Previous research suggests that the visual assessment of jaundice is an unreliable indicator of an infant's bilirubin level.1,2 A new study published in the Journal of Pediatrics adds to the evidence that although visual assessment can correlate with total serum bilirubin (TSB), the technique of visual assessment is highly prone to error and we should not use this practice as a means of screening term and late preterm newborn infants for their risk of significant hyperbilirubinemia.3

Riskin and colleagues3 tested the ability of 15 neonatologists and 17 nurses to use visual assessment to estimate bilirubin level and classify risk category during 3532 observations in 1129 newborn infants. Visual assessments were made under optimal and consistent lighting conditions. The investigators found that 61.5% of the 109 babies determined to be at high risk according to TSB level were misclassified as low risk by visual assessment, particularly in preterm infants (35-37 weeks' gestation) and those who were scheduled for early discharge. This level of misclassification was deemed unacceptable for a screening test. The ability to estimate TSB bore no relationship to age, seniority, or years of clinical experience.

Investigators concluded that predischarge screening for neonatal hyperbilirubinemia should be based on other methods, such as universal TSB testing or noninvasive transcutaneous bilirubinometry (TcB). Measurement of TSB or TcB alone, however, is not sufficient and must be combined with assessment of clinical risk factors and appropriate follow-up of infants at risk.3

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