Transcutaneous Bilirubin Measurements Research Articles

Comparative study of total serum bilirubin levels measured via blood vs skin in neonates

ObjectiveThe aim was to compare between total bilirubin levels measured via blood vs skin in neonates.BackgroundNeonatal jaundice is a common clinical problem. total serum bilirubin (TSB) with transcutaneous bilirubin (TCB) measurement can be used for evaluating bilirubin levels in neonates.Patients and methodsThis cross-sectional study was conducted on 200 jaundiced neonates with indirect hyperbilirubinemia, in the neonatal intensive care unit of Menoufia University Hospital, and they were randomly divided into three groups: group 1 (n = 100) included full-term neonates with gestational age ranged from 37 to 42 weeks; group 2 (n = 35) included late preterm neonates with gestational age ranged from 34 to 36 weeks; and group 3 (n = 65) included early preterm neonates with gestational age ranged from 30 to 33 weeks. Complete blood count with reticulocyte count was obtained along with TSB, Rhesus factor, and ABO blood groups for both mothers and neonates.ResultsThere was a strong positive significant correlation between TSB and TCB, but the correlation decreased as both levels advanced [Pearson correlation (r)=0.983]. The correlation was better in full tem with TSB-TCB difference of 1.88 ± 0.39 in comparison with late and early preterm, which was 2.27 ± 1.99 and 2.55 ± 0.64, respectively. There was a strong positive correlation between TSB and TCB regarding weight, gestational age, and postnatal ages, with Pearson correlation of 0.08, 0.404, and 0.505, respectively, for TSB and 0.477, 0.489, and 0.558, respectively, for TCB. TSB always overestimates TCB.ConclusionTCB is a reliable method in screening of neonatal jaundice in full-term babies, reducing the need for TSB, which is expensive and invasive. Reliability is lesser for the preterm.

Relationship between Transcutaneous and Serum Bilirubin in Preterm and Term Neonates before and during Phototherapy

Background Neonatal jaundice is a common condition. Total serum bilirubin (TSB) measuring is standard for bilirubin testing, while transcutaneous bilirubin (TcB) is an alternative method. We aimed to evaluate the correlation between TSB and TcB in term and preterm neonates. Materials and Methods This prospective cross-sectional study was conducted to on 93 term and preterm neonates in Fatemieh Hospital in 2018, Hamadan, Iran. The samples were categorized into two groups, including term and preterm icteric neonates. Neonates were evaluated to determine the necessity of bilirubin estimation with TSB measurement. After the confirmation of jaundice, the blood samples obtained were sent to the laboratory for bilirubin estimation, and at the same time, the TcB measurement was performed by the bilirubinometer. Selectra X-L was utilized by which the blood samples were analyzed through the dichloroanilin method. The Pearson correlation coefficient was used to evaluate the relationship and stringency of the correlation between the approaches. Results In general,61% and 38% of neonates were boys and girls, respectively. Before phototherapy, the TSB values were lower than TcB estimations in term and preterm neonates. The estimated Pearson correlation coefficients were obtained at r=0.729 (p <0.001), and r=0.802 (p <0.001) in term and preterm neonates, respectively. After phototherapy, contrary to the obtained results before phototherapy, the TSB concentration was higher than TcB concentrations. The difference between the measured values of the two approaches was more significant in term neonates. The Pearson correlation coefficient estimations were r=0.804 (p <0.001), and r=0.901 (p <0.001) in term and preterm neonates, respectively. Conclusion Based on the results, there was a significant correlation between the values of TSB and TcB in term and preterm neonates.

The forehead is a better site than the sternum to check transcutaneous bilirubin during phototherapy in sick infants

