Introduction:- Neonatal jaundice is one of the
most frequently encountered clinical problems in
newborns. Early intervention is needed to prevent
complications caused by increased level of serum
bilirubin. Kramer’s method is a non invasive visual
assessment technique to estimate the bilirubin
levels in neonates with jaundice especially useful
in low income settings like Nepal. This study was
conducted to determine whether visual assessment
of neonatal jaundice could serve as a screening
step for neonatal hyperbilirubinemia and this type
of non-invasive measurement of neonatal jaundice
has not been done in our settings.

Materials and Methods:- A prospective cross
sectional study was performed over a period of 12
months at Emergency Ward, Neonatal Intermediate
Care Unit (NIMCU), Neonatal Intensive Care unit
(NICU) of Kanti Children’s Hospital, Maharajgunj
Kathmandu where term neonates with jaundice
were assessed visually for jaundice by a single
pediatrician and categorized into different dermal
zones according to Kramer’s rule and mean of
three observations was taken as visual estimation of
jaundice and compared with total serum bilirubin

Results:- The common causes of neonatal jaundice
were physiological jaundice (56.17%) low birth
weight (18.5%) and sepsis (17.3%). The visual
assessment of neonatal jaundice was highly
correlated with total serum bilirubin level (Pearson's
correlation coefficient=0.837 with p value <0.0001).

Conclusion:Visual assessment of neonatal jaundice by Kramers’s rule was highly correlated with total serum bilirubin level. So, it can be used as a screening tool for
predicting neonatal hyperbilirubinemia


Keywords: Kramer’s criteria, Neonatal hyperbilirubinemia, Neonatal sepsis