Transcutaneous Bilirubinometry Research Articles

Machine Learning to Improve Accuracy of Transcutaneous Bilirubinometry

Plain Language SummaryNeonatal jaundice is a common condition that might occur in the first week of life. Severe high bilirubin levels can lead to long-term problems like cerebral palsy, hearing impairment, and developmental delay. Therefore, newborns are usually evaluated for jaundice every day during their first week. To accurately assess jaundice, we need to measure the total bilirubin in the blood. However, daily blood draws for bilirubin measurements can be uncomfortable and may cause anemia in newborns. Thus, transcutaneous bilirubinometry is devised. It is a device that measures bilirubin through the skin and is commonly used because it is non-invasive. However, transcutaneous bilirubinometry has some accuracy issues. In this study, we successfully improved the accuracy of bilirubin measurement by combining machine learning with transcutaneous bilirubinometry. Being used alone, the transcutaneous bilirubinometer had an error of 1.08 mg/dL. However, combining transcutaneous bilirubinometry with machine learning, the error decreased to 0.80 mg/dL, which is a 25% of improvement. Using this approach, unnecessary blood draws could be reduced by up to 78%. If we incorporate this algorithm into transcutaneous bilirubinometry, this novel method has the potential to improve prediction accuracy and reduce the burden on babies.

Can transcutaneous bilirubinometry safely be used to monitor rebound hyperbilirubinaemia after phototherapy in neonates ≥35 weeks’ gestation? A prospective, comparative study

IntroductionThere is insufficient evidence to determine if non-invasive transcutaneous bilirubin (TcB) measurement can replace serum bilirubin (SBR) in assessing rebound hyperbilirubinaemia after phototherapy.ObjectiveTo investigate if TcB can safely guide management...

Development of a Non-Invasive Jaundice Meter Using Transcutaneous Bilirubinometry

Proposed work focuses on the use of transcutaneous bilirubinometers as a non-invasive method for estimating total serum bilirubin (TSB) levels in jaundiced individuals. By measuring the yellowness of the skin and analyzing the optical signals reflected from subcutaneous tissues, these bilirubinometers provide a reliable technique for assessing bilirubin levels without the need for invasive procedures. The correlation between cutaneous bilirubin and TSB is explored in detail, highlighting the importance of this relationship in the management of jaundice. Experimental results demonstrate a high correlation between cutaneous bilirubin measurements and TSB levels, further supporting the efficacy of transcutaneous bilirubinometry. The report also discusses the advantages of this method over traditional spectro-photometric techniques, emphasizing its potential as a reliable alternative for estimating TSB levels in Jaundice Patients. Our proposed valuable insights into the use of transcutaneous bilirubinometers and their role in improving the management of jaundice.

Accuracy of transcutaneous bilirubinometry in term infants after phototherapy: a prospective observational study

Objective To test the accuracy of transcutaneous bilirubinometry (TcB) in neonates 12 h after discontinuing phototherapy. Study design In a prospective study of 91 neonates at ≥35 weeks of gestation, paired measurements of total serum bilirubin (TSB) and TcB were obtained 12 h after discontinuation of phototherapy. TcB measurements were obtained on the uncovered skin of the sternum and the covered skin of the lower abdomen. Bland–Altman plots were used to evaluate agreement between TSB and TcB. Results TcB was found to systematically underestimate TSB on both covered and uncovered skin. The smallest but statistically significant difference between TSB and TcB was found on the covered lower abdomen (–1.03, p < .0001) compared with the uncovered skin of the sternum (–1.44, p < .0001). The correlation between TSB and TcB was excellent on both covered (r = 0.86, p < .001) and uncovered skin (r = 0.90, p < .001). Bland and Altman plots showed poor agreement between TcB and TSB. Conclusions This study demonstrated excellent correlation between TcB and TSB 12 h after phototherapy but poor TcB–TSB agreement. TcB cannot be reliably used in neonates exposed to phototherapy.

