ABSTRACT
Neonatal hyperbilirubinemia is the most common condition that requires medical attention in newborns. The assessment of jaundice can be carried out using several methods. The aim of this work is to compare visual assessment and laboratory estimation of TSB in full term newborn infants and to evaluate the accuracy of visual assessment of neonatal jaundice in guiding management decisions in the out-patient settings. The study was conducted in the out-patient clinic of Alexandria University Children's Hospital for a period of eight months. 57.2% of babies were male infants while 42.8% were females with a mean gestational age of 38.5 +/- 1.58 weeks and mean weight of 2.98 +/- 0.62 kg. The total agreement between the lab-based management decision and the clinically based decision was 84.2% out of 500 cases involved in the study. Sensitivity of visual assessment was 95.8% while specificity was 80.5%. The false positive rate was 39.2% and positive predictive value was 60.8%. False negative rate and negative predictive value were 1.6% and 94.8% respectively. Also, the Spearman correlation of dermal zones determined by visual assessment and lab TSB in the whole sample was 0.76 [p = 0.000]. It was highest in Infants < 3 days [0.94] and lowest in infants > 14 days [0.69]. In conclusion, visual assessment of neonatal hyperbilirubinemia is a useful clinical tool, if used correctly and by trained medical personnel in resource-poor countries, where there is little or no access to reliable laboratory-based diagnostic services