Maternal assessment of neonatal jaundice after hospital discharge

OBJECTIVE: To determine whether mothers can accurately assess the presence and severity of jaundice in their newborns, both visually and with an icterometer, after hospital discharge. STUDY DESIGN: Mothers were taught how to examine their infants for jaundice by determining the extent of caudal progression of jaundice and by using an Ingram icterometer. The mothers documented the examinations for 7 days after discharge. Home health nurses examined the babies for jaundice after discharge and obtained serum bilirubin levels. POPULATION: Mothers of infants cared for in the normal newborn nursery of a 340-bed community hospital. OUTCOME MEASURED: Maternal assessment of the presence of jaundice and its caudal progression. RESULTS Jaundice extending below the nipple line had a positive predictive value of 55% and a negative predictive value of 86% for identifying infants with bilirubin levels of ≥ 12 mg/dL. Icterometer readings of ≥ 2.5 had a positive predictive value of 44% and a negative predictive value of 87% for identifying infants with bilirubin levels of ≥ 12 mg/dL. The 3 infants with bilirubin levels ≥ 17 mg/dL were recognized by their mothers as having jaundice below the nipple line and had icterometer readings of ≥ 2.5. CONCLUSIONS: Further study is needed to determine the optimum method of parental education about newborn jaundice. However, maternal use of the Ingram icterometer and determination of jaundice in relation to the infant's nipple line are both potentially useful methods of assessing jaundice after hospital discharge.