Transcutaneous Bilirubin Measurements Research Articles

Clinical and sociodemographic correlates of neonatal jaundice at a tertiary health facility in Lagos, Nigeria

Background: Varied aetiologies have been proposed for the prevalence of neonatal jaundice (NNJ) in different parts of Nigeria. The aim of this study was to determine the clinical and sociodemographic correlates of NNJ in a cohort of neonates presenting at a Tertiary health Facility in Lagos, Nigeria. Materials and Methods: One hundred and fifty consecutive neonates that presented at the neonatal unit of the hospital were enlisted for the study after checking them with set inclusion and exclusion criteria. The transcutaneous bilirubin (TcB) readings of the individuals were obtained on the forehead, sternum and abdomen of the calm neonate in a supine position and blood samples for total serum bilirubin estimation were drawn from a peripheral vein within 10 min of TcB measurement. Results: One hundred and fifty neonates were included in the study of which 89 (59.33%) were males and 61 (40.67%) were females. Mothers that had only a primary level of education had babies that presented with significantly higher bilirubin values (P = 0.000). Male neonates, those that presented after 48 h, those between 40 and 42 weeks' gestational age and those that were <2.5 kg birth weight also had higher values though it was not statistically significant. Those that were delivered at home or in a church, delivered by an auxiliary nurse or a traditional birth attendant and those with jaundice extending to the sole of the feet also presented with significantly higher mean bilirubin scores (P = 0.000). Conclusion: Majority of individuals in this study with NNJ were males, while those delivered at home or in a church or by traditional birth attendants and auxiliary nurses and had mothers that were poorly educated had higher mean bilirubin values. It is thus imperative that advocacy is increased to intervene on modifiable risk factors for this condition.

Accuracy of transcutaneous bilirubinometry in the preterm infants: a comprehensive meta-analysis

Background: Transcutaneous bilirubin (TcB) measurement is widely used in term babies. But its effectiveness till debated in preterm infants. So, our objective was to pool data to see the accuracy of transcutaneous bilirubinometry in preterm infants.Method: MEDLINE, Embase, Cochrane Library database were searched from 2000 to July 2017. The included studies had compared TcB with total serum bilirubin (TSB) in preterm infants before phototherapy and data were presented as correlation coefficients. Data were extracted by two reviewers and checked for accuracy by the third reviewer. The risk bias assessments were done by an assessment quality assessment of diagnostic accuracy studies tool. Pooled correlation coefficient assed after Fisher’s z transformation and then converted to r.Results: We included 28 studies; all those studies reported results as correlation coefficients. In combination of both sternal and forehead site measurement, our pooled estimates of r = 0.82 (95% CI: 0.78–0.85) in random effect and r = 0.803 (95% CI: 0.78–0.81) in fixed effect model. For separate sites of measurement of TcB pooled r for forehead and sternum were comparable, r = 0.82 (95% CI: 0.78–0.85), and pooled correlation coefficient for the two devices JM103 and Bilicheck the estimated pooled r were also comparable (Pooled r = 0.83).Conclusion: Our study found that TcB measurement is well related with TSB values and can represent a reliable method for evaluating preterm infants with possible hyperbilirubinemia. Our findings support the use of investigated devices at both forehead and sternum sites in preterm infants.

