Paired Transcutaneous Bilirubin Research Articles

The Impact of Phototherapy on the Accuracy of Transcutaneous Bilirubin Measurements in Neonates: Optimal Measurement Site and Timing

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.

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.

Implementation of a reformulated Roche® bilirubin Gen.3 reagent did not affect the relationship between BiliChek transcutaneous and Roche total serum bilirubin

ObjectiveDetermine whether introduction of a reformulated bilirubin reagent, the Roche bilirubin Gen.3 assay, changed the relationship between BiliChek transcutaneous bilirubin (TcB) and total serum bilirubin (TSB). Design and methodsTcB results from term infants in the level 1 nursery obtained within one hour of a TSB were reviewed over two periods, six months before and after the conversion from the previous generation Roche bilirubin reagent to the new Roche Gen.3 bilirubin assay. TcB measurements were performed using BiliChek transcutaneous devices (Respironics, Marietta GA). Distribution of TSB results, and TcB minus TSB bias, were compared before and after introduction of the reformulated Roche bilirubin Gen.3 assay. Median and interquartile range (IQR) TSB values and bias were calculated. A statistical difference between median TSB values and bias were assessed using Man-Whitney test. ResultsA total of 301 paired TcB and TSB results were obtained, 172 before and 129 after implementation of the reformulated Roche bilirubin Gen.3 reagent. Median (IQR) TSB was 7.8 (6.8–8.7)mg/dL (133.3 (116.3–148.8) μmol/L) before and 7.6 (6.7–8.4)mg/dL (130 (114.6–143.6)μmol/L) after implementation of the reformulated reagent (p = .1373). Median (IQR) bias between TcB and TSB was 2.9 (2.2–3.7) mg/dL (49.6 (37.6–63.3)μmol/L) before the reformulated reagent was implemented; and did not change at 2.9 (2.1–3.9) mg/dL (49.6 (35.9–66.7)μmol/L) after implementation (p = .8242). ConclusionImplementation of the reformulated Roche bilirubin Gen.3 reagent did not affect the relationship between BiliChek transcutaneous and total serum bilirubin; thus no changes were needed to the neonatal TcB screening protocol as a result of the new bilirubin reagent.

The accuracy of transcutaneous bilirubinometer measurements to identify the hyperbilirubinemia in outpatient newborn population

ObjectivesTo assess the ability of transcutaneous bilirubinometer for prediction total serum bilirubin levels in newborn infants after hospital discharge. MethodsNewborn infants requiring total serum bilirubin (TSB) level measurement during an outpatient follow-up visit were included into the study. Transcutaneous bilirubin (TcB) measurement was carried out using JH20-1C (Ningbo David, China) transcutaneous jaundice detector and total serum bilirubin was simultaneously determined by direct spectrophotometry. The agreement between paired TSB and TcB measurements were assessed by Bland-Altman plot and Deming regression analysis. Predictive indices were also identified in different TcB cut-off values for TSB levels of 222, 256 and 291 μmol/L. ResultsA total of 271 paired TcB and TSB measurements were obtained from 218 newborn infants. 40.2% had an age of above 7 days at measurement time. The mean difference (95% CI) between TcB and TSB values was −1.7 (−5.4 to 2.1) μmol/L. For TSB levels of at least 256 and 291 μmol/L, a TcB cut-off of 222 μmol/L shows sensitivity of 90.6% and 100%, respectively. It was also determined that 39.4% of TSB measurements could be avoided when using TcB cut-off value of 222 μmol/L. ConclusionThe measurement of TcB with JH20-1C seems to be a reliable screening method for hyperbilirubinemia in the outpatient population when used a TcB cut-off of 222 μmol/L. The use of transcutaneous bilirubinometer could reduce the number of invasive blood sampling for the determination serum bilirubin.

VALIDITY OF TRANSCUTANEOUS BILIRUBIN IN THE FIRST FEW DAYS OF LIFE

Objective: To study the validity of transcutaneous bilirubin (TCB) at different time points between 24 and 96 h of life. Materials and Methods: The study was conducted in a tertiary newborn center from November 2014 to June 2016. We have included all babies above 34 weeks of gestation while babies with established direct hyperbilirubinemia, neonatal septicemia, major congenital/gastrointestinal malformations and those on phototherapy were excluded from the study. After taking into consideration the inclusion and exclusion criteria, 396 babies were recruited. The correlation was analyzed using the ROC curves, and r values and plots of agreement were done using Bland Altman charts. Results: A total of 662 paired TCB and serum bilirubin readings were performed in 396 healthy neonates, at designated time points between 24 and 96 h of life. Mean TCB was found to be uniformly higher than total serum bilirubin (TSB) for all variables such as sex, birth weight, gestational age, and growth of the baby with an excellent correlation (r=0.698-0.932). The correlation between TCB and serum bilirubin improved as age increased with maximum correlation at 96 h (r=0.981). Test of agreement showed that at 24 h the TCB overestimated serum bilirubin by 1.5±0.7 mg/dl which decreased to 0.8±0.6 mg/dl by 96 h. Conclusion: TCB and TSB correlated significantly between 24 and 96 h of age. However, there is overestimation by TCB initially which decreases at 96 h.

