title: Home-use icterometry in neonatal hyperbilirubinaemia: Cluster-randomised controlled trial in Vietnam.
abstract: OBJECTIVE
  To determine whether home-use icterometry improves parental recognition of neonatal jaundice, early care seeking and treatment to minimize risks of bilirubin encephalopathy.
  
  
  METHODS
  Cluster-randomised controlled trial of community-level icterometry used at home by mothers in Chi Linh, Vietnam. Rural health-care workers identified and enrolled term newborns. Post-partum mothers received jaundice education and icterometry instructions and were cluster-randomised by commune. Cases received icterometers (icterometer group (IG)) and controls did not (control group (CG)). Subjects received mobile telephone calls from post-natal days 2-7 to determine maternal recognition by visual inspection and icterometer detection of jaundice (≥ 3.0 on five-point scale). Mothers without telephones, premature newborns (<35 weeks) or newborns hospitalised >5 days were excluded.
  
  
  RESULTS
  Three hundred fifty-two subjects were enrolled (183 IG and 169 CG), of whom 11 (3.4%) were lost to telephone follow-up. Jaundice was recognised and/or detected in 94 (27%) of all newborns. Icterometry helped 11 mothers (6%) detect neonatal jaundice that was not visually recognised by IG mothers. Detection by IG mothers was not statistically greater than CG mothers (P = 0.09). Follow-up care seeking was 8% in both groups (P = 0.2), and 11% of jaundiced newborns received treatment (9% IG vs. 16% CG, P = 0.3). Newborns who received care had bilirubin measurements that averaged 257 μmol/L IG vs. 322 μmol/L CG (P = 0.3). There were no deaths.
  
  
  CONCLUSIONS
  In this pilot study, home-use icterometry may help improve parental detection of jaundice in rural Vietnam. However, larger studies are necessary to determine the changes in recognition, care seeking and treatment.
authors.affiliation: Department of Medicine, University of California, San Francisco, California, United States.
authors.forename: Mitchell N
authors.initials: MN
authors.lastname: Luu
authors.forename: Loc T
authors.initials: LT
authors.lastname: Le
authors.forename: Bich H
authors.initials: BH
authors.lastname: Tran
authors.forename: Tuan K
authors.initials: TK
authors.lastname: Duong
authors.forename: Ha T
authors.initials: HT
authors.lastname: Nguyen
authors.forename: Vui T
authors.initials: VT
authors.lastname: Le
authors.forename: John C
authors.initials: JC
authors.lastname: Partridge
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D016000:Cluster Analysis; D003154:Community Medicine; D003880:Dermatology / Q000295:instrumentation*; D005260:Female; D005865:Gestational Age; D006701:Home Nursing / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000175:diagnosis*; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D010865:Pilot Projects; D012424:Rural Population; D012880:Skin Pigmentation; D014744:Vietnam; D055815:Young Adult
chemical_list: D001663:Bilirubin
keywords: community medicine; developing country; hyperbilirubinaemia; newborn; parent education; screening