BackgroundTo confirm the accuracy of transcutaneous bilirubin (TcB) in the neonatal intensive care unit both with and without phototherapy, and compare forehead and sternum as the TcB assessment site.MethodsWe simultaneously assessed the total serum bilirubin (TSB) and TcB at the forehead and sternum, using a JM-103 bilirubinometer. We analyzed the correlation between the TSB and TcB assessed at the forehead and sternum, with measurements classified as ‘without phototherapy’ (before phototherapy and > 24 hours after phototherapy discontinuation) and ‘with phototherapy’ (after 24 hours of phototherapy).ResultsThere were 1,084 paired forehead and sternum TcB measurements, with the corresponding TSB measurement, from 384 infants. Their mean gestational age of 35.4 ± 3.2 weeks (62% were preterm) and a mean birth weight of 2434 ± 768 grams, and TSB was 6.61 ± 3.56 mg/dL. Without phototherapy, TcB values at the forehead and sternum were correlated well to the TSB value (r = 0.925 and 0.915, respectively). With phototherapy, TcB values at the forehead and sternum were significantly correlated with the TSB value, but TcB at the forehead (r = 0.751) was a better match to the TSB than was TcB at the sternum (r = 0.668). Additionally, Bland-Altman plots showed a greater degree of underestimation of the TSB by TcB at the sternum with phototherapy.ConclusionsTcB was more accurate in infants not receiving phototherapy. During phototherapy, it is better to assess TcB at the forehead rather than at the sternum.

A Prospective Comparison of Serum and Transcutaneous Bilirubin in Indian Neonates

The objective of this study was to compare the transcutaneous bilirubin (TcB) with total serum bilirubin (TSB) and to find out the effect of phototherapy on correlation of TcB and TSB during and after phototherapy in Indian neonates. Prospective observational study was performed at neonatal intensive care unit of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, India. Blood samples for TSB estimation of 276 jaundiced neonates were sent, and simultaneously, TcB was measured at forehead and sternum on admission and 12 hourly till discontinuation of phototherapy as per the American Academy of Pediatrics nomogram chart and their correlation was assessed. The effect of phototherapy on correlation of TcB and TSB during and after phototherapy was also observed. The correlation between TSB and TcB was linear and significant for the entire study population over forehead (Pearson's r = 0.802, R 2 = 0.644, p < 0.001) as well as over sternum (Pearson's r = 0.825, R 2 = 0.681, p < 0.001) before starting the phototherapy. This correlation becomes slightly lower for TSB versus TcB forehead (Pearson's r = 0.753, R 2 = 0.568, p < 0.001) and for TSB versus TcB sternum (Pearson's r = 0.754, R 2 = 0.569, p < 0.001) after giving phototherapy for at least 24 hours. The correlation coefficients for TSB versus TcB measurements over forehead and sternum were 0.758 and 0.806, respectively, after 36 hours of phototherapy. TcB measurements using the transcutaneous bilirubinometer correlate closely with TSB levels, so it can be used as an easy and rapid noninvasive method of bilirubin measurement in jaundiced neonates.

Transcutaneous bilirubin measurements: useful, but also reproducible?

Transcutaneous bilirubin measurements: useful, but also reproducible?

Decision Accuracy and Safety of Transcutaneous Bilirubin Screening at Intermountain Healthcare

To quantify the risk that transcutaneous bilirubin (TcB) screening would fail to recommend phototherapy for a neonate who would have qualified for it if total serum bilirubin (TSB) screening were used. We conducted a quality improvement project where simultaneous TcB and TSB were obtained on neonates ≥35weeks of gestation during birth hospitalizations in our hospital system. Using our Utah bilirubin management algorithm, we quantified the risk that TcB screening would fail to identify the need for a confirmatory TSB when TSB screening alone would have revealed that phototherapy was indicated. In 3 hospitals, we obtained 727 paired TcB/TSB measurements. Two instances utilized a blood gas radiometer for TSB, and 725 utilized the clinical laboratory-based TSB method. One of the 727 instances had a TcB indicating NO PHOTOTHERAPY, when the simultaneous TSB indicated PHOTOTHERAPY NEEDED. The TSB from that instance was 1 of the 2 from the blood gas radiometer. We estimate the risk of such an error occurring is 1.4 per 1000 TcB measurements (95% CI 0.03-7.6 per 1000). When only the laboratory TSB is used, we estimate the risk of such an error occurring to be 0 per 1000 TcB measurements (95% CI 0.0-5.1 per 1000). Using TcB for screening at the birth hospital can identify those qualifying for phototherapy, using the Utah guidelines, with 1 of 727 neonates with a blood gas bilirubin and none of 725 with a laboratory-based analysis misidentified as not needing phototherapy when by TSB they did.

Hour-specific nomogram for transcutaneous Bilirubin in newborns in Myanmar.

