Transcutaneous Bilirubinometer Research Articles

Cord blood albumin as predictor of neonatal hyperbilirubinemia

Background: Measuring the Cord blood Albumin level and predicting neonatal hyperbilirubinemia.Methods: Prospective study was performed on 160 healthy term neonates. Relevant maternal history was collected. Cord blood was collected from the healthy term neonates at birth and cord serum albumin measured. Neonate was assessed for jaundice every day using transcutaneous bilirubinometer. Total Serum Bilirubin (TSB) was assessed if the Transcutaneous Bilirubin (TCB) values were found high and treated according to NICU protocol.Results: Study cohort was grouped as Group A, Group B and Group C based on Cord Serum Albumin (CSA) level ≤3.3 g/dl, 3.3-3.8 g/dl and ≥3.8 g/d respectively. Statistical analysis was done for correlation of CSA with Neonatal Hyperbilirubinemia (NH). It showed that cord serum albumin level ≤3.8 g/dl is critical, as it was seen in 9.1% of neonates who developed neonatal hyperbilirubinemia (p value-0.032).Conclusions: There is a correlation between cord serum albumin level and neonatal hyperbilirubinemia. Cord serum albumin level of ≤3.8 g/dl is a risk indicator in predicting the development of neonatal hyperbilirubinemia.

Reliability of transcutaneous bilirubin estimation during phototherapy in term infants: A hospital-based observational study

Background:Blood sampling method is the most common but invasive method for bilirubin estimation. Transcutaneous bilirubin (TCB) estimation, on the other hand is non-invasive. Objectives: The aim was to compare neonatal bilirubin estimation by serum bilirubin and transcutaneous bilirubinometer methods both pre- and during phototherapy and establish the precision of transcutaneous bilirubinometer. Materials and Methods: This prospective hospital-based observational study was conducted on 350 term neonates over a period of 2 years. Bilirubin was estimated in all newborn by both serum bilirubin and transcutaneous method, at the time of admission in nursery (prephototherapy), at 6 h after phototherapy (while neonates were still under phototherapy treatment), and at withholding phototherapy, and a photo opaque patch of 2.5 cm was used to cover the area on midforehead and transcutaneous bilirubin was estimated from this area after removing it during phototherapy. All data were tabulated and analyzed by relevant statistical tests. Results: A total of 350 term healthy newborns with mean gestational age of 38 ± 2 weeks and mean birth weight of 2.97 ± 0.9 kg were studied. Correlation analysis revealed a significant correlation between total serum bilirubin and transcutaneous method (TCB) measurements of bilirubin. When these methods were compared at pre-phototherapy, at 6 hours after phototherapy and before withholding phototherapy, correlation coefficient(r) of 0.9571, 0.7988, and 0.9206 were seen respectively. The precision levels of transcutaneous bilirubinometer (BiliCheck™) were good because plotting of Bland–Altman graphs showed maximum (>97%) data within agreement limits at all stages of phototherapy. Conclusion: Our study revealed good correlation and precision of transcutaneous bilirubinometer both before and during phototherapy. Thus, it supports the previous studies which justify the use of transcutaneous bilirubinometer in assessing newborn jaundice during 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.

Kramer’s scale or transcutaneous bilirubinometry: the ideal choice of a pediatrician? can we trust our eyes?

