KRAMERS RULE AS A SCREENING TEST TO ASSESS NEONATAL HYPERBILIRUBINEMIA

Background: neonatal jaundice is a frequently encountered condition in the postnatal ward. If not treated properly, it can lead to permanent neurological sequelae. The gold standard investigation for diagnosis is total serum bilirubin (TSB)level. Transcutaneous bilirubinometers and visual assessment of cephalo-caudal progression of yellowish discoloration of neonatal skin by Kramers rule are commonly used non-invasive methods to predict jaundice. If correctly applied, these methods can help in minimising the number of blood samples to be drawn for TSB testing.

Aims/Objectives:1. To assess the reliability of Kramers rule in predicting TSB in healthy neonates admitted in postnatal ward. 2. To assess theusefulness of Kramers rule in deciding which neonates require testing of TSB levels.

Methods: This is a cross sectional study conducted on 100 healthy neonates admitted in the post-natal ward of a tertiary care hospital. Data was collected in pre-designed case record sheets. Sensitivity and specificity of Kramers rule in correct prediction of serum bilirubin was identified by using true and false outcomes.

Results:The mean age at which neonates were examined was at 72 hours of life. 41% of the neonates were male and 59% were female.79% of the total babies were born via normal vaginal delivery and 21% via caesarean section.The sensitivity of Kramers rule in predicting serum bilirubin levels was 83.33% with a specificity of 54.55% (P value 0.015).

Conclusion: Kramers rule is a fairly reliable method for predicting serum bilirubin levels and can help in avoiding unnecessary blood testing in neonates, especially in resource limited settings where such facilities might not be available.