Use of Transcutaneous Bilirubin to Determine the Need for Phototherapy in Resource-Limited Settings

Background: Routine and timely determination of total serum bilirubin (TSB) remains a challenge in many resource-limited countries with substantial burden of severe neonatal hyperbilirubinemia. Limited evidence exists on the potential usefulness of transcutaneous bilirubin (TcB) to identify infants who may require phototherapy based on possible treatment criteria in such settings. Objective: To compare the number of infants requiring phototherapy across different TSB criteria and determine the predictive performance of TcB under each criterion. Methods: Infants with paired TcB and TSB measurements in a maternity hospital in Lagos, Nigeria, were assessed for phototherapy based on TSB criteria by the American Academy of Pediatrics (AAP), National Institute for Health and Clinical Excellence (NICE) UK, and World Health Organization (WHO), and an absolute threshold of ≥12 mg/dL. The predictive performance of TcB across treatment criteria was evaluated with receiver operating curve analysis. Results: A total of 1,011 infants with a mean TcB of 10.54 ± 3.19 (range: 2.7-19.9) mg/dL and TSB of 9.63 ± 2.61 (range: 0.3-19.5) mg/dL were assessed. Some 60 (5.9%) infants required phototherapy by 1 or more TSB criteria, with TSB ≥12 mg/dL identifying 55 (91.7%) and AAP 27 (45%) of these infants. All infants identified by the NICE and WHO criteria were equally detected by the AAP criterion. TcB showed negative predictive values of 99.0-99.9%, and positive predictive values of 7.7-15.5% across all criteria. Conclusions: The number of infants requiring phototherapy varies significantly across treatment criteria. TcB may be useful in identifying infants who do not require phototherapy, but may also identify a high proportion of false positives that is burdensome in resource-limited settings.

Correlation of transcutaneous bilirubin and serum bilirubin concentration in term and late preterm newborns

Objective: Neonatal jaundice is a common condition requiring evaluation and treatment for most newborns. However, kernicterus is just a “tip of the iceberg” of bilirubin-induced neurologic dysfunction. The objective of this study is to evaluate the use of a transcutaneous bilirubinometer for the detection of hyperbilirubinemia in newborns. Design and Setting: In this prospective study, we measured Transcutaneous bilirubin (TcB) concentration in clinically icteric term and late preterm babies. Total serum bilirubin (TSB) was measured if the initial TcB level was higher than the 50th centile in Bhutani's nomogram. Paired TcB and TSB results were correlated, and the mean difference was calculated. Patients: Neonates of gestational age more than 35 weeks and weighing more than 2 kg were included in this study. TcB recordings were taken in neonates who appeared clinically icteric. Results: Four hundred paired TcB and TSB measurements were taken. TcB was significantly correlating with TSB (P < 0.001) in both low-risk and medium-risk thresholds for phototherapy. TcB had a sensitivity and negative predictive value of 100% each, a specificity of 56%, and a positive predictive value of 23%. For high-risk cases, using the 75th centile as cutoff, the sensitivity and negative predictive value were reduced to 88% and 97.0%, respectively. Conclusion: TcB correlates closely with TSB concentration in neonates born after 35 weeks gestation. The rate of rise in TcB may help in identification of neonates at risk and minimizing invasive blood investigations.

Transcutaneous bilirubin measurement in healthy Saudi term newborns.

Objectives:To evaluate the accuracy of transcutaneous bilirubin (TcB) measurement in healthy, jaundiced Saudi term newborns.Methods:This prospective, cohort study was carried out from January 2009 to December 2012 on jaundiced, term infants admitted at the King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Paired TcB and total serum bilirubin (TSB) from healthy jaundiced term newborns were obtained. The correlation and the mean difference between the 2 methods were calculated, and Bhutani nomogram for prediction of TSB by TcB was used. Any bilirubin level at low and above the intermediate risk zone was considered significant.Results:We obtained 665 paired TcB and TSB measurements from 665 newborns. The mean age at bilirubin measurement was 44.2 ± 21 hour. Mean TSB was 147 ± 45 µmol/L, and TcB was 156 ± 50 µmol/L. Linear regression analysis showed a significant correlation between TcB and TSB (r: 0.84; 95% confidence interval [CI] = 0.82-0.86; p<0.001). The TcB tends to overestimate TSB. The mean difference between paired TcB and TSB was 17 µmol /L with a 95% CI of 40 ± 77 µmol/L. The TcB was sensitive, but less specific. The TcB sensitivity was 83% and specificity was 71% to predict TSB during the first 72 hours of life for the whole study group. The positive predictive value was 63%, and negative predictive value was 87%.Conclusion:As found in this study, among the jaundiced healthy term Saudi newborns, TcB measurement provided accurate estimates of TSB values. The TcB measurements can be used effectively to screen newborns for significant jaundice.

Transcutaneous bilirubinometry is a reliably conservative method of assessing neonatal jaundice

Objective: In order to reduce invasive testing in newborns prior to discharge, we tested the direction of the correlation between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB), the likelihood of missing high TSBs with a raised threshold for confirmatory testing, and also calculated potential cost savings from fewer laboratory testing.Methods: We performed a cross-sectional analysis of single paired TcB and TSB results measured at 36 ± 2 h of life in neonates ≥37 weeks admitted only to the Level 1 nursery. TcB was measured using the BiliChek® meter.Results: Of the 552 infants, 512 (92.8%) had TSB levels below TcB values. Correlation between TcB and TSB was 0.69. If TSB confirmation was to be performed at 11.7 mg/dL (medium risk threshold for phototherapy), the negative predictive value was 99.4%, with a potential cost savings of $6555.00 ($1500.00 per 100 patients). Of the 495 infants with TcB <11.7 mg/dL, only 3 had TSB levels higher than 11.7 mg/dL, and none met phototherapy threshold for low risk infants.Conclusions: TcB screening at our institution has a high negative predictive value, and can be used as a stand-alone test until values are close to phototherapy threshold, thus reducing invasive testing and cost.

Evaluation of a new transcutaneous bilirubinometer in Chinese newborns

Objective: To evaluate the use of a new transcutaneous bilirubinometer (JM-103 Minolta Airshields) for detection of hyperbilirubinaemia in term or near-term healthy Chinese newborns. Methods: Transcutaneous bilirubin (TcB) was used...