Transcutaneous Bilirubin Accuracy Before, During, and After Phototherapy: A Meta-Analysis.

Transcutaneous bilirubinometry (TcB) is used as a valid screening to identify neonates requiring measurement of total serum bilirubin (TSB) before phototherapy. Its use during and after phototherapy is not advised yet because of unknown reliability. To determine the agreement of TcB and TSB measurements before, during, and after phototherapy. PubMed Medline, Cochrane Library, and references of eligible studies were searched. Prospective and retrospective cohort and cross-sectional studies reporting Bland-Altman statistics of paired TcB and TSB measurements in term and preterm newborns. Meta-analysis was performed using the Mantel-Haenszel weighted approach. The agreement between TcB and TSB in μmol/L was described by pooled mean differences (MDs) and limits of agreement (LoA). Fifty-four studies were included. The pooled MD before phototherapy is 2.5 μmol/L (LoA -38.3 to 43.3). The pooled MD during phototherapy is -0.3 μmol/L (LoA -34.8 to 34.2) on covered skin and -28.6 μmol/L (LoA -105.7 to 48.5) on uncovered skin. The pooled MD after phototherapy is -34.3 μmol/L (LoA -86.7 to 18.1) on covered skin and -21.1 μmol/L (LoA -88.6 to 46.4) on uncovered skin. Subgroup analysis revealed the best agreement at the forehead. We did not find any difference in agreement between term and preterm neonates. Language restriction. TcB measurements before and during phototherapy on covered skin show good agreement compared with TSB in term and preterm newborns. More studies are needed to evaluate the accuracy after phototherapy.

Climatic factors and prolonged neonatal jaundice

Prolonged neonatal jaundice (PrNJ) in full-term newborns(NB) is defined if it persists beyond the 14th day after birth. Clinical experience shows that seasons of the year influence the frequency and severity of neonatal jaundice (NJ). Objective: To establish the role of climatic factors on PrNJ expression in term neonates. Material and methods: The study was conducted at the Neonatology Department of University Hospital "Medica Ruse" with 92 full-term newborns who were with PrNJ. The follow-up of NJ was carried out with transcutaneous bilirubinometry. The NBs are residents of Ruse region, Republic of Bulgaria. Results: We found that air temperature directly affects the levels of bilirubin(BR) for the entire neonatal period and the duration of PrNJ. The amount of rainfall during the first two weeks after birth directly correlated with bilirubinemia at end of neonatal period and the duration of PrNJ. A higher level of atmospheric pressure during the early neonatal period was associated with lower BR levels at the same and a shorter duration of PrNJ. The degree of cloudiness after postnatal day 14 is inversely related to the levels of BR and the duration of the PrNJ. Sunshine during the first two weeks affects the levels of BR on the end of neonatal perod and the prolongation of PrNJ. Conclusion: According to our data climatic factors: air temperature, amount of rainfaull, atmospheric pressure, degree of cloudiness, duration of sunshine affect the degree of manifestation and duration of PrNJ.

Season of birth and neonatal jaundice

Neonatal jaundice (NJ) is a multifactorial condition specific to the neonatal age. Clinical experience shows that seasons of the year influence the frequency and severity of NJ. Objective: To investigate the influence of annual seasons on the frequency and severity of NJ. Material and methods: The study was conducted at the Neonatology Department of University Hospital "Medica Ruse" with 566 full-term newborns. The follow-up of NJ was carried out with transcutaneous bilirubinometry. The newborns are residents of Ruse region, Republic of Bulgaria. Results: We found a significant difference in bilirubin (BR) levels depending on the season of birth during the early neonatal period. Summer-borns had the highest average levels, followed by spring-borns, and autumn-borns had the lowest. Вorn in the spring had significantly high levels of BR at the end of neonatal period. Climatic factors average and maximum monthly temperature, average monthly rainfall and monthly sunshine duration had a significant influence on the levels of bilirubin on Day 4 (p=0.014), Day 5 (p=0.016) and Day 14 (p=0.004). Prolonged NJ is most commonly observed in summer-borns (p&lt;0.001). Conclusion: Birth season along with meteorological factors affects the frequency of pathological neonatal jaundice.