Background: Neonatal hyperbilirubinemia, though benign in 80% cases, can lead to kernicterus if not diagnosed and treated early. The golden method of estimation is measuring serum bilirubin levels. Both Kramer’s scale and Transcutaneous bilirubinometer are non -invasive methods. Its high time the pediatricians choose an ideal non-invasive and reliable method to detect hyperbilirubinemia. Objective of this study is to find out which has a better correlation with serum bilirubin - transcutaneous bilirubinometer reading (TcB) or Kramer's scale.Methods: The study was conducted in a tertiary newborn center from November 2014 to June 2016. The inclusion criteria included all babies above 34 weeks gestation and exclusion criteria included babies with established direct hyperbilirubinemia, neonatal septicemia, major congenital/ gastrointestinal malformations and those on phototherapy. The sample size was 450 and the correlation was analyzed using ROC curves and plots of agreement was done using Bland Altman charts.Results: The incidence of significant Hyperbilirubinemia is 12%. Transcutaneous bilirubin level had a better correlation and prediction level compared to Kramer at both 24 hours and 48 hours. Bland Altman analysis showed that transcutaneous values were closer to the total serum bilirubin level compared to Kramer values.Conclusion: Transcutaneous bilirubinometry is a better and more ideal choice to replace serum bilirubin levels. In settings where TcB is not feasible, it’s always best to screen for jaundice using Kramer’s scale rather than estimating serum bilirubin values in all babies. In babies where TcB levels are above the cut off range, it’s better to do serum bilirubin levels.

Noninvasive transcutaneous bilirubin assessment of neonates with hyperbilirubinemia using a photon diffusion theory-based method.

Transcutaneous bilirubinometers are widely used to screen neonatal jaundice. However, it was reported that their accuracy is compromised at low and high bilirubin levels. We used a photon diffusion theory-based method valid in the 450-600 nm wavelength region to overcome this obstacle. Our clinical study results showed that our system could properly determine the transcutaneous bilirubin concentrations at total serum bilirubin levels higher than 14 mg/dL, where a commercial bilirubinometer failed to provide proper results in several cases. These findings suggested that photon diffusion theory could be employed to improve the core algorithm of modern bilirubinometers and enhance their applicability.

Quality improvement initiative using transcutaneous bilirubin nomogram to decrease serum bilirubin sampling in low-risk babies

BackgroundScreening for neonatal hyperbilirubinaemia in the postnatal ward has traditionally been performed using serum bilirubin sampling, but this has significant drawbacks such as risk of infection and slower reporting time.ObjectiveWe...

Newborn jaundice determination by reflectance spectroscopy using multiple polynomial regression, neural network, and support vector regression

Diffuse reflectance spectroscopy is a non-destructive method to obtain biochemical and physiological information by investigating the optical properties of skin. Transcutaneous bilirubin (TcB) measurement utilizes reflectance spectroscopy to determine the jaundice level in newborns. Although TcB measurement has some advantages over total serum bilirubin (TSB) measurement such as being non-invasive, noninfectious, painless, and instantaneous, the existing TcB devices cannot yet replace TSB devices due to the inaccuracy of measurements. In this paper, we propose the use of reflectance spectroscopy in conjunction with regression tools such as multiple polynomial regression (MPR), artificial neural network (ANN), and support vector regression (SVR) to predict the jaundice level. The proposed methods were tested on TcB measurement data obtained from 314 babies. TcB measurements were collected by two devices: a commercially available product, Draeger JM-103, and a prototype device on which we can implement the proposed algorithms. The results are encouraging towards increasing the clinical usage of transcutaneous bilirubinometers as all the three methods accurately predict the jaundice level with a correlation value between 0.932 and 0.943. The proposed use of ANN improves the non-invasive transcutaneous approach, with results converging to more accurate invasive serum bilirubin measurements by blood sampling.

Comparative study between serum and transcutaneous bilirubin measurements in new-borns

