Using this technique, jaundice was visible in 80% of newborns when TSB levels exceeded 6 mg/dL (103 µmol/L). skin of the forehead or the chin," 4(p962) a procedure that they state often revealed jaundice that was otherwise not apparent. To examine the newborns for jaundice, they "applied a tongue depressor with considerable force to the mucous membrane of the lower jaw and. Davidson et al 4 observed jaundice in the first 24 hours in 25% of newborns, despite examining them only once per day. However, available evidence suggests that jaundice by 24 hours is common. " 2(p764) In at least 1 widely publicized medical malpractice case, 3 failure to measure a bilirubin level in a newborn documented to have been jaundiced at 17 hours after birth was one of the allegations of negligence. aundice occurring before age 24 hours is generally considered ‘pathologic' and requires further evaluation." 1(p560) A more recent commentary reiterated this recommendation: "Any infant who is jaundiced before 24 hours requires a measurement of the serum bilirubin level. For example, the American Academy of Pediatrics practice guideline for treatment of hyperbilirubinemia in newborns states: ". JAUNDICE APPEARING in the first 24 hours after birth is generally regarded as abnormal, necessitating at least a measurement of the total serum bilirubin (TSB) level. Compared with newborns not noted to be jaundiced on the first day, newborns noted to be jaundiced within 24 hours were more likely to receive phototherapy (18.9% vs 1.7% relative risk, 10.1 95% confidence interval, 4.2-24.4) and to develop a bilirubin level of 25 mg/dL or higher (odds ratio, 2.9 95% confidence interval, 1.6-5.2), but the absolute risk increase for total serum bilirubin levels of 25 mg/dL or higher was 0.2%.Ĭonclusion Jaundice noted in the medical record in the first 24 hours after birth was uncommon and often clinically significant in this setting, but other factors also need to be considered in determining its importance. About 40% of bilirubin levels measured within 24 hours were above the estimated 95th percentile for age. In these newborns, cumulative proportions that had bilirubin levels measured were 38% within 12 hours and 43% within 24 hours of when jaundice was first noted. Results Among the controls, the cumulative probability of a notation of jaundice (corrected for early hospital discharge using survival analysis) was 2.8% within 18 hours and 6.7% within 24 hours. Main Outcome Measures Notations of jaundice in the medical record, timing and results of bilirubin testing, use of phototherapy, and development of bilirubin levels of 25 mg/dL or higher. Patients Six hundred thirty-one randomly selected newborns (controls) and 140 cases with total serum bilirubin levels of 25 mg/dL (428 µmol/L) or higher from a cohort of 105 384 newborns of at least 2000 g birth weight and at least 36 weeks' gestational age, born between January 1, 1995, and December 31, 1998. Setting Northern California Kaiser Permanente Medical Care Program. Objective To investigate the significance of jaundice noted in the first 24 hours after birth in a community setting.ĭesign Supplementary analyses of a nested case-control study.
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