Utility of Transcutaneous Bilirubinometer in Tertiary Care Hospital

Introduction: Hyperbilirubinemia is one of the most vexing problems that may occur in 60% of term and 80% of preterm neonates. In order to reduce the risk of developing serious hyperbilirubinemia, it is vital to identify jaundiced infants who are in need of treatment as soon as possible. The objectives of this study were to find whether transcutaneous bilirubin (TcB) measurement correlates with total serum bilirubin (TSB) levels, measured with standard laboratory method and to analyse the effect of gestational age, birth weight and postnatal life on TcB and TSB.Material and Methods: A prospective study was conducted in the Department of Paediatrics, Government Medical College, Amritsar on 300 neonates with visible jaundice. These neonates were divided into various groups depending upon gestational age, birth weight and day of life. TcB readings were recorded at forehead and sternum and serum bilirubin level was measured within 30 minutes. Test of significance applied was unpaired T-test; mean value, p-value, standard deviation and Pearson's correlation coefficient 'r' were calculated.Results: Overall Mean value TcB at forehead was 15.32 with SD ± 2.75, mean TcB at sternum was 14.94 with SD ±2.51, mean value of TSB was 13.80 with SD ±2.15. Pearson’s correlation coefficient r was 0.895 for TcB forehead vs TSB, 0.903 for TcB sternum vs TSB and 0.966 between TcB forehead vs TcB sternum.Conclusion: TcB levels correlates well with the gold standard measurement of TSB. Gestational age, birth weight and day of life had no effect on TcB and TSB correlation. Transcutaneous bilirubinometer can thus be used to measure bilirubin level as a screening method for neonatal hyperbilirubinemia.

Maternal detection of neonatal jaundice during birth hospitalization using a novel two-color icterometer.

BackgroundMothers are frequently the first to observe the onset of jaundice in their newborn infants before the decision to seek treatment. However, simple-to-use tools that could facilitate early detection of jaundice and assist mothers to seek professional care, especially after hospital discharge, are rare. This study therefore, set out to evaluate the performance of a -two-color icterometer (Bilistrip™) as a possible screening tool for detecting significant jaundice by mothers or care-givers in the first week of life.MethodsPrior to discharge, mothers in a maternity hospital were trained to use the Bilistrip™ on the blanched skin of their baby’s nose to ascertain absence (Light Yellow) or presence (Dark Yellow) of significant jaundice. Their babies had transcutaneous bilirubin (TcB) measurements independently, along with total serum bilirubin (TSB) if indicated. The reliability of Bilistrip™ as a screening test for significant jaundice was determined at different TcB and TSB thresholds. The predictive performance of Bilistrip™ was also evaluated with multivariable logistic regression.ResultsSome 2492 mother-infant pairs were enrolled over 15 months, of which 347 (13.9%) chose Dark Yellow. The mean TcB for Dark Yellow (10mg/dL) was significantly higher (p<0.001) than for Light Yellow (6.1mg/dL). Bilistrip™ showed increasing sensitivity (47.0% - 92.6%) and negative predictive value (NPV) (91.4% - 99.9%) for selected TcB thresholds (≥10mg/dL, ≥12mg/dL, ≥15mg/dL, and ≥17mg/dL). Among neonates with TSB measurements (n = 124), Bilistrip™ was associated also with increasing sensitivity (86.8% - 100%) and NPV (62.5% - 100%). The sensitivity and NPV for detecting neonates requiring phototherapy were 95.8% respectively. Only one of the 24 neonates who required phototherapy was missed by the Bilistrip™.ConclusionsBilistrip™ is a potential decision-making tool for empowering mothers to detect neonates with clinically significant jaundice that may require close monitoring or treatment, and neonates not requiring treatment for jaundice in the first week of life.

Case 1: The Icteric Infant 12 Hours After Birth

The nursery notifies the medical team of a term female infant born at 40 weeks’ gestation via vacuum-assisted vaginal delivery. Maternal prenatal care was unremarkable. Prenatal laboratory findings are significant for maternal rubella nonimmune status and maternal blood type B positive, antibody negative. Events surrounding the delivery are notable for category II tracings on fetal monitor, 3+ meconium, and 1 detachment (“pop-off”) during vacuum application. Apgar scores are 9 and 9 at 1 and 5 minutes, respectively. At approximately 12 hours after birth, the medical team is notified of a transcutaneous bilirubin measurement that is outside the normal clinical range. The infant appears jaundiced on physical examination. The total serum bilirubin concentration is 20.6 mg/dL (1821 μmol/L). The neonate is transferred to the NICU for close observation and initiation of triple phototherapy. ### Diagnosis and Hospital Course Hyperbilirubinemia observed in the first 24 hours after birth is considered pathologic, or non-physiologic jaundice, and warrants urgent evaluation. Blood dyscrasias and hemolysis should be suspected in cases of severe hyperbilirubinemia and should prompt …

Effectiveness of transcutaneous bilirubin measurement in managing neonatal jaundice in postnatal ward of a tertiary care hospital in Pakistan

IntroductionNeonatal jaundice is a common cause of concern in immediate newborn period for parents as well as for the caregivers. Babies with visible jaundice are identified by the healthcare provider,...

