Diagnostic Accuracy of WHO IMCI Visual Inspection for Neonatal Jaundice: A Prospective Multi-Country Cohort

Adverse consequences of neonatal hyperbilirubinemia disproportionately affect babies in low- and middle-income countries, where laboratory total serum bilirubin measurement is limited and simpler alternatives are needed. The study aimed to evaluate the diagnostic accuracy of visual inspection of jaundice using the World Health Organization Integrated Management of Childhood Illnesses algorithm compared with transcutaneous bilirubinometry for identifying hyperbilirubinemia in community settings.

In the PRISMA prospective cohort study at six sites in Asia and Africa, hyperbilirubinemia was assessed by visual inspection for jaundice and transcutaneous bilirubinometry at 0-72 hours, 3-5 days, and 5-14 days postnatal. The analysis assessed sensitivity, specificity, and positive and negative percent agreement.

The study analyzed data from 14,331 infants, including 1,852 preterm infants. At 3-5 days postnatal, 15% had hyperbilirubinemia defined by transcutaneous bilirubin values and NICE nomograms. Pooled across all sites and gestational ages, visual inspection versus transcutaneous bilirubin defined by NICE nomograms had a sensitivity of 16%, specificity of 96%, positive percent agreement of 56%, and negative percent agreement of 86%.

The poor sensitivity of visual inspection underscores an urgent need for accurate, affordable screening tools to improve screening for hyperbilirubinemia.