Neonatal hyperbilirubinemia is a significant health problem in Myanmar, and the rate of kernicterus is also higher than in developed countries. Non-invasive methods for early detection and treatment of hyperbilirubinemia are urgently needed. In this study, we used transcutaneous bilirubin (TcB) measurements to develop an hour-specific TcB nomogram for the effective management of hyperbilirubinemia in Myanmar newborns. The bilirubin levels of neonates born in Central Women Hospital in Yangon, Myanmar were measured three times a day within 72h after birth using a transcutaneous bilirubinometer. An hour-specific TcB nomogram was created based on the data. Participants were 512 infants (287 boys, 225 girls) born in Central Women's Hospital in Yangon. The mean (±SD) gestational age was 38.4±1.2weeks; birthweight was 3078±412g. A total of 3,039 plots were obtained, and the TcB nomogram was created with smoothed percentile curves (97.5th, 50th, and 2.5th percentiles) for 0-72h after birth. An hour-specific TcB nomogram was successfully created to manage hyperbilirubinemia in Myanmar newborns.

Reducing Outpatient Infant Blood Draws with Transcutaneous Measurement of Bilirubin.

Introduction:Newborn jaundice is a common outpatient problem. Transcutaneous bilirubin (TcB) measurements correlate well with total serum bilirubin (SB) measurements below 15 mg/dl and are efficient and noninvasive. Some concern exists that TcB measurement may subsequently lead to an increase in the number of SB measurements performed in the outpatient setting. We aimed to implement the use of a TcB device in an outpatient clinic. By doing so, we sought to increase the number of newborns screened solely by TcB as opposed to SB, by 30%, within 12 months.Methods:We conducted plan-do-study-act cycles with targeted interventions to promote the use of TcB in an outpatient clinic for eligible newborns older than 35 weeks gestational age, aged 1–20 days, and without a history of transfusion, phototherapy, extensive bruising, or risk of hemolysis. We used statistical process control methods to measure proportions of newborns evaluated with TcB (run chart) and patients-between SB measurements (G-chart) over time in the outpatient clinic.Results:We collected preintervention data for 18-months and intervention data for 12 months. For newborns attending the outpatient clinic, the proportion of TcB measurements increased after implementation of the use of TcB measurement. There was an increase in patients-between SB measurements. At project inception, SB was drawn for every 8 eligible patients. By the end of the project, there were 98 eligible newborns between instances of SB testing.Conclusion:Implementation of a quality-improvement initiative to measure TcB in the outpatient clinic was feasible and reduced the number of SB tests.

Accuracy of Transcutaneous Bilirubin Versus Serum Bilirubin Measurement in Preterm Infants Receiving Phototherapy: A Systematic Review.

Jaundice is a common condition among preterm infants in the neonatal intensive care unit (NICU). Total serum bilirubin (TSB) offers a gold standard tool for measurement, but blood sampling can be costly, time-consuming, and not without risks of infection and pain. Transcutaneous bilimeter (TcB) allows for noninvasive assessment of bilirubin. However, due to questions of accuracy the use of the TcB in preterm infants receiving phototherapy has not been widely adapted in the NICU. To systematically review studies that measure TcB versus TSB bilirubin in preterm infants who are receiving phototherapy. A systematic electronic search of databases (CINAHL, EMBASE, Cochrane, Medline, PubMed) was completed for English language publications. No date limitation was placed on the search. Inclusion criteria were based on preterm infants that were in the NICU receiving or had recently received phototherapy. Nine studies of different quantitative study designs were reviewed. A good to strong correlation between TcB and TSB in preterm infants receiving phototherapy was demonstrated. There was a stronger correlation found in studies that examined TcB in unexposed skin areas during phototherapy. TcB may allow for a reduction in blood sampling, which would reduce painful procedures, reduce the risk of infection and anemia resulting from repeated blood sampling. It also acts as a more time and cost-efficient measurement tool. Larger scaled quantitative studies on the accuracy of TcB in preterm infants receiving phototherapy are needed to provide more evidence-based data and guide clinical practice on this topic.

Neonatal Management During the Coronavirus Disease (COVID-19) Outbreak: The Chinese Experience.

