Stool color along with transcutaneous bilirubinometer may help predict neonatal jaundice accurately:Study

Neonatal jaundice is the most frequent problem encountered in the newborn. Timely intervention can prevent bilirubin toxicity leading to kernicterus with long term morbidity . Though serum bilirubin, an invasive test is the gold standard for determining bilirubin levels, various non-invasive methods such as transcutaneous bilirubinometer and Kramer grading are being widely used.

Researchers from JSS Hospital,Mysuru conducted a study to compare the predictive value of STrIP(Kramer and stool color) and TcB(transcutaneous bilirubin) against serum bilirubin levels for early detection of neonatal jaundice.

In this study babies born more than 35 weeks gestation on exclusive breast feeding with clinical jaundice were included. Serum bilirubin estimation was done on day 3. Stool sample was collected within 3 hours of detection of clinical jaundice, and the color of the stool was compared with the stool color card (stool strip). STrIP score was then calculated by adding the stool color weightage to clinical assessment by Kramer scale. average of three bilirubin readings was taken at the forehead by transcutaneous bilirubinometer in a quiet child soon after assessing the STrIP score.

Key findings of the study are:

-Out of 83 eligible neonates in the study, 15% had jaundice by 48 hours of age and 51% between 48-96 hours.

-From the analysis researchers found that the mean difference between Kramer scale and SBR was –3.2 mg/dL, between TcB and SBR was 1.6 mg/dL, and that between STrIP score and serum bilirubin was 0.9 mg/dL.

-On further analysis of Kramer, transcutaneous and STrIP score, method of bilirubin estimation against serum bilirubin, there was a mean difference 6 mg/dL, 4 mg/dL and 2 mg/dL, respectively.

Modified Kramer scale and transcutaneous bilirubin method was developed with the intention of having a test which is simple, reliable, accurate and to avoid repeated blood sampling. STrIP score has all the benefits as above along with added advantage of promising predictive accuracy.

Authors conclude-"STrIP score has the best agreement with serum bilirubin in neonates compared to other non-invasive techniques such as transcutaneous bilirubinometry and clinical assessment using Kramer scale."

Source: Krishnegowda S, Thomas BJ, Thandaveshwara D, Doreswamy SM. Comparison of the Predictive Accuracy of Stool Color for Triage of Infants for Phototherapy (STrIP) Score With Transcutaneous Bilirubinometer in Predicting Serum Bilirubin in Neonates. Indian Pediatr. 2021 Oct 15;58(10):936-939