Background: Hyperbilirubinemia is one of the common problems in neonates. The transcutaneous bilirubin (TCB) measurement is non-invasive, easy and rapid not requiring expertise and manpower. Fewer studies have been carried out to whether newer TCB measurements can correlate with serum bilirubin measurements using newer generation of transcutaneous bilirubinometer in our region.Methods: An observational cross-sectional study to compare serum and transcutaneous bilirubin measurements in newborns admitted to a neonatal intensive care unit, conducted from December 2015 to November 2017. Blood samples were obtained from neonates collected from venous sample into plain bulb and sent for analysis. For transcutaneous bilirubin measurement, the reading from forehead and sternum were taken using bilirubinometer and an average reading was taken for comparison.Results: Total 172 neonates were admitted during study period and enrolled in the study. It was observed that out of 172 patients, studied 102(59%) patients were male and 70(41%) patients were female. Out of 172 patients maximum 89(51.74%) mother have O positive blood group and only 2(1.1%) have O negative blood group. Common cause of neonatal hyperbilirubinemia was ABO incompatibility 81(48%), Rh incompatibility 11(6%), and other causes 80(46%). The mean and standard deviation of TSB for first, second and third reading were 19.21±3.44, 15.76±2.79 and 12.89±2.44 respectively. While mean and standard deviation of TCB for first, second and third reading were 18.34±2.99, 15.48±2.36 and 12.31±2.28 respectively with correlation coefficient of r=0.806513, r=0.694273, r=0.785471 respectively indicating linear relationship between two.Conclusions: There was a strong correlation between serum and transcutaneous bilirubin levels before and even after the phototherapy. As transcutaneous bilirubin estimation is non-invasive, gives quick and reproducible results. So, by using this method has potential screening value especially in the high-risk neonates to start early intervention.

A Novel Non-invasive Technique of Measuring Bilirubin Levels Using BiliCapture.

ObjectivesIn preterm infants, hyperbilirubinemia is common and can impair the central nervous system. The tests available for measuring bilirubin is to collect blood from heel pricking and occasionally taking blood samples from inserted cannulas, which is painful. Therefore, there is a need to develop a non-invasive device to detect bilirubin levels in newborns and interpret the severity of jaundice.MethodsWe conducted a cross-sectional study of 100 neonates. Patient data was collected between June 2015 and December 2016 from King Khalid Hospital at Al-Majma’ah, Saudi Arabia, and Alpine Hospital, Gurgaon, India. The mean gestational age of neonates was 39.0 weeks. Total bilirubin was measured using a transcutaneous bilirubinometer on the forehead and obtaining optical imaging through scanning of conjunctiva of eyes, also referred to as BiliChek and BiliCapture, respectively. Later the blood samples were obtained from these patients and tested in the laboratory to determine total serum bilirubin (TSB) levels.ResultsThe concentration of bilirubin as measured from serum, BiliChek, and BiliCapture were 10.7±2.0, 11.6±2.7, and 13.1±2.3 mg/dL, respectively. Correlation was high between TSB and BiliChek (r2 = 0.88) and between TSB and BiliCapture (r2 = 0.73). The Bland-Altman plots showed good agreement when comparing bilirubin values for both BiliChek and BiliCapture devices. Bilirubin measurement was further checked for the sensitivity and specificity and was 88.0% and 76.0% using BiliChek and 92.0% and 75.6% using BiliCapture, respectively.ConclusionsThe optical imaging of conjunctiva for bilirubin assay is a safe alternative to a laboratory bilirubin assay and transcutaneous bilirubinometer BiliChek.

Effectiveness of non-invasive hand held transcutaneous bilirubinometer for the diagnosis of neonates with hyperbilirubinemia

Effectiveness of non-invasive hand held transcutaneous bilirubinometer for the diagnosis of neonates with hyperbilirubinemia

Accuracy of Transcutaneous Bilirubinometry in Neonates Receiving Phototherapy

Introduction: Phototherapy remains mainstay of treating neonatal hyperbilirubinemia across gestational age spectrum. Neonates under phototherapy (PTx) require frequent estimation of serum bilirubin (TSB) to monitor disease progression. Transcutaneous bilirubinometer (TcB) is widely used for estimation of TSB with limited data for neonates receiving PTx. The aim of study was to assess the diagnostic accuracy of TcB as compared to TSB in preterm and term infants receiving phototherapy.Methods: This prospective study analyzed 385 paired TcB-TSB samples from 234 hemodynamically stable preterm (89) and term (145) neonates receiving in-hospital PTx. Indigenous photo-opaque patch was applied to sternum before starting PTx. TcB was measured from patched area of skin using Dräger JM-103 device at 12 and 24 hours during phototherapy within 5 minutes of blood collection for TSB. Linear regression and Bland-Altman plots were used to compare TcB with TSB.Results: The mean (SD) gestational age and birth weight were 35.8 (2.43) weeks and 2250 (560) grams. Difference of mean of TcB and TSB was ranging between 0.7-1 mg/dl with TcB underestimating TSB. At 12 hours and 24 hours of PTx, the correlation coefficient were (r = 0.84 and 0.81, p&lt;0.01) among preterm and (r = 0.76 and 0.79, p&lt;0.01) among term infants. Bland–Altman plot showed significant agreement between TcB from patched site and TSB in both preterm and term neonates.Conclusion: TcB demonstrated significant accuracy in predicting TSB in both term and preterm neonates receiving PTx with slight underestimation of TSB. The study showed marginally higher correlation for preterm infants.