Novel coronavirus infection is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was named COVID-19 by the World Health Organization on January 7, 2020. In early December 2019, a number of pneumonia cases of unknown origin emerged in Wuhan, Hubei province, China. (1)(2) The disease then spread rapidly throughout China and has now become a global pandemic. As of March 23, 2020, more than 340,000 cases have been reported in more than 150 countries. Because the disease is primarily an airborne respiratory infection and is documented to have a strong human-to-human transmission, the pediatric and neonatal populations are vulnerable to this disease. However, the incidence and clinical presentations of pediatric COVID-19 infections are varied and differ from those found in adult patients. The atypical clinical presentations and 2 potential modes of transmission in neonates (ie, maternal-fetal or maternal-neonatal) have led to diagnostic and management challenges. In this perspective, we would like to share some published information from Chinese pediatric and neonatal societies about their approach to handling the 2019-2020 COVID-19 outbreak in China. Since the COVID-19 outbreak in December 2019, more than 81,000 confirmed cases have been reported in China (as of March 23, 2020). Most of these cases occurred between late January and early February 2020. The diagnosis of COVID-19 is based on the epidemiologic history of contact with an infected person, typical clinical features such as fever and respiratory distress, and a positive real-time polymerase chain reaction to the SARS-CoV-2 RNA test. The nucleic test is considered the gold standard for confirmation. As of February 8, 2020, 731 confirmed pediatric cases were reported in China, mainly from Wuhan city. (3) Relative to the total number of cases (n=34,664) reported in China, on February 8, 2020, the pediatric COVID-19 population accounted for 2.1% …

Comparison of Serum Bilirubin Level of Neonates Under Phototherapy with Two Methods of Transcutaneous and Total Serum Bilirubin Measurement

Objectives: To compare the serum bilirubin level of neonates under phototherapy with two methods of transcutaneous (TcB) and total serum bilirubin measurement (TSB). Methods: This descriptive-analytical study was conducted on the icteric term and late preterm neonates in Sabzevar, Iran between Oct 30, 2016, and Aug 7, 2018. Within 24 hours of birth, the TcB and then TSB of the neonates were measured before and after phototherapy. The TcB was performed using BiliCheck (KJ-8000 Transcutaneous Jaundice Meter) during phototherapy, at the forehead between the two eyebrows and the middle part of the sternum which were covered by a white 3 × 3 cm gauze. Results: 200 neonates were eligible, the bilirubin level of 50.5% of male infants were ranging from 15 to 18 mg/dL of serum. The correlation for serological-transcutaneous frontal tests was 0.74, 0.82, 0.76, and 0.55 for the first to the fourth day, respectively, versus to 0.71, 0.91, 92 0, and 0.69 for the mentioned days for serological-transcutaneous sternal tests. Based on Bland-Altman and intraclass correlation coefficient (ICC) methods for four days; although the correlation between the two methods is high on the first day in both areas, the value of reduction is greater on day four in the frontal area. Conclusions: Our findings revealed that the covering of sternal and frontal areas does not affect the correlation between the TcB and TSB methods. Also, TcB in the absence of TSB could be a good alternative in order to measure the level of bilirubin.

Letter to “Comparison of Transcutaneous Bilirubin Measurement with Total Serum Bilirubin Levels in Term Neonates with Hyperbilirubinemia: A Descriptive-Analytical Study”

Letter to “Comparison of Transcutaneous Bilirubin Measurement with Total Serum Bilirubin Levels in Term Neonates with Hyperbilirubinemia: A Descriptive-Analytical Study”

Accuracy of Enhanced Transcutaneous Bilirubinometry Considering Various Measurement Sites

The goal of the study was to provide missing data on the accuracy of enhanced transcutaneous bilirubinometry in a monoracial population of term neonates, considering three different measurement sites.Transcutaneous bilirubin was measured using the JM-105 device on the forehead, chest, and abdomen. Blood sampling for total serum bilirubin concentration has been performed within 10 minutes of transcutaneous measurements. Paired transcutaneous bilirubin and total serum bilirubin measurements were statistically analyzed.The study group consisted of 102 healthy term Slovak infants. The correlation between total serum bilirubin and transcutaneous bilirubin was significant (coefficient of determination R2: 0.9045 forehead, 0.8808 sternum, 0.8467 abdomen). Transcutaneous measurements underestimated serum bilirubin levels significantly when total serum bilirubin values were higher than 15 mg/dL, irrespective of the site of transcutaneous measurements. The lowest mean difference between total serum bilirubin and transcutaneous bilirubin was identified on the sternum (median: -1.1 mg/dL). The area under the curve was >0.97 and >0.93 for detecting total serum bilirubin levels >10 mg/dL and >13 mg/dL, respectively, for all measurement sites. Transcutaneous measurements on the forehead and sternum provided very high sensitivity, with the best performance at the forehead.Transcutaneous bilirubinometry using an enhanced device is an accurate, sensitive, and convenient screening method in term Caucasian neonates. Transcutaneous bilirubin measurements on the forehead, sternum, and abdomen are reliable, with the best performance on the forehead. It is necessary to confirm higher transcutaneous bilirubin values with a total serum bilirubin measurement.

