{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:29:03Z","timestamp":1790371743449,"version":"4.1.0"},"reference-count":17,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T00:00:00Z","timestamp":1623024000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universitas Airlangga","award":["No. 391\/UN3.1.1\/KD\/2018"],"award-info":[{"award-number":["No. 391\/UN3.1.1\/KD\/2018"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: In some hospitals in low\/middle-income countries, methods to determine the bilirubin level in newborn infants are unavailable and based on a clinical evaluation, namely a clinical score designed by Kramer. In this study, we evaluated if this score can be used to identify those infants that need phototherapy. Method: Infants admitted between November 2018 and June 2019 to three hospitals in Surabaya, Indonesia were included. The jaundice intensity was scored using the Kramer score. Blood was sampled for total serum bilirubin (TSB) measurement. The infants were categorized into Treatment Needed (TN) group when treatment with phototherapy was indicated and the No Treatment Needed (NTN) group when phototherapy was not indicated, based on the Indonesian Guideline for hyperbilirubinemia. Result: A total of 280 infants with a mean birth weight of 2744.6 \u00b1 685.8 g and a gestational age of 37.3 \u00b1 2.3 weeks were included. Twenty-seven of 113 (24%) infants with Kramer score 2 needed phototherapy, compared with 41 of 90 (46%) infants with score 3 and 20 of 28 (71%) of infants with score 4. The percentage of infants that needed phototherapy was higher with decreasing gestational age. Conclusion: The Kramer score is an invalid method to distinguish between those infants needing phototherapy and those infants where this treatment is not indicated.<\/jats:p>","DOI":"10.3390\/ijerph18116173","type":"journal-article","created":{"date-parts":[[2021,6,7]],"date-time":"2021-06-07T13:25:43Z","timestamp":1623072343000},"page":"6173","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Kramer Score, an Evidence of Its Use in Accordance with Indonesian Hyperbilirubinemia Published Guideline"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7529-8142","authenticated-orcid":false,"given":"Mahendra Tri Arif","family":"Sampurna","sequence":"first","affiliation":[{"name":"Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia"},{"name":"Neonatology Division, Department of Pediatrics, Airlangga University Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3082-4479","authenticated-orcid":false,"given":"Muhammad Pradhika","family":"Mapindra","sequence":"additional","affiliation":[{"name":"Neonatal Research Group Surabaya, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Pradhiki","family":"Mahindra","sequence":"additional","affiliation":[{"name":"Neonatal Research Group Surabaya, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kinanti Ayu","family":"Ratnasari","sequence":"additional","affiliation":[{"name":"Neonatal Research Group Surabaya, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siti Annisa Dewi","family":"Rani","sequence":"additional","affiliation":[{"name":"Neonatal Research Group Surabaya, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kartika Darma","family":"Handayani","sequence":"additional","affiliation":[{"name":"Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Angelika","sequence":"additional","affiliation":[{"name":"Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agus","family":"Harianto","sequence":"additional","affiliation":[{"name":"Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martono Tri","family":"Utomo","sequence":"additional","affiliation":[{"name":"Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa","family":"Etika","sequence":"additional","affiliation":[{"name":"Neonatology Division, Department of Pediatrics, Dr. Soetomo Academic Teaching Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60285, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter J. J.","family":"Sauer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Beatrix Children\u2019s Hospital, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Olusanya, B.O., Osibanjo, F.B., and Slusher, T.M. (2015). Risk factors for severe neonatal hyperbilirubinemia in low and middle-income countries: A systematic review and meta-analysis. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0117229"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1152\/physrev.00004.2019","article-title":"Molecular physiology and pathophysiology of bilirubin handling by the blood, liver, intestine, and brain in the newborn","volume":"100","author":"Hansen","year":"2020","journal-title":"Physiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1056\/NEJMct0708376","article-title":"Phototherapy for neonatal jaundice","volume":"358","author":"Maisels","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"182","DOI":"10.5409\/wjcp.v5.i2.182","article-title":"Facility-based constraints to exchange transfusions for neonatal hyperbilirubinemia in resource-limited settings","volume":"5","author":"Mabogunje","year":"2016","journal-title":"World J. Clin. Paediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s12887-015-0358-z","article-title":"Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings","volume":"15","author":"Olusanya","year":"2015","journal-title":"BMC Paediatr."},{"key":"ref_6","first-page":"454","article-title":"Advancement of Dermal Icterus in the Jaundiced Newborn","volume":"118","author":"Kramer","year":"1969","journal-title":"Am. J. Dis. Child."},{"key":"ref_7","unstructured":"Menteri Kesehatan Republik Indonesia (2021, February 15). Pedoman Nasional Pelayanan Kedokteran Tata Laksana Hiperbilirubinemia, Available online: http:\/\/yankes.kemkes.go.id\/unduh\/fileunduhan_1610349726_94555.pdf\/16."},{"key":"ref_8","unstructured":"(2021, June 01). BiliNorm: Web-Based Hyperbilirubinemia Management. Available online: https:\/\/www.bilinorm.babyhealthsby.org\/#\/intro."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"F317","DOI":"10.1136\/adc.2008.150714","article-title":"Visual assessment of jaundice in term and late preterm infants","volume":"94","author":"Keren","year":"2009","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1111\/j.1365-3156.2010.02496.x","article-title":"Incidence of neonatal hyperbilirubinemia: A population-based prospective study in Pakistan","volume":"15","author":"Tikmani","year":"2010","journal-title":"Trop. Med. Int. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"151355","DOI":"10.1016\/j.semperi.2020.151355","article-title":"Noninvasive Methods for Bilirubin Measurements in Newborns: A Report","volume":"45","author":"Okwundu","year":"2021","journal-title":"Semin. Perinatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1055\/s-0034-1391602","article-title":"Transkutane Bilirubinbestimmung als Screening f\u00fcr alle Neugeborenen geeignet","volume":"4","author":"Afanetti","year":"2015","journal-title":"Neonatol. Scan"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1007\/s00431-020-03885-0","article-title":"Reliability of transcutaneous bilirubin determination based on skin color determined by a neonatal skin color scale of our own","volume":"180","year":"2021","journal-title":"Eur. J. Paediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1111\/j.1651-2227.2004.tb02635.x","article-title":"Assessment of jaundice in preterm neonates: Comparison between clinical assessment, two transcutaneous bilirubinometers and serum bilirubin values","volume":"93","author":"Szabo","year":"2004","journal-title":"Acta Paediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1542\/peds.75.3.443","article-title":"\u2018Like a Shrivelled Blood Orange\u2019\u2014Bilirubin, Jaundice, and Phototherapy Antony","volume":"75","author":"Mcdonagh","year":"1985","journal-title":"Pediatrics"},{"key":"ref_16","unstructured":"Wong, R.J. (2006). Neonatal jaundice and liver disease. Fanaroff and Martin\u2019s Neonatal-Perinatal Medicine: Disease of the Fetus and Infant, Elsevier Mosby."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1080\/17474086.2017.1331124","article-title":"Neonatal management and outcome in alloimmune hemolytic disease","volume":"10","author":"Ree","year":"2017","journal-title":"Expert Rev. Hematol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/11\/6173\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:11:44Z","timestamp":1760163104000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/11\/6173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,7]]},"references-count":17,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["ijerph18116173"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18116173","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,7]]}}}