaucher Y.E., Slusher T.M. Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings. BMC Paediatr. 2015;15:39. doi: 10.1186/s12887-015-0358-z. - DOI - PMC - PubMed

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