Abstract
Transcutaneous bilirubinometer devices are widely applied to assess neonatal hyperbilirubinemia. However, the optimal skin site and timing of transcutaneous bilirubin (TCB) measurements for the strongest correlation with total serum bilirubin (TSB) levels after phototherapy are still unclear. We conducted a retrospective observational study evaluating the correlation of TCB and TSB levels in neonates postphototherapy. The TCB measurements on the forehead and mid-sternum at 0 and 30 min postphototherapy were assessed by using a JM-103 bilirubinometer. Paired TCB and TSB measurements were assessed by Pearson correlation and Bland–Altman plots. We analyzed 40 neonates with 96 TSB and 384 TCB measurements. The TSB level correlated moderately with the forehead TCB level at 30 min postphototherapy (r = 0.65) and less strongly with the midsternum TCB level at 0 min postphototherapy (r = 0.52). The forehead at 30 min after cessation of phototherapy was the best time point and location of TCB measurement for the assessment of neonatal jaundice status. The reliability of TCB measurements varied across skin sites and durations after phototherapy. The effectiveness of TCB measurement to assess neonatal hyperbilirubinemia is much better on covered skin areas (foreheads) 30 min postphototherapy. The appropriate application of transcutaneous bilirubinometers could aid in clinical practice and avoid unnecessary management.
Highlights
More than 50% of term and preterm neonates have neonatal hyperbilirubinemia after birth [1]
A total of 40 neonates with neonatal hyperbilirubinemia who met the criteria for phototherapy between December 2017 and April 2018 in the NTUH Hsin-Chu branch were included
Correlations between transcutaneous bilirubin (TCB) and total serum bilirubin (TSB) in prematurity group were higher than term neonates, especially when measurements at forehead at 30 min postphototherapy (Table 3) (r = 0.69)
Summary
More than 50% of term and preterm neonates have neonatal hyperbilirubinemia after birth [1]. Severe hyperbilirubinemia, defined as total serum bilirubin over 20 mg/dL, affects 1.1 million infants annually [2]. Recognition and evaluation of severe hyperbilirubinemia in these neonates are important to avoid acute bilirubin encephalopathy. The gold standard evaluation of neonatal hyperbilirubinemia and indicator of phototherapy is the measurement of serum bilirubin levels. The accuracy of TCB measurement is uncertain and varies according to many factors, including preterm birth status, location of the TCB measurement, race, and concurrent phototherapy [4,5,6,7,8,9]. One metaanalysis reported a moderate correlation between TCB and total serum bilirubin TSB measurements during phototherapy [10]. The accuracy was better in the postphototherapy phase after the cessation of phototherapy
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