An appraisal of the use of the Kramer's scale in predicting hyperbilirubinaemia in healthy full term infants

Objective: Although jaundice is a common condition of the newborn, it rarely reaches levels that require intervention. Despite this, frequent assessments of serum bilirubin levels are made causing unnecessary trauma to the infant and family and avoidable costs to the facility. The objective of the present study was to assess whether cephalocaudal progression of jaundice (measured by Kramer's scale) could be useful as a measure to detect which infants in a well baby nursery require testing. Methods: Four hundred and five infants admitted to postnatal wards at a large teaching hospital in Brisbane were assessed for jaundice using Kramer's scale. Levels of jaundice were compared using the total serum bilirubin level as the reference standard. The scale was assessed using sensitivity, specificity, positive and negative predictive values. Results: There was a low level of agreement between jaundice predicted by Kramer's scale and the reference standard. A