Correlation between transcutaneous bilirubin levels and total serum bilirubin levels in postnatal period in a tertiary care center

Background: Neonatal jaundice is generally a benign condition seen during the postnatal period. The non-invasive methods including transcutaneous bilirubinometry have been developed for assessment of neonatal jaundice, transcutaneous bilirubin TcB) meters noninvasively estimate the bilirubin levels by measuring light transmission through the skin of neonates this value is then to be plotted against a chart in order to look for hyperbilirubinemia. Aim was to determine the efficacy of measuring the transcutaneous bilirubin as a screening tool for clinically significant hyperbilirubinemia. Methods: Study was a cross sectional study conducted under pediatric department of SMBT IMS and RC at tertiary care center after taking the approval from the ethical committee. Total of 110 neonates that appear to be clinically suffering from neonatal jaundice were considered for study after consent from respective parent/ guardian. Neonatal TCB levels and serum bilirubin levels were done. If bilirubin levels lie in phototherapy range, then baby was shifted to NICU and phototherapy treatment was given, and once levels came within normal range after the phototherapy treatment, again serum bilirubin levels were measured in order to compare pre-and post-treatment levels. Results: Present study showed male preponderance. 64 were male and 46 were female. Majority 61% were full term normal delivery and 39% were LSCS. Mean TCB level was 8.5±2.8. Statistical significance was seen for TCB and sever hyperbilirubinemia. Conclusions: Present study concluded that hyperbilirubinemia is commonly seen among males. Newborn delivered had hyperbilirubinemia. Statistical significance was seen between TCB level and severity of the disease. Thus, neonatal TCB levels can be used as a screening test for detecting hyperbilirubinemia in neonates. As TCB is a noninvasive and cost effective it can be used widely as predictor of the disease.

A Comparative Study between Transcutaneous Bilirubinometry and Total Serum Bilirubin Measurement in Jaundiced Newborns

Background: Drawing blood to measure total serum bilirubin is painful &amp; time consuming. Transcutaneous bilirubinometer working by multiwavelength spectral reflectance from the skin surface on forehead or upper sternum is a quick &amp; painless technique. Objectives: to compare the effectiveness of transcutaneous (over the upper sternum and forehead) and serum bilirubin measurement of neonate with jaundice. Subjects and Methods: This is a cross sectional prospective study. It enrolled 175 jaundiced neonates &amp; excluded those exposed to phototherapy. It was conducted at Child Central Teaching Hospital in Baghdad, Iraq from the 1st of August to the 30th of October 2018. Transcutaneous bilirubin measurement on forehead and upper sternum was done by JM 103 Minolta Air shields bilirubinometer. Total serum bilirubin was measured by APEL BR 501 BILIRUBIN METER. Data entered &amp; analyzed using SPSS 20 computer software. Means, frequencies, cutoff values, sensitivity &amp; specificity were calculated. Results: The mean age, gestational age &amp; birth weight were (6.3±4.3 days), (36.9±2.1 weeks) and (2.7±0.6 Kg) respectively. Mean total serum bilirubin, transcutaneous chest &amp; forehead bilirubin levels were 12.6±4.2 mg/dl, 11.8±3.8 mg/dl &amp; 11.2±3.9 mg/dl respectively. Mean total serum bilirubin was significantly higher than transcutaneous chest and forehead bilirubin. Cutoff values of transcutaneous chest &amp; forehead bilirubin levels were [(9 mg/dl) with sensitivity (95.4%) &amp; specificity (86.4%)] and [(8.2 mg/dl) with sensitivity (94.7%) &amp; specificity (86.4%)] respectively. Conclusions: Transcutaneous bilirubin measurements on chest and forehead have an acceptable validity in predicting hyperbilirubinemia with less accuracy on forehead.

Can serum albumin level affect the transcutaneous bilirubinometry in term neonates?