Evaluation of the Relationship Between Transcutaneous Bilirubin Measurement and Total Serum Bilirubin in Neonatal Patients Followed for Jaundice.

Objectives:Jaundice is a physiological condition caused by hyperbilirubinemia, which is common in neonatal period. However, severe hyperbilirubinemia can cause kernicterus, which is a serious condition that leads to neurological problems. In this study, we aimed to investigate whether it is safe to use transcutaneous bilirubin (TcB) instead of blood for the evaluation of jaundice by comparing TcB measurement with standard total serum bilirubin (TSB) measurement values.Methods:A total of 105 term and early term infants with gestational ages between 37 and 42 weeks were included in the study. MBJ20 TcB measuring device was used for TcB measurement. TcB was measured from the forehead and sternum. To evaluate the relationship between TcB measurements and TSB measurements, we performed Pearson correlation, Spearman correlation, linear regression analysis, and Bland-Altman analysis in which we evaluated the scatter plot of the differences between the average values of the measurements.Results:There was a positive and statistically significant correlation between TcB forehead and TSB measurements and TcB sternum and TSB measurements (p<0.001). Linear regression analysis showed a positive directional correlation between TcB forehead and TSB measurements (R²=0.85) and TcB sternum and TSB measurements (R²=0.87). Bland-Altman analysis showed a good consistency between TSB and TcB forehead measurement methods (mean difference: 0.39±1.46, 95% CI: [−2.47]–[3.26]), and between TSB and TcB sternum measurement methods (mean difference: 0.49±1.32 95% CI: [−2.1]–[3.07]).Conclusion:As a result of our study, we found that TcB measurement can be reliable instead of taking blood for jaundice evaluation.

Investigation of the relationship between cord clamping time and risk of hyperbilirubinemia.

Although the relationship between umbilical cord clamping time and various parameters such as hemoglobin (Hb) levels, iron deficiency, and risk of neonatal jaundice has previously been studied, to the best of our knowleadge there have been no studies investigating the relationship between cord clamping time and the risk of significant hyperbilirubinemia. We aimed to investigate the relationship between the time of umbilical cord clamping and transcutaneous bilirubin (TcB) measurements made on various postnatal hours, Hb and serum total bilirubin (STB) levels measured on postnatal 4th day, and the risk of development of significant hyperbilirubinemia requiring phototherapy treatment. Eligible newborns were divided into two groups on the basis of the time of cord clamping: those clamped late (60 seconds or more; Group I) and those clamped early (less than 60 seconds; Group II). Groups were compared with respect to the parameters of cord Hb, postnatal TcB measurements at 6th, 48th, 96th and 168th hours, and 96th hour Hb, STB and direct bilirubin levels. TcB levels at the 96th and 168th hour were significantly higher in Group I when compared to Group II (p < 0.001 and p < 0.001, respectively). The 96th hour STB level was significantly higher in Group I when compared to Group II (p < 0.001). The need of phototherapy requirement was higher in Group I when compared to Group II (p=0.001). Increase in cord blood Hb for each 1 gr/dl caused a 3.94-fold increased risk in the requirement of phototherapy treatment. Cord clamping time showed statistically significant positive correlations with both cord blood and 96th hour venous Hb levels, with both 96th hour and 168th hour TcB levels, and with 96th hour STB levels. Newborns whose cords are clamped late should be followed up closely with respect to high postnatal bilirubin levels and other risks associated with significant hyperbilirubinemia requiring phototherapy treatment.