Comparison of Transcutaneous Bilirubin Measurement With Total Serum Bilirubin Levels in Preterm Neonates Receiving Phototherapy.

To compare transcutaneous bilirubin with total serum bilirubin in preterm neonates after initiation of phototherapy. Jaundice was assessed in 30 preterm neonates with transcutaneous bilirubin and total serum bilirubin before initiation of phototherapy and at 12 hr after initiation of phototherapy. A photo-occlusive patch was applied over the sternum. Transcutaneous bilirubin has a good correlation with total serum bilirubin after initiation of phototherapy. (r=0.918, P<0.001). Transcutaneous bilirubin at 28-32 weeks of gestation (r = 0.97) was better correlated with total serum bilirubin than those at 32-37 weeks (r =0.88). The correlation was better for neonates <72 hours old (r = 0.96) than those >72 hours of age (r = 0.82). Transcutaneous bilirubin correlates significantly with total serum bilirubin at the patched sternal site after initiation of phototherapy in preterm neonates.

Patched Skin Bilirubin Assay to Monitor Neonates Born Extremely Preterm Undergoing Phototherapy

To verify the reliability and safety of transcutaneous bilirubin (TcB) measurements in patched skin areas in neonates born extremely preterm under phototherapy. Sixty neonates (<30 weeks' gestation) receiving phototherapy were enrolled and TcB was measured via a second-generation transcutaneous bilirubinometer in patched skin areas (of at least 2.5 cm diameter). Total serum bilirubin (TSB), lactate, pH, hemoglobin, and skin temperature were measured within 10 minutes of the TcB assay. Clinicians were blinded to TcB values, and clinical decisions about phototherapy were made with the TSB measurement only. TcB and TSB significantly were correlated (r = 0.84; P <.001), even after adjustment for hemoglobin, pH, lactate, gestational and postnatal age (standardized β = 0.8; P <.001; adjusted R2 = 0.75), or treatment duration (standardized β = 0.8; P <.001; adjusted R2 = 0.7). When the Bland-Altman analysis was used, TcB overestimated TSB at high values (mean difference TSB - TcB: -2.8 [2.4] mg/dL). If clinicians used the TcB only, no neonate would have had phototherapy stopped prematurely, and 21 (35%) would have continued phototherapy when it could have been stopped. The correlation between TSB and TcB (measured in patched skin areas) was comparable with that obtained in more mature neonates, and it was not influenced by clinical variables or factors affecting skin bilirubin passage. TcB overestimated TSB, and this may expose infants born preterm to unnecessary phototherapy, although it could spare approximately 65% of TSB assays.

Comparison of transcutaneous bilirubin with serum bilirubin measurements in neonates at tertiary care center in western part of India

Background: Noninvasive transcutaneous bilirubin measurement is an attractive option for jaundice evaluation in newborns. But variable accuracy had been reported in different studies. The aim of the study was to find out the correlation and agreement between TcB and TSB measurements in neonates.Methods: Prospective analytic study carried out in neonatal unit of tertiary care center. Newborns up to 10th postnatal DOL with visually found jaundice were enrolled in study. TcB was measured over forehead with Dragor JM 103 device. Simultaneous TSB measurements were done for all readings. Pearson’s correlation coefficient calculation and Bland Altaman analysis were done. ROC curve of mean TcB at different TSB level were constructed.Results: Total 160 newborns with male: Female ratios of 1.3:1 were enrolled. Mean values: gestational age 38.23±2.01; birth weight 2.403±0.61; age in hour at first reading 83.76±26.62; TSB11.65±4.58 mg/dl and TcB 11.73±3.53 mg/dl. A strong, positive and significant correlation was found between TcB and TSB measurements (r=0.836, r2=0.69, p &lt;0.001). The average error in evaluating hyperbilirubinemia with TcB as compared to TSB was 0.856 with limits of agreement between -3.41 to +5.48. The AUOC at three TSB levels (&gt;10mg/dl, &gt;12 mg/dl, &gt;15 mg/dl) of TcB were 0.899, 0.937 and 0.963 respectively. ROC analysis showed good sensitivity for all. Specificity was found to fall with increasing TSB concentration.Conclusions: In our study TcB correlated well with TSB measurements and showed good sensitivity and satisfactory specificity, thus validating its use as a screening tool for evaluation of jaundice in newborns.