Jaundice is the quite common benign condition in neonates, but due to its potential toxicity, neonates must be monitored. This study was aimed to evaluate the effect of serum albumin level on the transcutaneous bilirubin (TcB) measurements in term neonates with unconjugated hyperbilirubinemia. Serum albumin and total serum bilirubin (TSB) of 252 jaundiced term neonates were estimated and simultaneously TcB was measured over sternum and the effect of serum albumin on TcB measurements was evaluated. The correlation between TSB and TcB was linear and significant for the entire cohort. When this correlation was studied separately in the groups with different albumin levels, maximum correlation (r = 0.888, R2 linear = 0.789, p < 0.001) was observed in group 1 with hypo-albuminemia followed by in group 2 with normal albumin levels (r = 0.854, R2 linear = 0.729, p < 0.001) and group 3 with higher albumin levels (r = 0.809, R2 linear = 0.689, p < 0.001). Bland-Altman plot analysis of whole study population demonstrate good agreement between TSB and TcB [95% CI = -0.038 to 0.493 mg/dL, 17/252 = 6.75% outside the limits of agreement, Mean difference = 0.227]. This analysis in different groups also show good agreement between TSB and TcB. The correlation between the TSB and TcB may affected by serum albumin level. Therefore, transcutaneous bilirubinometry is not able to replace invasive TSB measurement. However, in the absence of TSB it could be an alternative to measure the level of bilirubin in term neonates.

Which Is More Accurate: Transcutaneous Bilirubin Measurement on the Forehead or Sternum?

The accuracy and reliability of noninvasive methods of neonatal jaundice assessment are not completely obvious, including which area of the body is more suitable to estimate actual bilirubin with transcutaneous bilirubinometry (TCB). This cross-sectional study compares the accuracy of three noninvasive methods for neonatal jaundice estimation included visual estimation, TCB on the forehead, and TCB on the sternum. The mean and standard deviation describe quantitative variables. In addition to analytical analysis, we used the linear regression test to evaluate the association of different variables with the accuracy of TCB as well as paired t test for comparing the TCB results on the sternum with the forehead before and after phototherapy. For all statistical tests, a P value less than 0.05 was considered as significant. We enrolled 100 neonates with a mean age (±SD, standard deviation) of 6.5±1.9 days (range 2-11 days) in our study. The mean gestational age (GA) of the participants was 38.94 weeks±1.00 w SD, and their mean (±SD) weight was 3302 g (±315.60). The mean (mg/dL)±SD for bilirubin level by clinical estimation of jaundice, TCB on the forehead and TCB on the sternum were 17.35±2.88, 17.23±1.63, and 17.77±1.58, respectively. Also, comparing mean differences before and after phototherapy showed that TCB on the sternum is a good predictor for neonatal jaundice before phototherapy (0.539 vs. 0.348). TCB on the sternum is more predictive than the forehead, especially before phototherapy, to assess the need for treatment in outpatient settings.

Significant hyperbilirubinemia among well neonates due for discharge at Kawempe-Mulago Hospital, prevalence, factors associated, and accuracy of transcutaneous bilirubinometry for screening.

Neonates in low resource settings with a lack of pre-discharge screening and early intervention are at risk for complications associated with significant hyperbilirubinemia (SHB). To determine the prevalence, factors associated and performance of transcutaneous bilirubin (TCB) in identifying well neonates with SHB. Over a one month period 235 well neonates 24 to 72 hours of age due for discharge at Kamempe-Mulago Hospital were enrolled in this study. Visual inspection using Kramer rule, transcutaneous bilirubin over the sternum using Draeger JM103 bilirubinometer, and serum bilirubin were determined. Neonates with SHB (total serum bilirubin warranting treatment) were referred for treatment. Relevant data were analyzed. A P-value of <0.05 was considered significant at 95% confidence interval. Thirty two (13.6%) of the neonates had SHB and three (1.3%) had levels above exchange transfusion threshold. Significant hyperbilirubinemia was independently associated with CRP ≥ 10mg/l (AOR 3.96, CI 1.23-12.73, p 0.021), ABO discordance (AOR 3.67, CI 1.28-10.49, p 0.015), jaundice in a previous sibling (AOR 3.565, CI 1.10-11.51, p 0.034) and time of first feed > 1 hour (AOR 2.74, CI 1.10-6.90, p 0.007). The sensitivity, specificity, positive and negative predictive values of TCB were 96.5%, 84.6%, 47.5% and 99.4% respectively compared to 31.2%, 98.5%, 76.9% and 90% respectively for visual assessment (Kramer grading). A significant number of well neonates have SHB. Transcutaneous bilirubinometry is a suitable screening tool in this setting. Early initiation of feeding should be promoted. The cause for high CRP among well neonates with SHB needs to be studied further.

