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An appraisal of the use of the Kramer’s scale in predicting hyperbilirubinaemia in healthy full term infants.

Webster, Joan (2006) An appraisal of the use of the Kramer’s scale in predicting hyperbilirubinaemia in healthy full term infants. Birth Issues, 14(3), pp. 83-89.

Abstract

Objective: Although jaundice is a common condition of the newborn, it rarely reaches levels that require intervention. Despite this, frequent assessments of serum bilirubin levels are made causing unnecessary trauma to the infant and family and avoidable costs to the facility. The objective of the present study was to assess whether cephalocaudal progression of jaundice (measured by Kramer’s scale) could be useful as measure to detect which infants in a well baby nursery require testing. Methods: Four hundred and five infants admitted to postnatal wards at a large teaching Hospital in Brisbane were assessed for jaundice using Kramer's scale. Levels of jaundice were compared using the total serum bilirubin level as the reference standard. The scale was assessed using sensitivity, specificity, positive and negative predictive values. Results: There was a low level of agreement between jaundice predicted by Kramer’s scale and the reference standard. At < 48 hours the sensitivity was 67% and specificity was 48%. The positive and negative predictive values were 4% and 98% respectively. Between 49 and 72 hours the sensitivity was 89% and specificity was 54% with a positive predictive value 10% and a negative predictive value 99%. Of the 111 infants who had blood drawn for testing, who were over 72 hours of age, none required phototherapy. Conclusion: Using Kramer’s scale to assess which infants require intervention for jaundice leads to over servicing. If the number of unnecessary tests is to be reduced, more accurate methods for identifying infants who may be at risk for hyperbilirubinaemia must be used.

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ID Code: 3827
Item Type: Journal Article
Keywords: Jaundice, Newborn, Kramer’s scale
ISSN: 1038-023X
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Midwifery (111006)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Copyright Owner: Copyright 2006 (please consult author)
Deposited On: 06 Apr 2006
Last Modified: 09 Jun 2010 22:31

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