INVESTIGATING THE ACCURACY OF AN UPGRADED TRANSCUTANEOUS BILIRUBIN SCREENING TOOL BY SITE OF TESTING

Abstract BACKGROUND: Severe neonatal hyperbilirubinemia continues to occur in healthy term infants. The incidence has decreased as a result of guidelines by the Canadian Pediatric Society (CPS) and American Academy of Pediatrics (AAP), requiring all healthy newborns to receive either a transcutaneous bilirubin (TCB) or total serum bilirubin (TSB) at discharge. Several studies have investigated the effectiveness of TCB tools. However, discrepancies still exist on the agreement between TCB and TSB by site and treatment. OBJECTIVES: The aim of this study was to determine the accuracy and agreement of TCB and TSB by site and treatment using the JM-105. DESIGN/METHODS: A multi-site prospective clinical trial of term infants requiring TSB measurements. Pearson’s correlation coefficient was used to determine the accuracy between TSB and TCB measurements by site and treatment. Bland-Altman Plots of the agreement between TSB and TCB values by site and treatment were generated. RESULTS: Paired TSB and TCB measurements from the forehead and sternum were collected from 75 term infants between 36-44 weeks gestational age. Bland-Altman Plots by site demonstrated the mean difference between TSB and TCB on the forehead to be -1.72 μmol/L ± 24.64 μmol/L (-66.7 μmol/L to 49.00 μmol/L) and sternum to be 1.2 μmol/L ± 37.99 μmol/L (-82.00. μmol/L to 136.33 μmol/L). The mean TSB level was 131.43 μmol/L ± 54.88 μmol/L (31 μmol/L – 285 μmol/L), mean TCB level on the forehead was 132.40 μmol/L ±57.029 μmol/L,(19 μmol/L-284.5 μmol/L) and mean TCB level on the sternum was 121.32 μmol/L ±58.27 μmol/L, (13.5 μmol/L-261.6 μmol/L). Paired t-tests revealed no significant mean differences between TCB and TSB measurements by site and treatment. The correlation between the TSB and TCB values from the forehead (Pearson’s correlation r =0.877, p<0.01) were higher than the correlation between TSB and TCB values from the sternum (r= 0.646, p<0.01). The correlation between TSB and TCB values on the forehead (r=0.879, p<0.01) and sternum (r=0.747, p<0.01) were higher prior to phototherapy. The mean difference between TSB and TCB after phototherapy on the forehead was 25.77 μmol/L ± 48.36 μmol/L and sternum was 95.69 μmol/L ± 73.72 μmol/L. CONCLUSION: The JM-105 is an accurate TCB screening tool for physicians to use in healthy newborns by site. After the initiation of phototherapy the forehead may be a more appropriate site of measure with an overestimate of bilirubin levels. Additional research is required to obtain a greater understanding of the impact of phototherapy and site on TCB screening tools.

