Abstract
Transcutaneous measurement of bilirubin is being used for neonatal jaundice. Its utility during phototherapy in preterm babies is not established. The objective of our study was to assess the efficacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at the covered skin area (glabella). It was a prospective observational study and conducted at the neonatal intensive care unit of a tertiary care hospital from January 2017 to January 2019. One hundred eligible preterm neonates were enrolled. Babies who were very sick, with poor peripheral circulation, edematous, having conjugated hyperbilirubinemia, with major congenital malformations, already received phototherapy or exchange transfusion were excluded. Paired total serum bilirubin and transcutaneous bilirubin were measured at admission and 6 h and 24 h during phototherapy. TcB was measured from the area (glabella) covered by an eye protector during phototherapy. The sample for TsB was taken within 10 min of TcB measurement. The mean differences between TsB and TcB values at admission and 6 h and 24 h of phototherapy were - 0.005 (0.353) mg/dl, - 0.350 (0.611) mg/dl, and - 0.592 (0.353) mg/dl, respectively. At admission or before starting of phototherapy, the difference (TsB-TcB) was statistically not significant (p = .125), while the difference in these values was statistically significant at 6 h and 24 h of phototherapy.Conclusion: TcB measurements from the covered skin area in jaundiced preterm infants during phototherapy were not correlated with TsB and cannot be used as an alternate of serum bilirubin testing. What is known • HPLC bilirubin measurement is a gold standard test for bilirubin measurement but impractical for day to day use. Serum total bilirubin is used for clinical testing.. • There is evidence for use of transcutaneous bilirubinometry for assessment of bilirubin in term newborn. What is new • TcB measurements from a covered skin area in jaundiced preterm newborns under phototherapy were not correlated significantly at 6 h and 24 h of phototherapy, but correlated before phototherapy. • TcB cannot be used as an alternate of serum bilirubin testing in preterm infants during phototherapy.
Highlights
Hyperbilirubinemia is a common occurrence in early neonatal period
Objective of our study was to assess the efficacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at covered skin area
TcB cannot be used as an alternate of serum bilirubin levels it reduces the frequency of blood sampling, iatrogenic blood loss, pain associated with prick and improves quality of neonatal care
Summary
About 50% of term and 80% of preterm neonates have serum bilirubin levels greater than 5 mg/dl in first few days of life. The levels may go up to 15 mg/dl in 6% of term neonates [1]. Total serum bilirubin (TsB) is the gold standard to estimate serum bilirubin levels in jaundiced preterm neonates. Transcutaneous bilirubinometry (TcB), on the other hand, is quick, handy and non-invasive way of screening for hyperbilirubinemia requiring intervention. It has been validated to assess jaundice in term neonates at the time of discharge [2]. Phototherapy leads to bleaching of the skin, rendering further TcB measurements unreliable. Covering a part of the skin during phototherapy has been shown to give better correlation with TsB values in some studies [3-8]. There has been conflicting evidence in studies [9, 10]. These studies were heterogeneous in regards to gestational age and were done in small number of babies
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