{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T16:17:29Z","timestamp":1793636249674,"version":"4.5.1"},"reference-count":30,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T00:00:00Z","timestamp":1640822400000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["GHS-A-00-00020-00"],"award-info":[{"award-number":["GHS-A-00-00020-00"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["HRN-A-00-90010-00"],"award-info":[{"award-number":["HRN-A-00-90010-00"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,11,17]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Determine the sensitivity and specificity of neonatal jaundice visual estimation by primary healthcare workers (PHWs) and physicians as predictors of hyperbilirubinaemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Multicentre observational cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Hospitals in Chandigarh and Delhi, India; Dhaka, Bangladesh; Durban, South Africa; Kumasi, Ghana; La Paz, Bolivia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Neonates aged 1\u201320\u2009days (n=2642) who presented to hospitals for evaluation of acute illness. Infants referred for any reason from another health facility or those needing immediate cardiopulmonary resuscitation were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Infants were evaluated for distribution (head, trunk, distal extremities) and degree (mild, moderate, severe) of jaundice by PHWs and physicians. Serum bilirubin level was determined for infants with jaundice, and analyses of sensitivity and specificity of visual estimations of jaundice used bilirubin thresholds of &gt;260\u2009\u00b5mol\/L (need for phototherapy) and &gt;340\u2009\u00b5mol\/L (need for emergency intervention in at-risk and preterm babies).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>1241 (47.0%) neonates had jaundice. High sensitivity for detecting neonates with serum bilirubin &gt;340\u2009\u00b5mol\/L was found for \u2018any jaundice of the distal extremities (palms or soles) OR deep jaundice of the trunk or head\u2019 for both PHWs (89%\u2013100%) and physicians (81%\u2013100%) across study sites; specificity was more variable. \u2018Any jaundice of the distal extremities\u2019 identified by PHWs and physicians had sensitivity of 71%\u2013100%\u2009and specificity of 55%\u201395%, excluding La Paz. For the bilirubin threshold &gt;260\u2009\u00b5mol\/L, \u2018any jaundice of the distal extremities OR deep jaundice of the trunk or head\u2019 had the highest sensitivity across sites (PHWs: 58%\u201393%, physicians: 55%\u201398%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In settings where serum bilirubin cannot be measured, neonates with any jaundice on the distal extremities should be referred to a hospital for evaluation and management, where delays in serum bilirubin measurement and appropriate treatment are anticipated following referral, the higher sensitivity sign, any jaundice on the distal extremities or deep jaundice of the trunk or head, may be preferred.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-048145","type":"journal-article","created":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T10:25:16Z","timestamp":1640946316000},"page":"e048145","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Validation of visual estimation of neonatal jaundice in low-income and middle-income countries: a multicentre observational cohort study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7522-5824","authenticated-orcid":false,"given":"Gary L","family":"Darmstadt","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4700-1495","authenticated-orcid":false,"given":"Davidson H","family":"Hamer","sequence":"additional","affiliation":[{"name":"Department of Global Health, 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