Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study.

OBJECTIVE: Determine the sensitivity and specificity of neonatal jaundice visual estimation by primary healthcare workers (PHWs) and physicians as predictors of hyperbilirubinaemia. DESIGN: Multicentre observational cohort study. SETTING: Hospitals in Chandigarh and Delhi, India; Dhaka, Bangladesh; Durban, South Africa; Kumasi, Ghana; La Paz, Bolivia. PARTICIPANTS: Neonates aged 1-20 days (n=2642) who presented to hospitals for evaluation of acute illness. Infants referred for any reason from another health facility or those needing immediate cardiopulmonary resuscitation were excluded. OUTCOME MEASURES: Infants were evaluated for distribution (head, trunk, distal extremities) and degree (mild, moderate, severe) of jaundice by PHWs and physicians. Serum bilirubin level was determined for infants with jaundice, and analyses of sensitivity and specificity of visual estimations of jaundice used bilirubin thresholds of >260 µmol/L (need for phototherapy) and >340 µmol/L (need for emergency intervention in at-risk and preterm babies). RESULTS: 1241 (47.0%) neonates had jaundice. High sensitivity for detecting neonates with serum bilirubin >340 µmol/L was found for 'any jaundice of the distal extremities (palms or soles) OR deep jaundice of the trunk or head' for both PHWs (89%-100%) and physicians (81%-100%) across study sites; specificity was more variable. 'Any jaundice of the distal extremities' identified by PHWs and physicians had sensitivity of 71%-100% and specificity of 55%-95%, excluding La Paz. For the bilirubin threshold >260 µmol/L, 'any jaundice of the distal extremities OR deep jaundice of the trunk or head' had the highest sensitivity across sites (PHWs: 58%-93%, physicians: 55%-98%). CONCLUSIONS: In settings where serum bilirubin cannot be measured, neonates with any jaundice on the distal extremities should be referred to a hospital for evaluation and management, where delays in serum bilirubin measurement and appropriate treatment are anticipated following referral, the higher sensitivity sign, any jaundice on the distal extremities or deep jaundice of the trunk or head, may be preferred.

AIEPI experiencia nacional en talleres para facilitadores / AIEPI national experience at workshops for intructors

En los paises en vias de desarrollo la morbi-mortalidad infantil en niños menores de 5 años es elevada y las causas mas importantes de esta alta mortalidad son: la deshidratacion secundaria a la enfermedad diarreica aguda las infecciones respiratorias agudas (sobre todo neumonias), malaria, sarampion, patologia propia del niño menor de dos meses de edad y en la mayoria se asocia la malnutricion. La atencion Integrada de las Enfermedades Prevalentes de la Infancia (AIEPI) nace con la finalidad de disminuir la morbimortalidad infantil en este grupo etareo y causada por las enfermedades antes descritas, las cuales pueden ser evitadas o tratadas mediante la aplicacion de normas apropiadas de evaluacion, clasificacion, tratamiento, seguimiento y consejos adecuados a la familia para la atencion del niño en el hogar. El presente trabajo describe los resultados encontrados con la realizacion de dos Talleres para Facilitadores realizados en La Paz y Santa Cruz. En general los resultados de ambos cursos fueron satisfactorios y cumplieron los objetivos esperados.