A Comparison Between Transcutaneous Bilirubin and Total Serum Bilirubin Levels for the Management of Jaundice in Preterm Neonates by Bland-Altman Plot.

Santosh K Panda,Soumini Rath,Palash Das,Abhinav Gaurav,Natabar Swain

doi:10.7759/cureus.18442

Santosh K Panda, Soumini Rath + Show 3 more

Open Access

https://doi.org/10.7759/cureus.18442

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Journal: Cureus	Publication Date: Oct 2, 2021
Citations: 1	License type: cc-by

Affiliation: All India Institute of Medical Sciences Bhubaneswar

Abstract

ObjectiveTo compare the bilirubin levels measured by transcutaneous bilirubinometer and serum samples for the management of jaundice in preterm neonates.MethodsThe study was a prospective comparative observational study conducted in a tertiary care neonatal unit of Odisha from January 2019 to June 2020. All inborn and outborn neonates with a gestational age of 280/7 weeks to 366/7 weeks with the clinical diagnosis of neonatal jaundice were included in the study. Transcutaneous bilirubin (TcB) was estimated by Dragger jaundice meter JM-105 and simultaneously venous blood and total serum bilirubin levels (TSB) were measured by diazonium method. The comparison between TcB and TSB values was analyzed by direct linear correlation in scatter plot and Bland-Altman plot.ResultsA total of 167 preterm neonates (66, 28-336/7 and 111, 34-366/7), with a mean gestational age 33.55 ±2.36 weeks and a mean birth weight of 1960 ± 613 grams, were analyzed. The mean TSB and TcB levels were 12.99 ± 3.47 mg/dl (min-max 4.9-18.3 mg/dl) and 14.156 ± 4.71 mg/dl (min-max 4-20.1 mg/dL), respectively. The TcB is excellently correlated with TSB with a correlation coefficient of r =0.948, p ≤0.001. The bias difference between TcB and TSB is -1.16 (95% CI: 2.35, -4.6) mg/dl. The correlation coefficients between 28-336/7 weeks gestational age groups (r = 0.944) and 34-366/7gestational age (r = 0.950) were similar.ConclusionTcB is well correlated with TSB level in preterm neonates. Hence, TcB can be used for the guidance of management in these neonates.

Highlights

Neonatal hyperbilirubinemia is a common problem with almost 50% term and 80% of preterm neonates suffering from some amount of neonatal hyperbilirubinemia [1]
The total serum bilirubin levels (TSB) level estimated by the conventional method has a significant correlation with the value of bilirubin as measured by the transcutaneous bilirubinometer in preterm neonates
The use of a transcutaneous bilirubinometer will decrease the frequency of painful phlebotomy in preterm neonates and will decrease parental anxiety

Summary

Introduction

Neonatal hyperbilirubinemia is a common problem with almost 50% term and 80% of preterm neonates suffering from some amount of neonatal hyperbilirubinemia [1]. Total serum bilirubin (TSB) level is the gold standard for the diagnosis of neonatal hyperbilirubinemia and is vital for the effective treatment of neonatal jaundice. The TSB estimation procedure involves invasive extraction of venous blood. In premature neonates, it is especially bothering as repeated phlebotomy causes iatrogenic anemia and increases parental anxiety [3]. Transcutaneous bilirubinometry is being used for serum bilirubin screening of neonates >35 weeks after 24 hours of age. The availability of newer equipment with advanced technology is used for the management of preterm jaundice. This study was carried out to measure transcutaneous bilirubin (TcB) levels in preterm jaundiced neonates between 28 and 37 weeks of gestational age and compare their values with TSB levels

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Discussion

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