Abstract
BackgroundThe gold standard to assess hyperbilirubinemia in neonates remains the serum bilirubin measurement. Unfortunately, this is invasive, painful, and costly. Bilimed®, a new transcutaneous bilirubinometer, suggests more accuracy compared to the existing non-invasive bilirubinometers because of its new technology. It furthermore takes into account different skin colours. No contact with the skin is needed during measurement, no additional material costs occur. Our aim was to assess the agreement between the Bilimed® and serum bilirubin in preterm and term infants of different skin colours.MethodsThe transcutaneous bilirubin measurements were performed on the infant's sternum and serum bilirubin was determined simultaneously. The agreement between both methods was assessed by Pearson's correlation and by Bland-Altman analysis.ResultsA total of 117 measurement cycles were performed in 99 term infants (group1), further 47 measurements in 38 preterm infants born between 34 - 36 6/7 gestational weeks (group 2), and finally 21 measurements in 13 preterm infants born between 28 - 33 6/7 gestational weeks (group 3). The mean deviation and variability (+/- 2SD) of the transcutaneous from serum bilirubin were: -14 (+/- 144) μmol/l; -0.82 (+/- 8.4) mg/dl in group 1, +16 (+/- 91) μmol/l;+0.93(+/- 5.3) mg/dl in group 2 and -8 (+/- 76) μmol/l; -0.47 (+/- 4.4) mg/dl in group 3. These limits of agreement are too wide to be acceptable in a clinical setting. Moreover, there was to be a trend towards less good agreement with increasing bilirubin values.ConclusionDespite its new technology the Bilimed® has no advantages, and more specifically no better agreement not only in term and near-term Caucasian infants, but also in non-Caucasian and more premature infants.
Highlights
The gold standard to assess hyperbilirubinemia in neonates remains the serum bilirubin measurement
The transcutaneous bilirubin concentration was measured three times. This was done by the same person and immediately before or within 15 minutes after capillary blood sampling for serum bilirubin concentration measurements
The group of preterm infants was subdivided into more mature premature infants born between 34 0/7 and 36 6/7 weeks gestational age and the more premature infants born between 28 0/7 and 33 6/7 weeks gestation. 111 measurements were performed in 99 term infants, 47 measurements in 38 preterm infants of group 2 and 21 measurements in 13 preterm infants allocated to group 3
Summary
The gold standard to assess hyperbilirubinemia in neonates remains the serum bilirubin measurement. Bilimed®, a new transcutaneous bilirubinometer, suggests more accuracy compared to the existing non-invasive bilirubinometers because of its new technology It takes into account different skin colours. Our aim was to assess the agreement between the Bilimed® and serum bilirubin in preterm and term infants of different skin colours. BMC Pediatrics 2009, 9:70 http://www.biomedcentral.com/1471-2431/9/70 urement of serum bilirubin concentration This method is invasive, painful and costly in terms of workload, time and money. Repeated blood samplings may lead to significant blood loss, which may be of particular concern in preterm infants Trying to overcome these drawbacks, non-invasive methods of bilirubin measurements have been proposed. In preterm infants transcutaneous bilirubinometry is less accurate than in term infants, as results are affected by the immature skin and by a different albumin-to-bilirubin binding [6,9,10]
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