Year: 2026 | Month: October | Volume: 16 | Issue: 10 | Pages: 28-36
DOI: https://doi.org/10.52403/ijhsr.20261004
Diagnostic Accuracy of Kramer’s Scale and Transcutaneous Bilirubinometer Compared with Serum Bilirubin Levels Among Neonates with Hyperbilirubinemia: A Cross-Sectional Study in a Tertiary Care Hospital, Mandya
M Muhurth1, Vinay B S2, Ramya M P3, Sridhar P V4
1Postgraduate Student, Department of Paediatrics, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
2Assistant Professor, Department of Paediatrics, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
3Assistant Professor, Department of Community Medicine, Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India.
4Associate Professor, Department of Paediatrics, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
Corresponding Author: Dr Vinay B S
ABSTRACT
Background: Neonatal hyperbilirubinemia is a common clinical condition affecting approximately 60% of term and 80% of preterm neonates during the first week of life. Although serum bilirubin measurement is the diagnostic gold standard, it requires invasive sampling. Non-invasive methods such as Kramer’s scale and Transcutaneous Bilirubinometer (TcB) are commonly used but their accuracy remains debated. This study aimed to evaluate the correlation and diagnostic performance of Kramer’s scale and TcB compared with serum bilirubin levels.
Methods: This cross-sectional study was conducted over 3 months in the Paediatrics wards of Mandya Institute of Medical Sciences, Mandya. A total of 100 neonates ≥34 weeks gestation presenting with clinical jaundice were enrolled. Kramer’s zones were assessed by a trained observer under natural light. TcB measurements were recorded using the Dräger JM-105 jaundice meter. Total serum bilirubin (TSB) values were obtained from laboratory reports.
Results: A total of 100 neonates were assessed, 60% delivered vaginally; most were appropriate for gestational age (85%). Kramer’s scale significantly underestimated serum bilirubin across all zones, whereas TcB showed no significant difference from TSB (p = 0.103). Correlations analysis demonstrated a moderate relationship between Kramer’s and TSB (r = 0.644) while TcB showed a stronger correlation (r = 0.851). Receiver Operating Curve (ROC) analysis showed superior diagnostic accuracy for TcB (AUC= 0.952) as compared to Kramer’s scale (ACU=0.819).
Conclusion: TcB demonstrated strong correlation with serum bilirubin levels and outperforms Kramer’s scale in detecting significant hyperbilirubinemia. TcB provides a more reliable, objective, and non-invasive method for neonate’s jaundice assessment.
Key words: Neonatal jaundice, hyperbilirubinemia, Transcutaneous Bilirubinometer, Kramer’s scale, serum bilirubin, diagnostic accuracy.