Main Article Content
Background The gold standard for diagnosis of neonatal jaundice is total serum bilirubin (TSB) measurement. This method, however, is invasive, painful, and costly in terms of workload, time, and money. Moreover, repeated blood sampling may lead to significant blood loss, which is of particular concern in preterm infants. To overcome these drawbacks, non-invasive methods of bilirubin measurement have been proposed. Transcutaneous bilirubinometry (TcB) determines the yellowness of the subcutaneous tissue of a newborn infant by measuring the difference between optical densities for light in the blue and green wavelength regions.
Objective To evaluate the accuracy of transcutaneous bilirubinometry for estimating TSB levels in neonatal jaundice.
Methods Subjects were infants aged < 28 days with jaundice who had never been treated with phototherapy or exchange transfusion. The study was done from February to July 2016 in Mohammad Hoesin Hospital. Subjects underwent transcutaneous bilirubin (TcB) and TSB assays, with a maximum interval of 15 minutes between tests.
Results One hundred fifty patients were included in this study. The TcB values > 5 mg/dL were correlated to TSB > 5 mg/dL, with 100% sensitivity and 83.3% specificity. This cut-off point was obtained from a receiver-operator characteristic (ROC) curve with AUC 99.3% (95%CI 97.9 to 100%; P< 0.001).The correlation coefficients (r) for TSB and TcB measurements on the forehead were 0.897 (P<0.001).
Conclusion Transcutaneous bilirubinometry can be used to accurately estimate TSB levels in neonatal jaundice, and may be useful in clinical practice as a non-invasive method to reduce blood sampling.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
2. Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson textbook of pediatrics. 18th ed. Vol 1. Philadelphia: WB Saunders; 2007. p 756-58, 768, 772-4.
3. Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001;344:581-90. https://doi.org/10.1056/NEJM200102223440807
4. el-Beshbishi SN, Shattuck KE, Mohammad AA, Petersen JR. Hyperbilirubinemia and transcutaneous bilirubinometry. Clin Chem. 2009;55:1280-7. https://doi.org/10.1373/clinchem.2008.121889
5. Donzelli G, Pratesi S.Transcutaneous bilirubinometry in healthy preterm newborns. Clin Biochem.2000;33:505-8. https://doi.org/10.1016/S0009-9120(00)00140-5
6. Carbonell X, Botet F, Figueras J, Riu-Godo A.Prediction of hyperbilirubinaemia in the healthy term newborn. Acta Paediatr.2001;90:166-70. https://doi.org/10.1111/j.1651-2227.2001.tb00279.x
7. Engle WD, Jackson GL, Sendelbach DM, Manning DM, Frawley WH. Assessment of a transcutaneous device in the evaluation of neonatal hyperbilirubinemia in a primarily Hispanic population. Pediatrics.2002;110:61-7. https://doi.org/10.1542/peds.110.1.61
8. Szabo P, Wolf M, Bucher HU, Fauchère JC, Haensse D, Arlettaz R. Detection of hyperbilirubinemia in jaundiced full-term neonates by eye or by bilirubinometer? Eur J Pediatr.2004;163:722-7. https://doi.org/10.1007/s00431-004-1533-7
9. Knudsen A, Ebbesen R.Transcutaneous bilirubinometry in neonatal intensive care units. Arch Dis Child Fetal Neonatal Ed.1996;75:F53-6. https://doi.org/10.1136/fn.75.1.F53
10. Yasuda S, Itoh S, Isobe K, Yonetani M, Nakamura H, Nakamura M, et al. New transcutaneous jaundice device with two optical paths. J Perinat Med.2003;31:81–8. https://doi.org/10.1515/JPM.2003.012
11. Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or =35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124:1193-8. https://doi.org/10.1542/peds.2009-0329
12. Lo S, Doumas BT, Ashwood E. Performance of bilirubin determinations in US laboratories - revisited. Clin Chem 2004;50:190-4. https://doi.org/10.1373/clinchem.2003.019216
13. Tan KL. Transcutaneous bilirubinometry in fullterm Chinese and Malay infants. Acta Paediatr Scand. 1982;71:593-6. https://doi.org/10.1111/j.1651-2227.1982.tb09480.x
14. Jacques S, Saidi I, Ladner A, Oerlberg D. Developing an optical fiber reflectance spectrometer to monitor bilirubinemia in neonates. SPIE Proceedings 2975, Laser Tissue Interactions;1997 June 16; San Jose CA. p. 7. https://doi.org/10.1117/12.275465
15. Bhutani VK, Gourley GR, Adler S, Kreamer B, Dalin C, Johnson LH. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics.2000;106:E17. https://doi.org/10.1542/peds.106.2.e17
16. Maisels MJ, Ostrea EM Jr, Touch S, Clune SE, Cepeda E, Kring E, et al. Evaluation of a new transcutaneous bilirubinometer. Pediatrics. 2004;113:1628-35. https://doi.org/10.1542/peds.113.6.1628
17. Lam TS, Tsui KL, Kam CW. Evaluation of a point-of-care transcutaneous bilirubinometer in Chinese neonates at an accident and emergency department. Hong Kong Med J. 2008;14:356-60.
18. Briscoe L, Clark S, Yoxall CW. Can transcutaneous bilirubinometry reduce the need for blood tests in jaundiced full term babies? Arch Dis Child Fetal Neonatal Ed. 2002;86:F190-2. https://doi.org/10.1136/fn.86.3.F190
19. Rubaltelli FF, Gourley GR, Loskamp N, Modi N, Roth-Kleiner AM, Sender A, et al. Transcutaneous bilirubin measurement: a multicenter evaluationof a new device. Pediatrics.2001;107:1264-71. https://doi.org/10.1542/peds.107.6.1264
20. Panburana J, Boonkasidach S, Rearkyai S. Accuracy of transcutaneous bilirubinometry compare to total serum bilirubin measurement. J Med Assoc Thai. 2010;93:S81-6.