Accuracy of transcutaneous bilirubin on covered skin in preterm and term newborns receiving phototherapy using a JM-105 bilirubinometer

ObjectiveDetermine the suitability of transcutaneous bilirubin (TCB) as a tool to assess the effectiveness of phototherapy on patched skin.Study designA prospective observational study was conducted. We covered a fragment of skin (sternum) with a photo-opaque patch. Several simultaneous TCB and TSB measurements were performed with the JM-105 bilirubinometer. Bland and Altman test evaluated the agreement between bilirubin levels.ResultA total of 217 patients were studied, 48.8% were preterm. The mean difference between TSB and TCB before the start of treatment was 1.07 mg/dL. During phototherapy, differences on covered skin were 0.52, 0.27, and 0.39 mg/dL at 24, 48, and 72 h of therapy respectively. The best correlation was observed at 48 h in preterm infants.ConclusionThe measurement of TCB on patched skin (PTCB) is useful for monitoring the response to phototherapy in term and preterm infants. We use a patch with a removable flap that eases successive measures without disturbing the patients.

Comparison of Transcutaneous Bilirubin Measurement with Total Serum Bilirubin Levels in Term Neonates with Hyperbilirubinemia: A Descriptive-Analytical Study

Background: A common procedure for the diagnosis of hyperbilirubinemia is the total investigation of total serum bilirubin (TSB); however, this procedure is invasive for neonates. For two decades, transcutaneous bilirubin (TCB) was used as a non-invasive and painless method to assess bilirubin. Objectives: This study aimed to compare the accuracy of TCB versus TSB before and after phototherapy. Methods: This descriptive-analytical study included 85 neonates. Neonates were selected by convenience sampling methods. Neonates had a normal birth weight and physiological jaundice; having no need for blood transfusions. Data were collected using a BiliChek device (APEL, Japan). The researcher, before phototherapy and simultaneously by checking the TSB, pressed the BiliChek three consecutive times in the middle of the neonate’s forehead and then, recorded the results. The correlation between TCB and TSB were determined before and after phototherapy. Pearson, t-test, and ROC were used by SPSS v.18 for analysis data. Results: There was a strong correlation between the TCB and the TSB in neonates weighing 3001 to 4000g before phototherapy (r = 0.74, P 0.05), the cut-off value of bilirubin was 6 - 8 mg/dL. The sensitivity was (100%) and specificity was 90% for bilirubin at the levels of 6.7 mg/dL. Conclusions: TCB procedure can be a reliable alternative to the TSB, especially in the initiation of phototherapy with bilirubin levels of 6 - 8 mg/dL. However, it is not a device with a high accuracy after phototherapy.

Evaluation of the Kejian KJ‐8000 bilirubinometer in an Australian setting

To evaluate the accuracy of the Kejian 8000 (KJ-8000) transcutaneous bilirubinometer in infants of differing ethnicity and gestational age. This was a prospective study of infants in the Newborn Care Unit at Gold Coast University Hospital. Transcutaneous bilirubin (TcB) and serum bilirubin (SBR) results were compared using linear regression and a Bland-Altman plot. Predicted indices were calculated to assess the KJ-8000 as a screening tool using local jaundice management guidelines. A total of 416 paired samples were collected from 201 infants. There was a strong correlation between TcB and SBR with a Pearson correlation coefficient of 0.8 (<0.00001). The bias was -5.9 μmol/L (95% confidence interval: -101, 89). The bias was not evenly spread, with the KJ-8000 tending to underestimate at higher SBR levels. Infants <32 weeks' gestation had a poor correlation of 0.48. Non-Caucasian infants were more likely to have TcB overestimation, and measurements were less precise. As a screening tool using local guidelines, the KJ-8000 had a sensitivity, specificity, positive predictive value and negative predictive value of 83, 53, 20 and 96%, respectively, and is predicted to avoid blood tests in 48% of infants screened. In this study, the correlation and agreement of TcB measurements using the KJ-8000 were not as good as has been reported with other more studied devices but may still have value as a screening tool. The poor correlation in preterm infants suggests that use should be restricted to term infants. The overall results of this study are affected by an underrepresentation of term infants, and so, further clinical assessment of this device should be undertaken before it can be recommended for widespread use.

How skin anatomy influences transcutaneous bilirubin determinations: an in vitro evaluation

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.

Screening and treatment to reduce severe hyperbilirubinaemia in infants in primary care (STARSHIP): a factorial stepped-wedge cluster randomised controlled trial protocol

IntroductionJaundice caused by hyperbilirubinaemia is a physiological phenomenon in the neonatal period. However, severe hyperbilirubinaemia, when left untreated, may cause kernicterus, a severe condition resulting in lifelong neurological disabilities. Although...