Transcutaneous bilirubin nomogram for the first 144 hours in Thai neonates

Objectives: To develop an hour-specific transcutaneous bilirubin (TcB) nomogram for Thai neonates and to compare the ability of this nomogram with that of Bhutani’s total serum bilirubin (TSB) nomogram for prediction of significant hyperbilirubinemia requiring phototherapy.Methods: Healthy Thai neonates, gestational age ≥35-week-gestation and birth weight ≥2000 grams were enrolled. Neonates who could not attend the postdischarge follow-up at our center were excluded. TcB measurements were routinely performed at 6 am and 6 pm using JM103 transcutaneous bilirubinometer until the neonates were discharged or received phototherapy. TcB levels were also measured at least once during 24–72 hours after discharge and thereafter depending on the pediatricians’ decision. The nomogram was developed from the TcB data during age 12–144 hours of neonates who did not require phototherapy. The TcB values that obtained predischarge or before receiving phototherapy of all neonates were used to determine the predictive ability of this nomogram and Bhutani’s TSB nomogram.Results: A total of 1071 neonates were included. Two hundred forty-one neonates (22.5%) required phototherapy. The nomogram was constructed using 4834 hour-specific TcB values. It provided a good prediction with the area under curve (AUC) of 0.89. The 75th percentile tract revealed sensitivity and negative predictive value (NPV) of 87.1 and 95.4% while that of the 40th percentile tract were 97.9 and 98.5% respectively. When Bhutani’s nomogram was used, the AUC was 0.84. The sensitivity and NPV of the 75th percentile tract were 56.4 and 88.2%, and for the 40th percentile tract were 97.1 and 98.0% respectively.Conclusion: The newly developed TcB nomogram revealed slightly better predictive ability than Bhutani’s TSB nomogram for term and late preterm Thai neonates who were the population with high prevalence of significant hyperbilirubinemia. The 40th percentile curve of both nomograms should be considered as an appropriate cut-off level for prediction.

Agreement test of transcutaneous bilirubin and bilistick with serum bilirubin in preterm infants receiving phototherapy

BackgroundThis study compares the minimally invasive Bilistick and a noninvasive method with standard Total Serum Bilirubin (TSB) measurement in preterm newborns receiving phototherapy. We assess the agreement of Transcutaneous Bilirubinometer (TcB) and Bilistick bilirubin measurements with standard TSB measurement in preterm infants receiving phototherapy.MethodsBilirubin was measured by using TcB and Bilistick in 94 preterm infants in RSCM Jakarta Neonatal Ward from October 2016 to March 2017, with gestational ages of < 35 weeks, before phototherapy and after 24 and 48 h of phototherapy.ResultsThere was significant correlation before, at 24 and 48 h of phototherapy between TSB and either TcB (r = 0.874; r = 0.889; r = 0.878 respectively; p < 0.0001), or Bilistick (r = 0.868; r = 0.877; r = 0.918 respectively; p < 0.0001). The mean difference and limits of agreement before, at 24 and 48 h of phototherapy between TcB and TSB were 0.81 ± 1.51 mg/dL (− 2.14 to 3.77 mg/dL); 0.43 ± 1.57 mg/dL (− 2.66 to 3.51 mg/dL); 0.41 ± 1.58 mg/dL (− 2.69 to 3.50 mg/dL), respectively. For Bilistick they were − 1.50 ± 1.47 mg/dL (− 4.38 to 1.38 mg/dL); − 1.43 ± 1.47 mg/dL (− 4.32 to 1.46 mg/dL); − 1,15 ± 1.31 mg/dL (− 3,72 to 1,42 mg/dL), respectively.ConclusionsBoth methods are reliable for measuring TSB before, during, and after phototherapy in preterm infants. TcB tends to overestimate while Bilistick underestimates TSB.