Accuracy of transcutaneous bilirubinometer in assessing jaundice in newborns in Indian context

Background: Jaundice is a very common problem in newborns. Though measuring serum bilirubin is considered the gold standard method for estimating jaundice, Transcutaneous Bilirubin (TCB) measurement by TCB meter is now used in various centers. The accuracy of TCB meter is affected by many factors, skin colour being one of them. Aim: To analyze the accuracy of TCB meter in comparison to serum bilirubin for assessing jaundice in babies with different skin colours, in a tertiary care centre in South India. Methods: The study was performed in 200 babies in a medical college, in South India over a period of five months from august 2016 to December 2016. Term babies upto 7th post natal day without any complications were analyzed. Babies were categorized based on their skin colour into 6 groups using the Fitz Patrick’s colour scale. Jaundice was quantified in these babies by TCB meter and by measuring serum bilirubin at the same time and the values were compared. Results: Out of 200 babies, 6 babies were in group 2, 100 in group 3, 83 in group 4 and 11 in group 5. Though the Pearson correlation was linear in all the groups, it was lesser in the dark skinned babies. So we concluded that assessment of jaundice by TCB meter is not accurate in dark skinned babies. Hence serum bilirubin must be done in these babies before intervention. Conclusion: TCB is not accurate in assessing jaundice in dark skinned babies. Still it can be used as a valid screening tool.

Transcutaneous bilirubin nomograms in African neonates.

BackgroundThe use of transcutaneous bilirubin (TcB) as a screening tool, based on relevant population-specific nomogram, or proxy for total serum bilirubin (TSB) levels in assessing the risk of subsequent hyperbilirubinemia is supported by several clinical guidelines on the management of neonatal hyperbilirubinemia. However, while TcB has been found to significantly over-estimate TSB in neonates of African-American ancestry, with variations across TcB devices, no nomogram has been specifically reported for this racial group. This study therefore set out to develop TcB nomograms for healthy late pre-term and term black African neonates derived from two widely used bilirubinometers.MethodsA retrospective analysis of 12,377 TcB measurements obtained from 6,373 neonates in the first postnatal week, over a period of 48 months using Bilichek and JM-103 bilirubinometers. TcB percentiles were computed from hour-specific TcB values and nomograms developed for each of the screening devices. Predictive ability of the 75th and 95th percentiles to detect significant hyperbilirubinemia was evaluated between 24–96 hours of age. The 95th percentile curve was compared with those from other populations.ResultsThe velocity of TcB rise at 75th and 95th percentiles was generally higher with JM-103 than Bilichek. Both percentiles also peaked at higher TcB levels with JM-103. The 95th percentile for both instruments showed a downward trend as from approximately 114 hours. Both instruments had high negative predictive values across the selected time-epochs and lower discriminatory ability than reported in non-black populations.ConclusionsThe predictive utility of TcB as a potential screening tool varies across devices in black African neonates with or without risk of significant hyperbilirubinemia, and lower than levels reported in non-black populations. Equipment-specific nomograms should be considered for TcB monitoring in this racial population where TSB is not routinely available.

Implementation and validating transcutaneous bilirubinometry for neonates

During the first week of life all newborns have increased bilirubin levels by adult standards, with approximately 60% of term babies and 85% of preterm having visible jaundice. A significant reduction in serum bilirubin analysis which is traumatic and painful, could be achieved after implementation of transcutaneous bilirubin (TCB) measurements in preterm babies. Measurements made on the forehead and sternum have the best correlation with TSB. ObjectivesIs to evaluate the use of non-invasive transcutaneous spectrophotometer, its efficiency and the influence of the site of measurement of transcutaneous bilirubin (forehead and sternum) on the accuracy of bilirubin levels. Subjects and methodsThis study was conducted on 316 clinically jaundiced neonates in NICU and post-natal clinics of Ain-Shams University Hospital, El Monira Governmental Public Hospital and El Amreky Private Hospital. Neonates of both sexes and gestational age ⩾30weeks were included, with no hemolytic disease, no known skin disorders or receiving phototherapy or exchange transfusions. Transcutaneous bilirubin using Minolta JM-103 probe from sternum and forehead was measured and compared to serum bilirubin levels. ResultsThere was statistically significant correlation between TSB and TCB in all the groups of studied cases, but was slightly higher in the cases with bilirubin measured in postnatal age of ⩽3days. In preterm newborns, measurement of TCB from forehead was less accurate than from sternum. ConclusionNoninvasive TCB measurement by Minolta JM-103has demonstrated significant accuracy compared to TSB measured by clinical laboratory methods in all cases with better accuracy in cases of IHB. TCB measurement over sternum is more accurate than forehead.

