In the eye of the beholder: How accurate is clinical estimation of jaundice in newborns?

Aim: Hour-specific serum total bilirubin (STB) percentiles have proved useful in predicting which babies will develop significant neonatal hyperbilirubinemia (NHB) requiring intervention. This study investigated whether this assessment could be performed visually instead of by blood test. The aim was to evaluate the ability of experienced clinicians to determine accurately the level of clinical jaundice in neonates by visual means. Methods: Four neonatologists were asked to estimate the level of bilirubin in a group of 283 term clinically jaundiced infants before discharge from the nursery on day 3 of life. Their clinical estimation was compared with actual measurement of STB from samples drawn simultaneously. Results: Clinical estimation of STB had a high correlation to actual serum bilirubin levels (Pearson's correlation coefficient = 0.682, p < 0.001). Conclusion: Clinical impression of jaundice by the eye of an experienced clinician is a reliable method to assess newborns for significant NHB and may diminish the need for universal serum sampling.