Comparison of diagnostic accuracy of transcutaneous bilirubinometry during phototherapy by using skin patch

Background: Neonatal jaundice is a very common condition. Serious unconjugated hyperbilirubinemia may result in neurological dysfunction as catastrophic as kernicterus. Phototherapy is the method of choice in treatment of hyperbilirubinemia. Aim and objectives: the aim of the study was to assess the accuracy of transcutaneous bilirubin measurement during phototherapy by using skin patch and comparing this with skin and serum bilirubin measurement at the same time. Subjects and methods: This was an observational prospective study was conducted in special care baby unit at Al-wahda teaching hospital –Derna-Libya over a period of nine months (June 1st 2021 to March 2022).Eighty (80) newborn (41 Male, 39 Female) were enrolled in the study .Transcutaneous bilirubin measurement from skin over sternum, skin under patch at Rt. Side of chest, simultaneously serum bilirubin sample were collected. Results: during phototherapy; the mean± SD TSB (14.94 ± 4.57 μmol/L) and mean± SD TCBC (13.52 ± 4.84) and at skin level was 9.45 ± 3.62. Bland–Altman plot showed significant agreement between TcB from patched site and TSB Conclusion: TCB measurements correlate strongly with TSB levels during and after PT.

COMPARISON OF TOTAL SERUM BILIRUBIN AND TRANSCUTANEOUS BILIRUBIN IN NEONATES WITH HYPERBILIRUBINAEMIA

Background: Jaundice is considered as one of the most prevalent and common clinical problems during neonatal period which may require interventional treatment. Transcutaneous bilirubinometry is a simple method for estimating bilirubin levels and diagnosing jaundice in neonates. This study was done to compare transcutaneous bilirubin and total serum bilirubin in jaundiced neonates. Methods: A hospital based prospective cross-sectional study of neonates from Out Patient Department, Emergency Ward, and Neonatal Intensive Care Unit with clinical jaundice was conducted between January 2016 and December 2016, at Kanti Children’s Hospital, Maharajgunj, Nepal. A total of 162 neonates were interviewed using preformed questionnaires. Then the correlation between the transcutaneous bilirubin and plasma bilirubin level was assessed by linear regression analysis. It was then analyzed with the help of SPSS Version 20. p-value &lt;0.05 was considered statistically significant. Results: Out of 162 cases, 61.7% were males and 38.3% were females. There was a high correlation between TcB and TSB level in neonates (r = 0.981) and this finding was statistically significant (p-value&lt;0.001). Correlation coefficient of 0.98 and 0.97 were found in term and preterm neonates respectively, which suggested strong correlation between TcB and TSB in both groups of neonates. Conclusions: Transcutaneous bilirubin measurement can be considered as a suitable tool for predicting neonatal bilirubinemia as it has high sensitivity.

