Don't rely on jaundiced eye for assessing newborns

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Don't rely on jaundiced eye for assessing newborns

Study challenges common medical practice

March 24, 2009

Source: Children's Hospital of Philadelphia

Nurses used this five-point scale to grade the farthest extent of jaundice in

the newborns they examined.For hundreds of years, doctors, nurses and midwives

have visually examined newborn babies for the yellowish skin tones that signify

jaundice, judging that more extensive jaundice carried a greater risk of

illness.

The yellowness comes from a blood byproduct, bilirubin, and a child that

develops high levels of bilirubin has a potentially serious condition called

hyperbilirubinemia.

Now pediatric researchers say that this longstanding practice of visual

inspection is an unreliable method of predicting the baby's risk of

hyperbilirubinemia. Only infants with a total absence of visible jaundice can

confidently be expected to have a very low risk of hyperbilirubinemia.

" Our study tells clinicians that our ability to estimate a baby's bilirubin

level, or predict the baby's risk of developing clinically significant

hyperbilirubinemia, by visually observing the extent of visual jaundice, is

inadequate, and not very helpful, " said study leader Ron Keren, M.D., M.P.H., a

pediatrician in the Center for Pediatric Clinical Effectiveness at The

Children's Hospital of Philadelphia. Keren also is a faculty member of the

University of Pennsylvania School of Medicine.

The study appeared March 22 in the online version of Archives of Disease in

Childhood--Fetal and Neonatal Edition.

Neonatal jaundice is very common, occurring in as many as 60 percent of newborns

annually, according to the American Academy of Pediatrics. It appears as a

yellow skin color, a sign of excess bilirubin, a byproduct of the normal

breakdown of red blood cells. In the vast majority of cases, jaundice disappears

in one to two weeks as the baby's liver reduces bilirubin to normal levels,

permitting the excess to be excreted.

But extremely high levels of bilirubin can cause kernicterus, a potentially

life-threatening condition that can result in long-term brain damage, hearing

loss and other neurological problems. Although extremely rare, kernicterus has

been increasing in the U.S. over the past two decades, leading some professional

organizations to advocate universal bilirubin screening before newborns leave

the hospital. The standard treatment for significant hyperbilirubinemia is

phototherapy—exposing the baby to ultraviolet lights that chemically change

bilirubin under the skin to a harmless form.

The current study was the first systematic analysis of jaundice assessment as a

predictor of significant hyperbilirubinemia risk. It was also the largest such

study, involving 522 term and late-preterm newborns.

Clinicians have long known that neonatal jaundice progresses from head to foot,

as shown by yellowing of the baby's skin. In this study, conducted in the Well

Baby Nursery of the Hospital of the University of Pennsylvania, nurses used a

five-point scale to grade the farthest extent of jaundice along the newborn's

body. The nurses who did the ratings did not know the actual bilirubin levels,

which were measured by other caregivers using a noninvasive device.

On analyzing the results, the researchers found that, while there was some

correlation between the extent of jaundice as rated by the nurses and the

measured bilirubin levels, the extent of jaundice could not be used to estimate

the bilirubin level or to accurately predict an infant's risk of developing

significant hyperbilirubinemia (defined in this study as a bilirubin level for

which phototherapy is recommended). Furthermore, contrary to a common belief

that it is harder to visually assess jaundice in dark-skinned infants, there was

no significant difference in the results between black and white newborns.

The correlation between visually assessed jaundice and bilirubin level was

especially weak in late-preterm infants, those at 35 to 38 weeks gestational

age. This is important, said Keren, because late-preterm infants are at greater

risk of developing significant hyperbilirubinemia.

The one exception to the poor predictive value of visual assessment came in the

91 infants (17 percent of all those studied) rated by the nurses as having a

complete absence of jaundice. For those infants, the actual risk of developing

significant hyperbilirubinemia was extremely low, less than 1 percent. Even for

those infants, said Keren, absence of visual jaundice may require a caveat.

" Less experienced observers may be less capable of accurately assessing a

complete absence of jaundice. 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. "

 

P.S. But thet they are given a HEP B shot hours after birth, a vaccine that

affects the liver and all of its functions and that makes the risk even

higher!!!

Our kids are sent home and just told to put them in the sun... As if it was a

normal and not dangerous cituation...

 

Love, Gabby. :0)

http://stemcellforautism.blogspot.com/

 

" I know of nobody who is purely Autistic or purely neurotypical. Even God had

some Autistic moments, which is why the planets all spin. " ~ Jerry Newport