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Clinical examination could not accurately predict neonatal jaundice

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 QUESTION: How accurate are clinicians in assessing neonatal jaundice?


Blinded comparison of clinicians' visual observations with serum bilirubin test results.


Well newborn nursery of a hospital in Houston, Texas, USA.


122 healthy full term infants (mean age 2 d, 54% boys).

Description of tests and diagnostic standard

The infants were observed by 2 clinicians independently (paediatric resident, nurse practitioner, or attending physician) under fluorescent lighting near a window. The clinicians assessed jaundice as being absent, slight, or obvious for prespecified body zones starting at the head and progressing down the body. The record of each clinical assessment was placed in a sealed envelope before the serum bilirubin test was done.

Main outcome measures

Agreement between the 2 observers and correlation with serum bilirubin concentrations. The cut point for clinically significant …

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  • Source of funding: no external funding.

  • For correspondence: Dr V A Moyer, Department of Pediatrics, University of Texas–Houston Health Science Center, 5656 Kelley Street, Houston, TX 77026, USA. Fax +1 713 636 5844.