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Parental detection of neonatal jaundice using a low-cost colour card: a multicentre prospective study
Guochang Xue1, Huali Zhang2, Xuexing Ding3
1Department of Paediatrics, Wuxi Ninth People's Hospital affiliated to Soochow University, Wuxi, Jiangsu, China gcxue@163.com.
Insights
Parents can reliably use the jaundice colour card (JCard) to assess newborn jaundice after hospital discharge. This low-cost tool helps detect high bilirubin levels, though accuracy decreases with very high levels.
Area of Science:
- Neonatal care
- Pediatric diagnostics
- Public health interventions
Background:
- Most infants are discharged before peak bilirubin levels occur, necessitating post-discharge monitoring.
- Visual assessment of neonatal jaundice by parents is unreliable.
- The jaundice colour card (JCard) is a low-cost tool for assessing neonatal jaundice.
Purpose of the Study:
- To evaluate the effectiveness of parental use of the JCard for detecting neonatal jaundice.
- To compare parental JCard assessments with pediatrician assessments and total serum bilirubin (TSB) levels.
Main Methods:
- A multicenter, prospective, observational cohort study involving 1161 newborns (≥35 weeks gestation) in China.
- Parents and pediatricians used the JCard to measure jaundice levels.
- JCard measurements were compared against total serum bilirubin (TSB) levels.
Main Results:
- Parental JCard use showed strong correlation with TSB (r=0.754).
- Parents' JCard assessments demonstrated high sensitivity (95.2%) for detecting TSB ≥153.9 µmol/L.
- Diagnostic performance for parents was slightly lower than pediatricians but showed good accuracy (AUCs ranging from 0.813 to 0.967).
Conclusions:
- The JCard is a viable tool for parents to classify bilirubin levels in newborns.
- Parental JCard use can aid in identifying neonates requiring further medical evaluation.
- While effective, the JCard's accuracy is reduced at higher bilirubin concentrations.
Background:
Since most infants are usually discharged before age 48-72 hours, peak bilirubin levels will almost always occur after discharge. Parents may be the first to observe the onset of jaundice after discharge, but visual assessment is unreliable. The jaundice colour card (JCard) is a low-cost icterometer designed for the assessment of neonatal jaundice. The objective of this study was to evaluate parental use of JCard to detect jaundice in neonates.
Methods:
We conducted a multicentre, prospective, observational cohort study in nine sites across China. A total of 1161 newborns ≥35 weeks of gestation were enrolled in the study. Measurements of total serum bilirubin (TSB) levels were based on clinical indications. The JCard measurements by parents and paediatricians were compared with the TSB.
Results:
JCard values of parents and paediatricians were correlated with TSB (r=0.754 and 0.788, respectively). The parents' and paediatricians' JCard values 9 had sensitivities of 95.2% vs 97.6% and specificities of 84.5% vs 71.7% for identifying neonates with TSB ≥153.9 µmol/L. The parents' and paediatricians' JCard values 15 had sensitivities of 79.9% vs 89.0% and specificities of 66.7% vs 64.9% for identifying neonates with TSB ≥256.5 µmol/L. Areas under the receiver operating characteristic curves of parents for identifying TSB ≥119.7, ≥153.9, ≥205.2, and ≥256.5 µmol/L were 0.967, 0.960, 0.915, and 0.813, respectively, and those of paediatricians were 0.966, 0.961, 0.926 and 0.840, respectively. The intraclass correlation coefficient was 0.933 between parents and paediatricians.
Conclusion:
The JCard can be used to classify different levels of bilirubin, but it is less accurate with high bilirubin levels. The JCard diagnostic performance of parents was slightly lower than that of paediatricians.