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.

Comparison of BiliCare Transcutaneous Bilirubinometer with Standard Laboratory Assay

ABSTRACT Introduction Jaundice is the visible manifestation of chemical bilirubinemia and is characterized by yellow discoloration of skin. In a pediatric emergency department, evaluation of jaundice includes a precise medical history, physical examination, and estimation of bilirubin by laboratory tests. Measurement of total serum bilirubin (TSB) by transcutaneous bilirubin (TcB) is interpreted according to the age (in hours) of the newborn infant. Studies have also indicated that the TcB determination is more accurate than visual estimation methods. Aim To compare BiliCare System against standard laboratory testing for bilirubin estimation. Results The coefficient of correlation was r = 0.7245, and the standard deviation between the mean values of TcB and TSB is ±0.55. Conclusion It is concluded from the study that there is good correlation between TcB measurement and laboratory estimation of total bilirubin levels. It is recommended that transcutaneous measurement can be used for initial screening of jaundice as well as monitoring of phototherapy in neonates. How to cite this article Warade J. Comparison of BiliCare Transcutaneous Bilirubinometer with Standard Laboratory Assay. Indian J Med Biochem 2017;21(1):1-4.

Screening for neonatal jaundice in El Galaa Teaching Hospital: A Egyptian Maternity Hospital – Can the model be replicated?

Screening for neonatal jaundice may allow early detection and treatment of severe cases and thus help prevent kernictrus. Aim: This pilot study aims to evaluate the effectiveness as well as the practicality of screening for neonatal jaundice at the same time of the Egyptian obligatory thyroid screening program among a sample of non-hospitalized newborns. Subjects and Methods: A population of 3834 term and near-term newborns delivered at El Galaa Teaching Hospital, Cairo, Egypt, was screened for neonatal jaundice at its Maternal Child Health Center within the 1st week of life at the time of thyroid screening (3rd-7th day postnatal). A transcutaneous bilirubinometer (BiliCheck, Respironics, Philips) was used, and bilirubin levels were plotted on the hour-specific bilirubin nomogram. Accordingly, parents were either given a specific date for rescreening or were immediately referred for appropriate intervention. Results: The mean Transcutaneous bilirubin (TcB) measurement was 16.1 mg/dl in 1.9% of the studied newborns placing them in the high-risk zone and requiring immediate referral for serum bilirubin ± phototherapy. In addition, 3.3% of cases had a mean TcB of 14.4 mg/dl (high-intermediate zone) requiring close follow-up. The TcB levels in the remaining babies placed them either in the low or low-intermediate risk zones of the bilirubin nomogram. All babies in the intermediate zone (n = 440) were advised to return for repeat TcB within 48 h. Of 155 babies attending rescreening, 1 case was in the high-risk zone with TcB of 17.2 mg/dl. By the end of the study, 1.2% of all the tested babies had required admission for phototherapy. Conclusion: The already established thyroid screening program offers a golden opportunity for concomitant screening for neonatal jaundice and the detection and management of missed cases of severe hyperbilirubinemia. However the set timing (3-7 days of life) might be quite late for hemolytic cases who develop severe hyperbilirubinemia early.

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 Correlation with Total Serum Bilirubin in Healthy Newborns

Transcutaneous Bilirubin Measurement Correlation with Total Serum Bilirubin in Healthy Newborns

