Abstract
BackgroundTranscutaneous bilirubinometry is an effective screening method for neonatal hyperbilirubinemia. Current transcutaneous bilirubin (TcB) meters are designed for the “standard” situation of TcB determinations on the forehead or sternum of term newborns. We hypothesize that skin anatomy can considerably influence TcB determinations in non-standard situations—e.g., on preterm newborns or alternative body locations.MethodsA commercially available TcB meter (JM-105) was evaluated in vitro on phantoms that accurately mimic neonatal skin. We varied the mimicked cutaneous hemoglobin content (0–2.5 g/L), bone depth (0.26–5.26 mm), and skin maturity-related light scattering (1.36–2.27 mm−1) within the clinical range and investigated their influence on the TcB determination. To obtain a reference frame for bone depth at the forehead, magnetic resonance head scans of 46 newborns were evaluated.ResultsThe TcB meter adequately corrected for mimicked hemoglobin content. However, TcB determinations were influenced considerably by clinically realistic variations in mimicked bone depth and light scattering (deviations up to 72 µmol/L). This greatly exceeds the specified accuracy of the device (±25.5 µmol/L).ConclusionAs bone depth and light scattering vary with gestational maturity and body location, caretakers should be cautious when interpreting TcB measurements on premature newborns and non-standard body locations.
Highlights
Since the introduction of the first transcutaneous bilirubin (TcB) meter in 1980,1 transcutaneous bilirubinometry has become an effective noninvasive method for screening hyperbilirubinemia in newborns and can be employed to reduce the number of invasive total serum bilirubin (TSB) measurements.[2,3,4] Transcutaneous bilirubinometry cannot completely replace TSB determinations, since the TcB concentration is a physiologically different parameter from the TSB.[5]
This study We investigated the influence of hemoglobin concentration, the amount of light scattering by the skin, and bone depth on TcB measurements
A moderate trend can be observed of increasing TcB with higher cutaneous hemoglobin concentration, this variation falls within the accuracy specified by the manufacturer (±25.5 μmol/L)
Summary
Since the introduction of the first transcutaneous bilirubin (TcB) meter in 1980,1 transcutaneous bilirubinometry has become an effective noninvasive method for screening hyperbilirubinemia in newborns and can be employed to reduce the number of invasive total serum bilirubin (TSB) measurements.[2,3,4] Transcutaneous bilirubinometry cannot completely replace TSB determinations, since the TcB concentration is a physiologically different parameter from the TSB.[5] it is known that TcB measurements correlate less well with the TSB for other body locations than the forehead and sternum[6] and for premature newborns.[7,8] TcB measurements on premature newborns are becoming increasingly more common in clinical practice.[9] measurements on other body locations than the forehead and the sternum are gaining popularity, e.g., to avoid the influence of ambient light[10] or to investigate the cephalocaudal progression of jaundice.[11,12,13]. CONCLUSION: As bone depth and light scattering vary with gestational maturity and body location, caretakers should be cautious when interpreting TcB measurements on premature newborns and non-standard body locations
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