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

Webster, Joan, Blyth, Rosemary and Nugent, Fran (2005) An appraisal of the use of the Kramer's scale in predicting hyperbilirubinaemia in healthy full term infants. Birth Issues, 14 3: 83-89.

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Author Webster, Joan
Blyth, Rosemary
Nugent, Fran
Title An appraisal of the use of the Kramer's scale in predicting hyperbilirubinaemia in healthy full term infants
Journal name Birth Issues   Check publisher's open access policy
ISSN 1038-023X
Publication date 2005
Year available 2005
Sub-type Article (original research)
Volume 14
Issue 3
Start page 83
End page 89
Total pages 7
Place of publication Yarraville, VIC, Australia
Publisher Capers Bookstore
Language eng
Subject 1110 Nursing
Abstract 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. At <48 hours the sensitivity was 67% and specificity was 48%. The positive and negative predictive values were 4% and 98% respectively. Between 49 and 72 hours the sensitivity was 89% and specificity was 54% with a positive predictive value 10% and a negative predictive value 99%. Of the 111 infants who had blood drawn for testing, who were over 72 hours of age, none required phototherapy. Conclusion: Using Kramer's scale to assess which infants require intervention for jaundice leads to overservicing. If the number of unnecessary tests is to be reduced, more accurate methods for identifying infants who may be at risk for hyperbilirubinaemia must be used. (author abstract)
Keyword Jaundice
Kramer’s scale
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
ERA 2012 Admin Only
School of Nursing, Midwifery and Social Work Publications
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Created: Fri, 16 Jan 2009, 12:46:53 EST by Judy Dingwall on behalf of School of Nursing, Midwifery and Social Work