75: Effect of Phototherapy on the Reliability of Transcutaneous Devices in Infants >35 Weeks of Gestational Age: A Systematic Review

Abstract

American Academy of Pediatrics (AAP) recommends the use of TcB devices for the diagnosis of significant hyperbilirubinemia in infants >35 weeks of gestational age and for making decisions for initiation of phototherapy. However, the accuracy of TcB devices in infants receiving phototherapy is unclear. To conduct systematic review of diagnostic accuracy studies comparing TcB devices with total serum bilirubin (TSB) estimation in near-term and term neonates receiving phototherapy or post-phototherapy phase Search Strategy MEDLINE, EMBASE, Cochrane library, CINAHL, Scopus databases (all from the date of inception to August 2013) were searched. Additional citations were identified from the bibliography of selected articles and from abstracts of the conference proceedings. Study Selection and Data Extraction The studies were included if they compared TcB results with TSB in term and near-term infants during phototherapy or after discontinuation of phototherapy in neonatal period. Two reviewers independently assessed studies for inclusion and discrepancies were resolved with consensus. Data were extracted by one reviewer and checked for accuracy by the second reviewer. Quality assessment of included studies was performed using QUADAS-2 tool. Seventy-three studies were selected for full text review of which 12 were eligible for inclusion (seven studies awaiting decision). Studies varied in terms of site of TcB estimation (forehead [12], sternum [6], back [2]); TcB devices used (Bilicheck [2], Minolta air shields [4], JM101 [6]); method of estimation of TSB (Direct Spectrophotometry [5], Diazo method [8], both [2], not specified [1]). All studies provided results of comparison of TcB with TSB as co-relation coefficients (r=0.67 [95% CI 0.61 to 0.72]), with five studies providing data separately for TcB measurements from a covered area (r=0.71 [95% CI 0.65 to 0.77]) and two studies providing results for post phototherapy phase (r=0.75 [95% CI 0.66 to 0.82]) data One study provided data for Bland-Altman difference plots and showed TcB underestimated TSB by a mean difference of29.2 mmol/L. Our results show that TcB devices were not as reliable for estimation of serum bilirubin in infants receiving phototherapy as compared to pre-phototherapy phase. However, majority of studies were conducted using older TcB devices that are currently not in practice. Also, there is insufficient data for recommending the use of TcB devices in post phototherapy phase.