Objective To compare 3 methods of clinical assessment of jaundice in newborns
by home health nurses.
Design Prospective clinical trial.
Setting Homes of newborns living within 10 miles of a 340-bed community hospital
where they were delivered.
Participants Home health nurses and newborn patients (
2 weeks old).
Interventions The nurses examined the newborns and documented whether they detected
jaundice. In newborns thought to have jaundice, the nurses estimated bilirubin
levels, documented the extent of caudal progression of the jaundice, and determined
the Ingram (Cascade Health Care Products, Salem, Ore) icterometer readings
from the newborns' noses. Total serum bilirubin tests were obtained from all
newborns studied.
Outcome Measures Nurse assessment of the presence of jaundice and its caudal progression,
nurse estimates of bilirubin levels, icterometer readings, and bilirubin levels.
Results The nurses determined that 82 (50%) of the 164 newborns had jaundice.
Their estimates of bilirubin levels were most highly correlated with serum
bilirubin levels (Pearson correlation, 0.61). All 3 newborns with bilirubin
levels greater than or equal to 291 µmol/L (
17 mg/dL) were recognized
by the nurses as having jaundice. These newborns had icterometer readings
greater than or equal to 3.5 and had estimated bilirubin levels of greater
than or equal to 274 µmol/L (16 mg/dL).
Conclusions The method of evaluation that each nurse was accustomed to using was
the most accurate in determining the severity of newborn jaundice. These results
suggest that postpartum home health nurses can effectively evaluate newborns
for the presence and severity of jaundice.