Comparison of Diagnostic Accuracy of Transcutaneous Bilirubinometry During Phototherapy by Using Skin Patch

Comparison of Diagnostic Accuracy of Transcutaneous Bilirubinometry During Phototherapy by Using Skin Patch

Smartphones&amp;#x2019; Skin Colour Reproduction Analysis for Neonatal Jaundice Detection

Abstract In recent years, smartphone-based colour imaging systems are being increasingly used for Neonatal jaundice detection applications. These systems are based on the estimation of bilirubin concentration levels that correlates with newborns’ skin colour images corresponding to total serum bilirubin (TSB) and transcutaneous bilirubinometry (TcB) measurements. However, the colour reproduction capacity of smartphone cameras are known to be influenced by various factors including the technological and acquisition process variabilities. To make an accurate bilirubin estimation, irrespective of the type of smartphone and illumination conditions used to capture the newborns’ skin images, an inclusive and complete model, or data set, which can represent all the possible real world acquisitions scenarios needs to be utilized. Due to various challenges in generating such a model or a data set, some solutions tend towards the application of reduced data set (designed for reference conditions and devices only) and colour correction systems (for the transformation of other smartphone skin images to the reference space). Such approaches will make the bilirubin estimation methods highly dependent on the accuracy of their employed colour correction systems, and the capability of reducing device-to-device colour reproduction variability. However, the state-of-the-art methods with similar methodologies were only evaluated and validated on a single smartphone camera. The vulnerability of the systems in making an incorrect jaundice diagnosis can only be shown with a thorough investigation of the colour reproduction variability for extended number of smartphones and illumination conditions. Accordingly, this work presents and discuss the results of such broad investigation, including the evaluation of seven smartphone cameras, ten light sources, and three different colour correction approaches. The overall results show statistically significant colour differences among devices, even after colour correction applications, and that further analysis on clinically significance of such differences is required for skin colour based jaundice diagnosis.

Correlation of serum bilirubin and transcutaneous bilirubin in newborns

Background: Hyperbilirubinemia is a very common entity in newborns. Screening all the babies for hyperbilirubinemia is must. Serum bilirubin is the standard method of checking the bilirubin in newborns. This is very cumbersome, invasive and time consuming method. Hence many newborns will be discharged without screening. Transcutaneous bilirubinometry would help us in making this task easy and safe. Hence the present study was planned.Methods: This is an institutional cross sectional study conducted in a tertiary care hospital for a period of 6 months. After a written informed consent from parents/ guardians and considering selection criteria, 500 newborns with clinical jaundice were included in study. Each newborn was examined, transcutaneous bilirubin checked at forehead and sternum and serum bilirubin was done at the same time. Data was statistically analyzed to see the correlation between TcB and TSB.Results: Out of 500 newborns, 316 were males, 184 were females and 475 were term gestation and 25 were preterm. Coefficient of correlation was 0.73 and 0.72 for total serum bilirubin versus forehead and sternum respectively which were statistically significant.Conclusions: Transcutaneous bilirubinometer readings closely correlate with that of serum bilirubin. Hence TcB can be used as a safer, economical and effective tool in screening newborns for hyperbilirubinemia.

Correlation of transcutaneous bilirubin with total serum bilirubin in neonates with hyperbilirubinemia

Background: For determining hyperbilirubinemia in a neonate, clinical evaluation, serum bilirubin estimation and trans cutaneous bilirubin estimation are the modalities available. Transcutaneous bilirubinometry (TcB) is routinely used to monitor jaundice in term and near-term infants. Literature shows a positive correlation observed between TcB and total serum bilirubin (TSB). The present study was conducted determine the correlation of TcB with TSB in neonates with hyperbilirubinemia admitted at a tertiary care hospital, ChennaiMethods: A cross sectional study was conducted at a tertiary care hospital, Chennai where 350 neonates who have clinical jaundice and require estimation of serum bilirubin who are admitted to the tertiary care centre, Chennai during December 2020-March 2021 were included in the study. The ROCHE INTEGRA-e 411+ autoanalyzer was used to estimate TSB (mg/dl) using a modified diazo method. The Jaundice Meter JM-103 to measure TcB, (Manufactured by Draeger medical systems, Germany). Pearson corelation coefficient was used to find the correlation between the two variables. P&lt;0.05 was considered to be statistically significant.Results: Out of 350 neonates admitted to the tertiary care centre, term deliveries were 57.1% and pre term were 42.9%. 83.1% were in the age group of 3-7 days. The mean weight of the study population was 2.16±0.60 kg. In term babies, Pearson corelation between TSB and TcB shows a statistically significant positive correlation, r=0.90 with p≤0.0001. Among pre term babies, Pearson corelation between TSB and TcB shows a statistically significant positive correlation, r=0.96 with p≤0.0001.Conclusions: This study's findings support the use of a TcB metre as a screening tool for clinically significant hyperbilirubinemia.

