Evaluating the Ingram Icterometer as a screening tool for significant neonatal hyperbilirubinaemia at The Kenyatta National Hospital

Abstract

Background: Neonatal Jaundice (NNJ) occurs in 30-60% of term newborns and is significant (>221 μmol/l) in 3.5-12% of these neonates.  In rural Kenya, severe NNJ accounts for about 22% of admissions, with an in-patient case fatality rate of 26%. No single, sensitive, non- invasive screening device for significant neonatal jaundice exists. The main objective of this study was to determine the sensitivity and  specificity of the Ingram icterometer for predicting serum bilirubin levels in jaundiced term newborns.

Methodology: A Cross-sectional study done at Kenyatta National Hospital (KNH) Paediatric Units. Transcutaneous bilirubin (TcB)  measurements were done by pressing the icterometer on the nose until it blanched and matching the resulting colour with the  corresponding yellow strip on the icterometer.

Results: A total of 143 jaundiced term neonates were recruited into the study. The mean  gestational age was 39.3 weeks, and the mean birth weight was 3100 g, with the most common comorbidity being neonatal sepsis  (63.6%). The sensitivity and specificity of the icterometer at index 3 at a serum bilirubin cut-off of 221 µmol/l were 99% and 55.3%,  respectively. At serum, bilirubin cut-off of 257 µmol/l, the sensitivity and specificity of clinical assessment at the sole was 67% and 74.5%, respectively. Poor outcome was associated with higher mean serum bilirubin levels.

Conclusion: The icterometer at a cut-off index of 3  offers excellent sensitivity but only moderate specificity. The clinical assessment at the sole offers moderate sensitivity and specificity.