Medical Education Content Required for Kernicterus Risk Recognition|
Macedo de Lima, Gláucia; Porto, Maria Amélia Sayeg Campos & Alves da Cunha, Antônio Ledo
Objective: The objective of this study was to define the minimum academic content required for pediatricians
to recognize the risk of kernicterus.
Methods: A questionnaire was developed on the basis of American Academy of Pediatrics guidelines seeking
to develop a consensus for pediatricians in training on the theoretical content about neonatal
hyperbilirubinemia. To validate the instrument, we used the Delphi consensus method. The 14 invited experts
interviewed, eminent Brazilian researchers of neonatal hyperbilirubinemia, analyzed the questions posed in
accordance with the literature and validated the instrument
Findings: An assessment instrument, the Student Questionnaire (SQ), was developed on the basis of
indicators of risk of neonatal hyperbilirubinemia obtained from the literature. A panel of academic experts,
composed of the leading researchers of neonatal hyperbilirubinemia in Brazil according to research rankings
of the Brazilian government’s Lattes Platform, was assembled for consensus validation of the assessment
instrument. Validation of the SQ was achieved after two rounds of the Delphi technique. Finally, the SQ itself
was validated with the medical education content required for recognition of kernicterus risk.
Conclusion: The consensus among experts stressed the need to identify the primary epidemiologic risk
factors for significant hyperbilirubinemia associated with neonatal jaundice and to characterize risk of
bilirubin encephalopathy according to the literature. The minimum capacity required of physicians in training
is that they have the insight to consult the reference material specific to each clinical situation in which
hyperbilirubinemia may be involved. The present study emphasized the need for knowledge of the four
variables related to management of neonatal jaundice: gestational age, birth weight, infant age, and total
serum bilirubin. This validated questionnaire can be a useful tool to prepare pediatricians to recognize the
possibility of bilirubin encephalopathy in neonates and prescribe intervention as necessary.
Neonatal jaundice; Neonatal hyperbilirubinemia; Kernicterus; Delphi technique; Practice guideline