Efficacy of transcutaneous bilirubinometry as compared to serum bilirubin in preterm newborn during phototherapy.

Transcutaneous measurement of bilirubin is being used for neonatal jaundice. Its utility during phototherapy in preterm babies is not established. The objective of our study was to assess the efficacy of transcutaneous bilirubin (TcB) measurement in comparison to total serum bilirubin in preterm newborns at admission and during phototherapy at the covered skin area (glabella). It was a prospective observational study and conducted at the neonatal intensive care unit of a tertiary care hospital from January 2017 to January 2019. One hundred eligible preterm neonates were enrolled. Babies who were very sick, with poor peripheral circulation, edematous, having conjugated hyperbilirubinemia, with major congenital malformations, already received phototherapy or exchange transfusion were excluded. Paired total serum bilirubin and transcutaneous bilirubin were measured at admission and 6 h and 24 h during phototherapy. TcB was measured from the area (glabella) covered by an eye protector during phototherapy. The sample for TsB was taken within 10 min of TcB measurement. The mean differences between TsB and TcB values at admission and 6 h and 24 h of phototherapy were - 0.005 (0.353) mg/dl, - 0.350 (0.611) mg/dl, and - 0.592 (0.353) mg/dl, respectively. At admission or before starting of phototherapy, the difference (TsB-TcB) was statistically not significant (p = .125), while the difference in these values was statistically significant at 6 h and 24 h of phototherapy.Conclusion: TcB measurements from the covered skin area in jaundiced preterm infants during phototherapy were not correlated with TsB and cannot be used as an alternate of serum bilirubin testing. What is known • HPLC bilirubin measurement is a gold standard test for bilirubin measurement but impractical for day to day use. Serum total bilirubin is used for clinical testing.. • There is evidence for use of transcutaneous bilirubinometry for assessment of bilirubin in term newborn. What is new • TcB measurements from a covered skin area in jaundiced preterm newborns under phototherapy were not correlated significantly at 6 h and 24 h of phototherapy, but correlated before phototherapy. • TcB cannot be used as an alternate of serum bilirubin testing in preterm infants during phototherapy.

Comparison of the Predictive Accuracy of Stool Color for Triage of Infants for Phototherapy (STrIP) Score With Transcutaneous Bilirubinometer in Predicting Serum Bilirubin in Neonates

To compare the agreement of stool color for triage of infants for phototherapy (STrIP) score and transcutaneous bilirubinometer values with measured serum bilirubin in neonatal hyperbilirubinemia. Babies more than 35 weeks of gestation, with clinical jaundice, and on exclusive breastfeeding were included in the study. Babies with who were clinically unstable or who had received phototherapy based on clinical assessment were excluded. The agreement was analyzed using Bland-Altman charts. Results of three non-invasive methods were further compared with the measured serum bilirubin levels. There was a mean difference of 4 mg/dL of bilirubin between transcutaneous bilirubin and serum bilirubin levels, whereas the agreement between the STrIP score and Serum bilirubin shows a difference of only 2 mg/dL. On further analysis of Kramer, transcutaneous and STrIP score, method of bilirubin estimation against serum bilirubin, there was a mean difference 6 mg/dL, 4 mg/dL and 2 mg/dL, respectively. STrIP score has the best agreement with serum bilirubin in neonates compared to other non-invasive techniques such as transcutaneous bilirubinometry and clinical assessment using Kramer scale.