Transcutaneous bilirubinometer use and practices surrounding jaundice in 150 California newborn intensive care units.

Transcutaneous bilirubin measurements (TcBs) provide a noninvasive method for screening infants for hyperbilirubinemia and have been used extensively in term and late preterm newborns in well baby nurseries, offices, and outpatient clinics. Several studies have also demonstrated the utility of TcBs as a screening tool for infants > 28 weeks' gestation and their ability to reduce the need for blood sampling. The objectives of this study are to identify how often TcBs are used among California Newborn Intensive Care Units (NICUs) in preterm, late preterm and term infants, and other aspects of jaundice management. We conducted a survey on TcB use and practices relating to jaundice management in 150 California NICUs between April and October 2016. TcB screening is routinely used in 28% (42/150) of NICUs. Only 7% (11/150) of NICUs use TcB in preterm infants < 28 weeks. Practice varied similarly across NICU levels of care. Among the subset of NICUs that responded to questions related to phototherapy and screening practices, prophylactic phototherapy was used in 38% (23/59) and 90% (55/61) screened for glucose-6-phosphate dehydrogenase deficiency based on race, ethnicity, and/or family history. Despite studies validating the accuracy of TcB in preterm infants > 28 weeks, only 28% of California NICUs routinely use TcB devices. TcB screening in infants < 28 weeks gestation is not widely used and no recommendation can be made in this regard until there is more experience with its application using a standardized protocol in these infants and on a large scale.

Accuracy of the Bilicare™ transcutaneous bilirubinometer as the predischarge screening tool for significant hyperbilirubinemia in healthy term and late preterm neonates

Background: The Bilicare™ is a new device that measures transcutaneous bilirubin (TcB) level at the ear pinna. There are only few studies which have evaluated its accuracy in clinical practice.Objective: This study aims to determine the accuracy of Bilicare™ as a predischarge screening tool in late preterm and term neonates and to define the optimal cutoff point for determining the need to measure total serum bilirubin (TSB).Methods: The 35 weeks’ gestation or more and healthy neonates who underwent predischarge TSB measurement were enrolled. Bilicare™ TcB was measured within 30 minutes of blood sampling. Paired TcB and TSB data were analyzed.Results: We collected 214 paired samples. Mean age (SD) at TcB measurement was 57.17 (7.47) hours. Mean TSB (SD) was 9.79 (2.83) mg/dL. TcB showed a significant correlation with TSB (r = 0.84, r2 = 0.7). The mean difference (SD) between TcB and TSB was 0.7 (0.21) mg/dL (95%CI 0.49–0.91). TcB tended to overestimate TSB level at the TSB values of <12 mg/dL but underestimate at the higher TSB level. The accuracy of using TcB values to detect neonates who required phototherapy was 92.5%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 78.3, 94.2, 62.1, and 97.3%, respectively. If TcB +3 mg/dL was applied as a cutoff point, the sensitivity, specificity, PPV, and NPV were 100, 53.9, 20.7, and 100%, respectively.Conclusions: Bilicare™ TcB and TSB measurements were well correlated. The TcB level +3 mg/dL could detect all neonates who had significant hyperbilirubinemia requiring phototherapy during their birth hospitalization.