신생아 황달의 예방적 치료에 대한 연구동향

Introduction Jaundice is one of the most common conditions found in neonatal period. Phototherapy is one of the main treatments for neonatal jaundice. However, several adverse effects of the phototherapy have been reported, including DNA damage recently. Therefore, a variety of treatments have been conducted to shorten the duration of phototherapy. Meanwhile, it has been hardly tried to prevent neonatal jaundice, but diverse approaches have been tried in traditional Chinese medicine (TCM) for many years. Therefore, this study aims to analyze the studies for the treatments to prevent neonatal jaundice based on TCM. Materials and Methods Various literatures have been searched via CNKI, and PubMed using the terms "neonatal jaundice" (新生儿黄疸, 胎黃, 胎疸) in category of 'Traditional Chinese Medicine', 'Traditional Chinese Medicinal Herbs' and 'Combination of Traditional Chinese Medicine With Western Medicine'. The search range included randomized controlled trials (RCTs), controlled clinical trials (CCTs), case reports, reviews and animal experiments published from 2013 to 2015. Results A total of 104 studies were found. 93 articles were excluded by reviewing the titles and abstracts. Out of the remaining 11 studies, 9 articles were RCTs, 2 articles were CCTs. The treatment used in neonatal babies in the studies were, using herbal remedies (meditation 5, bath 3 and retention enema 1) and the acupressure. All treatments were initiated within the first 24-48 hours after their birth. Then, there was a study that the subjects taken the herbal medicine were women during pregnancy. The outcome assessments used were the serum total bilirubin (TB), transcutaneous bilirubin measurement (TCB), the incidence of the hyperbilirubinemia, the duration time of the jaundice. Especially, TB, TCB and the incidence of the hyperbilirubinemia have decreased significantly more than that of the control group in the most of the results. No severe adverse events were reported in all articles reviewed. Conclusions Conventional treatment such as, herbal medicine in TCM, seems to be the effective way to prevent neonatal jaundice or hyperbilirubinemia. Therefore, the conventional treatment may be favorable choice for preventive treatment for neonatal jaundice.

Close monitoring of transcutaneous bilirubin ensures better outcome in neonates with hyperbilirubinemia

Objective To explore the influence of regular measurement of transcutaneous bilirubin (TcB) on clinical outcome of neonatal hyperbilirubinemia. Methods Healthy term and late-preterm newborns (gestational age ≥35 weeks) born between January 1 and December 31, 2013 at Peking University Third Hospital were reviewed retrospectively. All neonates were divided into monitoring group (n=1 071) or control group (n=2 437) according to whether regular monitoring of TcB was performed. General clinical information and TcB levels on admission were recorded. The incidence of hyperbilirubinemia and readmission for hyperbilirubinemia, level of bilirubin and length of hospital stay were compared between the two groups. Chi-square test or independent sample t test were used for statistical analysis. Results (1) The incidence of hyperbilirubinemia and readmission rate for hyperbilirubinemia were lower in monitoring group when compared with control group [4.7% (50/1 071) vs 7.1% (172/2 437) and 1.3% (14/1 071) vs 3.3% (81/2 437) respectively, P 0.05). (2) Of all the 222 hyperbilirubinemia patients, the number of neonates with gestational age 38 weeks was 26 (11.7%), 33(14.9%) and 163(73.4%), respectively. There was no significant difference of gestational age, birth weight and gender proportion between the two groups. (3) The follow-up rate in January was 41.5% (49/118), and the mean follow-up rate in February, April, July and October (with revised follow-up methods) was 83.1% (345/415), higher than that in January (χ2=82.505, P<0.01). (4) The first three causes of hyperbilirubinemia in all 222 patients were early-onset breast milk jaundice (72 cases, 32.4%), perinatal causes (60 cases, 27.0%) and unknown reasons (50 cases, 22.5%). The first three causes of hyperbilirubinemia in monitoring group (50 cases) were unknown reasons (24 cases, 48.0%), early-onset breast milk jaundice (14 cases, 28.0%) and hemolysis (9 cases, 18.0%). Those in the control group (172 cases) were early-onset breast milk jaundice (58 cases, 33.7%), perinatal causes (57 cases, 33.1%) and unknown reasons (26 cases, 15.1%). Conclusions Regular monitoring of TcB can reduce the incidence of hyperbilirubinemia and the readmission for hyperbilirubinemia. Key words: Hyperbilirubinemia, neonatal; Jaundice, neonatal; Bilirubin