Benefits of Measuring the Transcutaneous Bilirubin in Neonates: Its Role in Preserving the Quality of Examination, Manipulation and Cost Effectiveness

Abstract

Introduction: Hyperbilirubinemia is one of the most common diagnoses of neonatal period affecting about 60% of babies born around term 1,8 . The clinical evaluation of jaundice only through inspection is insufficient. The most accurate way of assessing it is measuring the value of venous bilirubin (VB), which is an invasive method. A simpler way is to measure transcutaneous bilirubin (TB), a spectrometric method that evaluates the bilirubin based on skin color 1,2 . Objectives: This study aims to test the effectiveness of the TB measurements in newborns, the impact on the frequency of manipulations and the cost-effectiveness of this procedure in the neonatology discipline in our country. Materials and methods: This retrospective study was conducted with a sample of neonatal population of a total of 1044 individuals, at the American Hospital 3, Tirana. With regard to the patients data collected from March-August 2017, 505 neonates were part of the study, 22 of which were excluded when the decision to take VB or from them was left at the doctor’s judgment. With respect to the patients data collected from March-August 2018, there were 539 neonates part of our study, 8 of which were excluded when the decision to take VB or not depended on the TB values. The exclusions criteria were: neonatal weight < 2000 gr, gestational age < 34 weeks, other pathologies that required NICU care, blood sample taken after the 14th day of life, and when data were incomplete. The quantitative and qualitative data of the total sample in the two years of the respective study were evaluated and analyzed according to the relevant protocols for the scientific study, using SSPI 2019. Results: It turned out from the evaluated and analyzed data of the population of the study, from 1044 subjects - neonates, out of whom, 505 belonged to 2017 and 539 belonged to 2018, that in the period March – August 2017, there were 483 neonates included in the study, of whom, 249 males and 234 females, 18 less than 2500 gr, 77 less than 3000 gr, 283 between 3000-4000 gr, 105 over 4000 gr. In terms of gestational age, 18 were less 37 weeks and 465 over 37 weeks. As regards the 2018 period, the study included 531 neonates, of whom, 272 males and 259 females, 16 less than 2500 gr, 95 less than 3000 gr, 381 were among 3000 - 4000 gr, 39 were over 4000 gr; 28 of them were less than 37 weeks, 513 were over 37 weeks. It was observed also that during 2018, the neonatal manipulations have been decreased from 39.8% to 24.2%, consequently, it corresponds integrally to reduced costs. Conclusions: At the end of the study it was found that the use of transcutaneous bilirubin significantly reduces the number of manipulations in infants. Keywords: Bilirubin, jaundice, neonate, transcutaneous DOI: 10.7176/ALST/92-03 Publication date: February 28 th 2022