An Overview of Neonatal Unconjugated Hyperbilirubinemia and It’s Management

Neonatal hyperbilirubinemia is the most common clinical condition in the newborn requiring hospital readmission. About 60% of term and 80% of preterm infants develop jaundice during 1st week of life. Unconjugated hyperbilirubinemia occurs mostly due to increased hemolysis, decreased hepatic clearance, enterohepatic circulation, immaturity, blood group incompatibility and infections. Evaluation of neonatal jaundice is done based on history, age of onset of jaundice and physical examination findings which is necessary for proper management. Otherwise significant hyperbilirubinemia may endanger life of the baby and may lead to acute and subsequently chronic bilirubin encephalopathy. There are many diagnostic tools those help to detect jaundice such as Kramer’s rule, transcutaneous bilirubinometer, Bilichecker apps and smartphone apps. Besides these BIND score added a new dimension in diagnosis of acute bilirubin encephalopathy which can be confirmed by measuring bilirubin – albumin ratio in blood. Management of unconjugated hyperbilirubinemia includes: Phototherepy, Exchange transfusion are two major effective therapeutic modalities available today. Additional options include Pharmacotherapy in the form of phenobarbital and intravenous immunoglobulin. Each therapy has its pros and cons. Even there is dilemma in many therapeutic conditions like role of prophylactic phototherapy in preterm neonates, role of sunlight etc. As pediatricians have to deal cases with unconjugated hyperbilirubinemia frequently, so an updated knowledge is required. From this concern we reviewed issues on neonatal unconjugated hyperbilirubinemia and compiled for better understanding of the condition.Bangladesh J Child Health 2018; VOL 42 (1) :30-37

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.

Transcutaneous bilirubinometry: Influence of gestational age and measurement site

Introduction: Neonatal jaundice is the most frequently encountered diagnostic and therapeutic problem in neonates. An estimation of bilirubin is essential for decision making. Transcutaneous bilirubinometer (TcB) is a non-invasive, quick and widely used screening and monitoring tool for the estimation of serum bilirubin. Objectives: To determine correlation and agreement between TcB and total serum bilirubin (TSB) and to verify the influence of different measurement sites for TcB estimation (forehead, sternum and abdomen) in preterm and full-term neonates. Method: In a prospective study, 306 paired TcB-TSB samples from 306 haemodynamically stable term (150) and preterm (156) infants, up to 14 postnatal days with clinical jaundice were analysed. TcB was measured at the forehead, sternum and abdomen within 5 minutes of blood collection, by a single investigator using Drager jaundice meter JM-103 device. Linear regression analysis and Bland-Altman plots were used to compare TcB values at each site with TSB levels. Results: The mean ± standard deviation (SD) for gestational age, birth weight and postnatal age were: 35.22±2.56 weeks, 2017±0.59g and 96.21±68.2 hours respectively. The mean ± SD TcB at different sites were; forehead 13.46±4.32, sternum 13.33± 4.38 and abdomen 11.88 ± 4.27 mg/dl. The mean ± SD TSB was 15.59±5.93 mg/dl. TcB significantly correlated with TSB at all three measurement sites ( p Conclusions: The TcB levels can accurately predict TSB in both preterm and term neonates and also at all measurement sites viz. forehead, sternum and abdomen. Sri Lanka Journal of Child Health, 2018; 47 (1): 27-32

The smart phone study: assessing the reliability and accuracy of neonatal jaundice measurement using smart phone application

Background: Current gold standard for bilirubin estimation in newborns is invasive while transcutaneous bilirubinometer which is a noninvasive option is costly. Smart phone applications can be used as an alternative to measure bilirubin. We did the study to evaluate “Biliscan” medical application for screening of neonatal jaundice.Methods: During the first seven days, neonates with suspected jaundice were taken blood samples for serum bilirubin. Within two hours photographs were taken using Biliscan app by placing a colour calibration card over the chest. Bilirubin estimate obtained after colour balancing, feature extraction and machine learning regression were compared with blood values.Results: There is a good correlation (0.6) between Biliscan bilirubin estimation and serum bilirubin levels (p &lt;0.0001) in the present study on 35 neonates. Biliscan thorax values correlated better than abdomen values (0.6 versus 0.551) with serum values. Hence chest is the preferred area for Biliscan measurement. Conclusions: Biliscan app appears to be a good cheap option to screen for jaundice in newborns noninvasively.

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.